Despite robust tobacco control measures, smoking rates have increased in South Africa, and today more than a quarter (28%) of adults are smokers, as overall cigarette consumption continues to increase.
Considering that declared volumes of cigarettes sold by legal manufacturers have dramatically declined over the past five years, there is only one plausible explanation for South Africa’s stubbornly high smoking rates: the runaway growth of the illicit tobacco trade.
Since the 2020 tobacco sales ban — which South African courts have declared unconstitutional — forced consumers to experiment with brands they had never heard of before, illicit trade has skyrocketed to up to 70% of the market. This has created widespread access to cigarettes selling for as little as R7 for a pack of 20 and made a mockery of the existing tobacco control framework. As a reminder, the minimum collectible tax on a pack of 20 is now R23.92.
It is a public health crisis that the new Tobacco Products and Electronic Delivery Systems Control Bill urgently needs to address. Yet, it is silent on the issue of illicit trade.
Instead, the bill seeks to introduce new measures that can only accelerate the destruction of the legal tobacco value chain and permanently entrench a dominant illicit trade, without reducing smoking. Measures such as plain packaging and retail display bans will simply incentivise remaining smokers of legal cigarettes to migrate to illicit products.
The bill fails to recognise that brands play an important role in consumer choice. Many consumers remain willing to pay more for trusted brands for the quality and confidence they provide. Removing unique brand identifiers through plain packaging will make price the primary consumer consideration, causing a shift to cheaper, predominantly illicit options. This will make smoking more affordable and likely increase consumption.
As with the 2020 tobacco ban, the bill ignores the realities of the South African market, which is dominated by the informal trade, where loose cigarette sales are the order of the day. While the legal industry will have no option but to comply with plain packaging and retail display bans, informal traders will be faced with an impossible choice, between complying and losing business to competitors who don’t comply.
Their only other option to survive will be to make themselves guilty of an offence punishable by 10 years in jail (plus a fine), by continuing to sell illicit branded products and loose sticks. Considering the huge challenges law enforcement faces from violent and organised crime, and extremely limited resources, it is simply not feasible for these measures to be properly enforced.
If the bill is implemented in its current form, British American Tobacco South Africa (Batsa) estimates the legal industry's market share will shrink below its current 30%. This is potentially the final straw for BAT’s operations in South Africa.
Batsa supports the need for sensible regulation and is committed to reducing the health impacts of its business by giving smokers a viable opportunity to migrate from cigarettes to less risky products. However, this bill will entrench illicit trade and foreclose the opportunity for tobacco harm reduction.
The most egregious missed opportunity from a health perspective is the bill’s failure to distinguish between less harmful new categories of nicotine products and traditional combustible products, such as cigarettes. It does not acknowledge the potential of tobacco harm reduction as a public health strategy.
Traditional tobacco products should be regulated differently from new category nicotine products based on their relative risk profiles as reflected in scientific literature, and many other governments recognise this.
Since the 2020 tobacco sales ban forced consumers to experiment with brands they had never heard of, illicit trade has skyrocketed to 70% of the market
For example, in the UK, the government recently launched a "Swap to Stop" programme in which a million UK smokers will be encouraged to swap cigarettes for vapes to improve the health of the nation and cut smoking rates. An independent study estimated that 50,000 to 70,000 smokers in England stopped smoking successfully using e-cigarettes.
In the US, the Food & Drug Administration has, as part of its Premarket Tobacco Products Applications and Modified Risk Tobacco Products processes, effectively deemed a range of branded tobacco and nicotine products, from heat-not-burn, to vapes, to smokeless tobacco pouches, as "appropriate for the protection of public health".
Separately, Sweden has progressively and systematically made smokeless and less harmful alternatives to cigarette smoking accessible, affordable and acceptable to its population over the past five decades.
As a result, Swedes have slashed their smoking rates from 15% in 2008 to 5.6% in 2023. Sweden now has a cancer incidence 41% lower than its European counterparts, corresponding to a 38% lower level of total cancer deaths. It has achieved a 39.6% lower rate of death from all tobacco-related diseases, compared to the EU average. Sweden is one of the three countries with the fewest deaths attributed to lung cancer.
The bill ignores this evidence of the benefits of tobacco harm reduction, and the measures it introduces will instead push ex-smokers who have successfully migrated to less risky products back to cigarettes.
These examples show why a complete, unbiased review of all the evidence is needed so South Africa can benefit from global best practice. It is not too late: now that parliament’s portfolio committee on health has advertised for public comments, MPs who sit on the committee have the opportunity to carefully consider all submissions and follow peer-reviewed science, to produce a world-class tobacco control framework that can save millions of lives.
Parliament should step in if the department of health won’t do its job, and seriously consider what appropriate tobacco control in South Africa is. Nedlac should also step in.
• Moloto is the spokesperson for British American Tobacco South Africa
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