The tobacco industry has set its sights on Africa, exploiting regulatory loopholes and targeting a rapidly growing youth population with new nicotine products.
This warning was issued by Professor Lekan Ayo-Yusuf, Head of the School of Health Systems and Public Health at the University of Pretoria (UP), during his inaugural address, titled ‘Turning the Tide on Tobacco and Industry’s Product Innovation Gambit’. Prof Ayo-Yusuf further serves as the director of Protect our Next, a partnership of South Africa’s leading health organisations in support of South Africa’s proposed Tobacco Products and Electronic Delivery Systems Control Bill.
Prof Ayo-Yusuf said the industry is aggressively marketing products such as e-cigarettes, heated tobacco products (HTPs), snuff and other smokeless tobacco alternatives to young people in Africa as ‘safer’ options, despite mounting evidence of their health risks. “Africa’s demographic dividend – a projected increase in the 15- to 24-year-old age group – makes it a prime target for these products,”
During his address, he discussed his recent research, which revealed how the industry’s shift towards electronic nicotine delivery systems (ENDS), including e-cigarettes and HTPs, is not the solution it claims to be, but rather a new front in the battle against tobacco-related diseases.
Prof Ayo-Yusuf’s research shows that despite being marketed as harm-reducing, many of the emerging tobacco products still pose considerable health risks. “Smoking even one cigarette a day generates more than 50% of the risk of coronary heart disease. Low toxic exposure does not mean no harm,” he explained.
He also cited recently published research that shows that South Africa’s heated tobacco products contain even higher levels of carcinogens (cancer-causing substances) than similar products sold elsewhere, suggesting regulatory gaps that allow for more harmful formulations.
More concerning for South Africa is the widespread use of snuff, a smokeless tobacco product that is often perceived as a safer alternative to smoking. “In South Africa, local snuff contained more cancer-causing substances than many other smokeless tobacco products we tested,” Prof Ayo-Yusuf said.
Unlike cigarettes, which primarily cause lung cancer, snuff has been linked to significantly higher risks of oral, oesophageal and pancreatic cancers. Despite these risks, it remains widely used, particularly among women and older populations, due to cultural and social norms.
Prof Ayo-Yusuf’s research also shows that, rather than helping South African smokers quit, e-cigarettes may actually reduce long-term quit rates and increase nicotine dependence.
Prof Ayo-Yusuf’s research also shows that, rather than helping South African smokers quit, e-cigarettes may actually reduce long-term quit rates and increase nicotine dependence.
“E-cigarette use reduces long-term quitting [and] quit intentions, [and] increases smoking relapse and nicotine dependence. Dual use, where individuals smoke both conventional cigarettes and e-cigarettes, is becoming more common. Rather than fully replacing cigarettes, many users remain addicted to both products.”
Prof Ayo-Yusuf emphasised that Africa’s youth population is increasingly vulnerable to the industry’s aggressive marketing tactics. A South African study he co-authored found that vape shops are strategically placed near higher education institutions rather than in communities with traditionally high smoking rates.
“This so-called harm reduction should ideally target communities with high smoking rates, if it were genuinely driven by public health as opposed to profits,” he said.
He also debunked the claim that tobacco harm-reduction strategies using electronic nicotine delivery systems (ENDS) are effective, saying that countries that have effectively regulated access, such as Australia, or banned e-cigarettes, such as Uganda and Brazil, have achieved better public health outcomes than those that have embraced them with fewer restrictions, such as England.
“It is clear that the industry’s so-called ‘harm reduction’ narrative in South Africa is a business strategy rather than a public health strategy.”
A major theme in Prof Ayo-Yusuf’s address was the persistent interference of the tobacco industry in public health policy. Drawing from global case studies, he illustrated how industries that profit from health-harming products – including tobacco, sugar-sweetened beverages and ultra-processed foods – use similar tactics to stall regulation and maintain market control.
In South Africa, industry-funded reports have been used to challenge measures such as tobacco taxation and plain packaging laws. “Raising tobacco taxes is the most effective policy to reduce tobacco use and save lives, while bringing in significant government revenue. Yet, raising taxes continues to be the least implemented measure,” he noted.
He called for stronger international co-operation and governance to counter industry influence, particularly in light of impending trade agreements that could be leveraged by tobacco companies to bypass national regulations.
Prof Ayo-Yusuf called for more robust policy interventions, increased taxes on tobacco products while also addressing the criminality associated with illicit tobacco trade, and comprehensive monitoring of new and emerging nicotine delivery systems.
His research has led to the establishment of the Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM) at UP. The centre serves as a hub for transdisciplinary research and advocacy and provides policymakers with the evidence needed to strengthen tobacco control efforts across the continent.
“The battle against the tobacco epidemic is not just about regulating cigarettes,” Prof Ayo-Yusuf concluded. “It’s about exposing industry tactics, closing regulatory loopholes and ensuring that public health policies are based on science, not corporate interests.”
JOHANNESBURG, South Africa – As the world marks 20 years of the Framework Convention on Tobacco Control (FCTC) on 27 February, global organisation Campaign for Tobacco-Free Kids (CTFK) has highlighted South Africa’s tobacco control efforts in a mini-documentary showcasing bold actions to protect public health: The Rise of a Tobacco-Free Nation.
“The Rise of a Tobacco-Free Nation forms part of a pan-African storytelling series, spotlighting the resilience, leadership, and advocacy driving tobacco control efforts across the continent,” says Bintou Camara, Regional Director, Africa Program for CTFK. “South Africa’s story is one of many inspiring journeys shaping a healthier future for Africa.”
At the heart of this powerful story is Protect Our Next, a movement of public health organisations, community organisations and citizens driven by a shared determination to safeguard the well-being of generations to come. Protect Our Next was launched in 2018 with a singular purpose to convey a unified message to policymakers, government, and the society that public health must be prioritised over tobacco industry profit.
For seven years, Protect our Next has mobilised South Africans to advocate for stronger tobacco control by empowering communities through education, awareness, and grassroots support, fostering youth leadership by equipping young people with the skills and knowledge to be effective advocates, and strengthening partnerships with diverse stakeholders such as health professionals, civil society organisations, schools, and government. Together, these efforts aim to build a united front against the might of the tobacco industry.
The mini-documentary features personal stories and expert insights from key partners that form part of Protect our Next, including the South African Medical Research Council (SAMRC), the National Council Against Smoking (NCAS), the Cancer Association of South Africa (CANSA), the South African Tobacco Free Youth Forum (SATFYF), and the Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM).
“With the new Control of Tobacco Products and Electronic Delivery Systems Bill finally in parliament after seven years, and the final rounds of public consultations complete, South Africa is at a critical point in strengthening critical tobacco control laws,” says Zanele Mthembu, South Africa country lead for CTFK and the convenor of Protect our Next. “We want government to know that people of South Africa say yes to this bill. It’s going to save lives. We have truth and evidence on our side.”
South Africa was one of the first signatories to the WHO Framework Convention on Tobacco Control (FCTC). In alignment with South Africa’s FCTC commitments, this landmark Bill incorporates evidence-based measures that address critical gaps in the country’s existing tobacco control policies. Key provisions include a comprehensive ban on smoking in public spaces, stricter regulations on the advertising, promotion, and sponsorship of tobacco and electronic delivery systems, and the introduction of plain packaging to reduce the appeal of these products.
“By implementing these evidence-based strategies, South Africa reaffirms its dedication to protecting public health and complying with the global standards set by the FCTC,” says Mthembu. “This Bill is a significant and essential step towards reducing tobacco consumption and its associated health burdens.”
Dr Catherine Egbe, Senior Specialist Scientist in the Mental Health, Alcohol, Substance Use and Tobacco Research Unit at the SAMRC, emphasises the significance of collective action, saying, “The 2021 South African Global Adult Tobacco Survey Report is a wake-up call, revealing the high prevalence of tobacco use in South Africa. 29.4% of adults aged 15 years and older use tobacco. I’m inspired by the efforts of all partners in the Protect Our Next campaign to change the narrative, particularly with the progress of the Tobacco Control Bill, which prioritises the health of every citizen, every community and the nation at large.”
The 2021 South African Global Adult Tobacco Survey (GATS-SA) reveals that the prevalence of tobacco use in South Africa remains alarmingly high, with 29.4% of adults aged 15 years and older identified as current tobacco users. This stark figure underscores the urgency of implementing stringent tobacco control measures to safeguard public health and reduce the burden of tobacco-related diseases across the nation.
Monitoring the tobacco industry activities is crucial to the Protect our Next collective mission. Prof Lekan Ayo Yusuf, Director of NCAS, ATIM and Head of the School of Public Health at the University of Pretoria, says the tobacco industry tactics are clear, hook them young, profit from their addiction, and sacrifice their future. “Exposing and countering manipulative marketing strategies by the tobacco industry, preventing the exploitation of regulatory loopholes, protecting children and adolescents from targeted advertising and sales, and supporting the development and implementation of effective tobacco control policies are all critical priorities.”
Youth advocacy plays a central role in Protect Our Next, with initiatives led by SATFYF amplifying the voices of young South Africans. Sanele Zulu, Convenor of SATFYF, says: “We bring the youth energy to Protect Our Next, ensuring young voices are heard. We mobilise youth to safeguard their own futures and empower communities to demand change. With the proposed Tobacco Products and Electronic Delivery Systems Control Bill, we are closer to achieving our vision of a smoke-free South Africa where young people can thrive, free from nicotine addiction. ”
Through Protect Our Next, South Africa’s diverse communities are coming together, united by a shared love for their country and a determination to build a healthier, smoke-free future.
“Protect Our Next was born, driven by passion, informed by research, and fuelled by determination to protect the health and the future of South Africans,” says Lorraine Govender, National Manager Health Promotion at CANSA. “We will not rest until our youth are protected, our communities are empowered, and our future is tobacco-free.”
http://www.protectournext.co.za
JOHANNESBURG, South Africa – Global organisation The Campaign for Tobacco-Free Kids (CTFK) focuses on South Africa’s tobacco control efforts in The Rise of a Tobacco-Free Nation, a mini-documentary focused on bold action to protect public health and build a tobacco-free future.
“The Rise of a Tobacco-Free Nation forms part of a pan-African storytelling series, spotlighting the resilience, leadership, and advocacy driving tobacco control efforts across the continent. South Africa’s story is one of many inspiring journeys shaping a healthier future for Africa,” says Bintou Camara, Regional Director, Africa Program for CTFK.
At the heart of this powerful story is Protect Our Next, a movement of public health organisations, community organisations and citizens driven by passion, resilience, and a shared determination to safeguard the well-being of generations to come.
The mini-documentary features compelling personal stories and expert insights from key partners within South Africa’s tobacco control landscape that form part of Protect our Next, including the South African Medical Research Council (SAMRC), the National Council Against Smoking (NCAS), the Cancer Association of South Africa (CANSA), the South African Tobacco Free Youth Forum (SATFYF), and the Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM).
With the new Control of Tobacco Products and Electronic Delivery Systems Bill finally in parliament after seven years, South Africa is at a critical point in strengthening critical tobacco control laws that will save lives, says Zanele Mthembu, South Africa country lead for CTFK and the convenor of Protect our Next. “Initially dubbed Thina Abantu, which means we the people, Protect Our Next was launched in 2018 with a singular purpose to convey a very strong message to policymakers, government, and the society that we must prioritise public health over tobacco industry profit. We want our government to know that the people of South Africa say yes to this bill. It’s going to save lives.”
The initiative mobilises South Africans to advocate for stronger tobacco control by:
Dr Catherine Egbe, Senior Specialist Scientist in the Mental Health, Alcohol, Substance Use and Tobacco Research Unit at the SAMRC, emphasises the significance of collective action, saying, “The 2021 South African Global Adult Tobacco Survey Report is a wake-up call, revealing the high prevalence of tobacco use in South Africa. I’m inspired by the efforts of all partners in the Protect Our Next campaign to change the narrative, particularly with the progress of the Tobacco Control Bill, which prioritises the health of every citizen, every community and the nation at large.”
Monitoring the tobacco industry activities is crucial to the Protect our Next collective mission. Prof Lekan Ayo Yusuf, Director of NCAS, ATIM and Head of the School of Public Health at the University of Pretoria, says the tobacco industry tactics are clear, hook them young, profit from their addiction, and sacrifice their future. “Exposing and countering manipulative marketing strategies by the tobacco industry, preventing the exploitation of regulatory loopholes, protecting children and adolescents from targeted advertising and sales, and supporting the development and implementation of effective tobacco control policies are all critical priorities.”
Youth advocacy plays a central role in Protect Our Next, with initiatives led by SATFYF amplifying the voices of young South Africans. Sanele Zulu, Convenor of SATFYF, says: “We bring the youth energy to Protect Our Next, ensuring young voices are heard. We mobilise youth to safeguard their own futures and empower communities to demand change. With the proposed Tobacco Products and Electronic Delivery Systems Control Bill, we are closer to achieving our vision of a smoke-free South Africa where young people can thrive free from nicotine addiction.
Protect Our Next, South Africa’s diverse communities are coming together, united by a shared love for their country and a determination to build a healthier, smoke-free future
Protect Our Next was born, driven by passion, informed by research, and fuelled by determination to protect the health and the future of South Africans,” says Lorraine Govender, National Manager Health Promotion at CANSA. “We will not rest until our youth are protected, our communities are empowered, and our future is tobacco-free.”
Hey everyone! Valentine’s Day is just around the corner, a time for love, laughter, and showing your special someone just how much they mean to you. But let’s be real, sometimes a sneaky habit can put a damper on even the most sizzling romance. This year, why not give a gift that truly shows you care: quitting smoking.
Now, we know life can be tough. Whether you’re hustling in the office, holding down the fort at home, or looking for work, stress can creep in, and sometimes that cigarette seems like the only escape. But think about it: is it really helping? Or is it creating a different kind of stress, the kind that affects your health, your pocket, and your relationships?
A recent study showed how smoking can be linked to relationships. It found that sometimes, especially for couples living together, there can be extra pressure. And for some folks, especially those who are single, that loneliness can make it even harder to quit. It’s a tough situation, but it’s one we can tackle together.
This Valentine’s Day lets chat straight, smoking affects everyone. It doesn’t care about your bank balance or your background. But you can choose to take control
More Quality Time means no more ducking out for a quick smoke break. More time for cuddles, conversations, and just being together. Whether it’s a fancy dinner or sharing a simple meal, you’ll enjoy it more without the craving.
Health is Wealth so quitting isn’t just about adding years to your life, it’s about adding life to your years. More energy to chase after the kids, dance to your favourite tunes, or just enjoy a relaxed Sunday.
Love in Your Pocket let’s face it, those packets are expensive! Imagine what you could do with that extra cash. A special treat for your partner, a new pair of shoes, or even just putting a little extra away for a rainy day.
There’s support out there. Pop into your local clinic, chat to a healthcare worker, or check out the online resources. There are groups, patches, and even medication that can help you kick the habit. Don’t be shy to ask for help – we’re all in this together.
This Valentine’s Day, show your love is stronger than any craving. Quit for love, quit for health, quit for a better future. Let’s make this year the year of fresh air and fresh starts!
The Portfolio Committee on Health will over the coming weekend hold final public hearings on the Tobacco Products and Electronic Delivery Systems Control Bill (B33-2022) in the Free State and Western Cape, lead by the Chairperson of the Portfolio Committee on Health, Dr. Sibongiseni Dhlomo.
| DATE | DISTRICT/LOCAL MUNICIPALITY | VENUE | TIME |
Friday, 31st January 2025 | Kopanong Local Municipality | Trompsburg Town Hall) (Trompsburg) | 10:00 – 15:00 |
Sunday, 2nd February 2025 | George Local Municipality | Conville Community Hall (George) | 10:00 – 15:00 |
While conducting provincial public hearings, the 6th Parliament committee was only able to conduct two hearings in both Free State and Western Cape. “In order to ensure that there is parity and that all provinces hold three public hearings, the 7th Parliament committee resolved that it would hold single hearings in the two provinces. This is in line with the obligation to hold meaningful public participation and afford all South Africans the opportunity to contribute to the Bill,” said Dr Sibongiseni Dhlomo, the Chairperson of the committee.
Currently in the parliamentary process, the bill is a vital updated piece of legislation that seeks to protect the health of all South Africans by regulating the use, packaging, and marketing of tobacco and electronic delivery systems, including e-cigarettes.
Protect Our Next organisations, including the National Council Against Smoking (NCAS), the Cancer Association of South Africa (CANSA), the South African Medical Research Council (SAMRC), the Heart and Stroke Foundation South Africa (HSFSA), the South African Tobacco Free Youth Forum (SATFYF) and The Africa Centre For Tobacco Industry Monitoring and Policy Research (ATIM), say the Bill is a vital step towards a tobacco-free South Africa.
Legislation for a healthier society
“Strong tobacco control policy is central to reducing South Africa’s heavy burden of non-communicable diseases and will support sustainable implementation of South Africa’s National Health Insurance,” says Dr Sharon Nyatsanza of the National Council Against Smoking (NCAS). Measures in the new Bill close loopholes in the Tobacco Products Control Act of 1993, as amended, and are set to reduce tobacco use, exposure to second-hand tobacco smoke as well as the initiation of tobacco use by young people. It brings South Africa’s domestic legislation closer to full implementation of the WHO Framework Convention on Tobacco Control (FCTC), a global standard.”
The 2021 Global Adult Tobacco Survey-South Africa (GATS-SA) reveals high rates of tobacco use in the country, the highest of African countries surveyed. This highlights the urgent need to pass the Bill as soon as possible, says lead investigator of GATS-SA, Dr. Catherine Egbe of the South African Medical Research Council (SAMRC) Mental Health, Alcohol, Substance Use and Tobacco Research Unit (MASTRU)
“GATS-SA indicates that 29,4% of the those aged 15years+, equating to 12,7 million people, use tobacco, exposing themselves to severe health risks such as cancer, cardiovascular diseases, and respiratory disorders. E-cigarette use among youth is also on the rise, raising concerns about nicotine addiction and long-term health implications especially for young people whose brains can be impacted by nicotine.”
E-cigarettes taking hold
According to a national SAMRC university study, one in four university students aged 18 to 24 years (26%) reported current use of e-cigarettes, while almost 40% reported ever use. The study indicates significant exposure to advertising and marketing of these products among young people, with 77.8% exposed to e-cigarette marketing. Students exposed to marketing were three times as likely to use the products.
Youth advocate from the South African Tobacco-Free Youth Forum, Lesego Mateme, says, “It’s clear that the youth are the targets of the aggressive marketing tactics of the tobacco and e-cigarette industries. We fervently advocate for comprehensive bans on tobacco advertising, promotion, and sponsorship across all media, including digital platforms. Tobacco and emerging tobacco products should be viewed as threats to our generation.”
Dr Sharon Nyatsanza, Deputy Director of the National Council Against Smoking (NCAS), says the Bill is a vital measure in the fight against non-communicable diseases in South Africa, and its economic and public health benefits cannot be overstated. “The aim of this legislation is to reduce the consumption of tobacco and e-cigarettes, thereby safeguarding public health, particularly the well-being of future generations. However, this well-considered legislation is meeting strong resistance from the tobacco industry for self-serving reasons, as expected. They attempt to sow discord by propagating several false narratives, including the notion of a complete ban on e-cigarettes or tobacco products and the imposition of harsh penalties such as imprisonment for smokers.”
The tobacco industry also exaggerates the negative economic impact of the bill, such as job losses, according to Nyatsanza. “The Bill will in fact be good for the economy and is essential for the implementation of National Health Insurance. A decrease in spending on tobacco often correlates with increased spending on other goods and services, driving job creation in other sectors.”
There has been notable public endorsement for smoke-free zones, with citizens recognising their importance in protecting non-smokers. Additionally, clauses in the bill around the regulation of advertising, electronic delivery systems, and the introduction of standardised packaging have all received strong support, says Nyatsanza. “It’s time for the citizens to take this opportunity to voice their support for the important measures in this Bill,” she concludes.
www.protectournext.co.za
South Africa’s leading health and community organisations, united as Protect Our Next, have welcomed the U.S. Food and Drug Administration’s (FDA) recently proposed policy to reduce nicotine to minimally addictive or non-addictive levels in cigarettes and other combusted tobacco products. This landmark initiative represents a decisive step toward reducing tobacco addiction and its devastating health consequences.
The FDA estimates that implementing this proposal could have a profound public health impact. In the US alone, it could prevent 48 million youth and young adults from becoming smokers and save 4.3 million lives just by the end of this century. Within just five years, it is projected to prompt nearly 19.5 million current smokers in the US to quit.
Speaking about the significance of the FDA’s policy, Dr. Catherine Egbe, from the South African Medical Research Council’s (SAMRC) Mental Health, Alcohol, Substance Use and Tobacco Research Unit (MASTRU), a partner in Protect Our Next, says: “Reducing nicotine to non-addictive levels in products is one of the tobacco endgame strategies – effective ways to create a tobacco-free society and save lives. Various endgame strategies are increasingly being adopted around the world, and this is just one way the US is adding on to other strategies like banning flavours that are being adopted in different parts of the US, although this may arguably be the biggest game changer. Nicotine is the addictive drug in cigarettes and electronic cigarettes. More than 80% of adults who currently smoke cigarettes started smoking as teenagers, before they could understand how addictive these products can be and the negative impacts these products can have on their lives. Protecting people from a lifetime of addiction should take priority over profits, always.”
Prof Lekan Ayo-Yusuf, Director, National Council Against Smoking, Head of the School of Health Systems and Public Health at the University of Pretoria, and Director: Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM), says:
The FDA’s proposed nicotine reduction rule has the potential to reshape global efforts in addressing tobacco addiction. Curtailing nicotine content in cigarettes will not only prevent young people from developing lifelong addiction but also enable millions of existing smokers to finally quit. This rule provides an evidence-based framework to prevent the initiation of smoking and reduce tobacco-related harm, particularly for vulnerable populations disproportionately affected by tobacco use. Reducing nicotine in cigarettes can help bridge health inequalities by encouraging cessation and preventing new addictions in these groups.Such actions are critical in reducing the burden of diseases like cancer and cardiovascular conditions caused by smoking.
Technologically, it is entirely feasible to manufacture cigarettes with significantly reduced nicotine levels, explains Ayo-Yusuf. “Research over the decades has shown how such approaches effectively reduce dependence without leading to compensatory smoking behaviors, where individuals try to consume more cigarettes or inhale more deeply.”
Research shows that very low nicotine content cigarettes reduce cravings, dependence, and overall smoking rates. Smokers who use cigarettes with only 0.4 mg of nicotine per gram of tobacco—95% less than standard cigarettes—report double the quit attempts compared to smokers using regular cigarettes.
The proposed nicotine reduction standard is designed to cover all combusted tobacco products, including cigars, cigarillos, pipe tobacco, and roll-your-own tobacco. This is critical to prevent smokers from switching to other harmful alternatives and undermining the policy’s effectiveness
“Evidence suggests that the tobacco industry often exploits loopholes in tobacco control legislation,” says Dr Egbe. “Including all forms of combustible tobacco in the rule will help mitigate such tactics and prevent the promotion of other high-risk products as substitutes for cigarettes.”
Dr Egbe did however expect that this should have been extended to electronic cigarettes. “Much still needs to be done to properly regulate electronic cigarettes. Hopefully, this will be done in the near future.”
A new era in Tobacco Control
As tobacco remains the leading cause of preventable death worldwide, this proposed rule by the FDA signals a turning point in how governments can take bold action to protect the health of their populations. Nicotine, known for its addictive properties, is the driving force behind tobacco dependency. Adolescents are particularly vulnerable to nicotine addiction, which harms brain development, impacting attention, learning, and impulse control. Research has shown that significantly reducing nicotine content can decrease dependence, reduce cravings, and increase successful quit attempts.
The FDA’s proposal builds on over a decade of scientific research and global tobacco control practices, such as flavour bans, to address tobacco addiction. By setting an ambitious precedent, this move encourages countries around the globe, including South Africa, to consider bold regulatory actions to save lives and improve public health outcomes.
Protect Our Next joins experts around the world in urging swift finalisation and implementation of this rule. Limiting the addictiveness of cigarettes is not just a step forward—it is a giant leap toward breaking the cycle of tobacco addiction and preventing millions of premature deaths.
www.protectournext.co.za
Furthermore, the National Council Against Smoking (NCAS), together with Protect our Next partners, is calling on smokers to embrace 2025 as the year to quit smoking and reclaim their health
New research from University College London highlights the alarming risks of smoking, showing that just one cigarette shortens life by 20 minutes a day -double previous estimates.For South African smokers, who smoke an average of 8.5 cigarettes daily, this equates to 43 days of life lost each year.
This New Year presents an ideal opportunity to leave cigarettes behind and commit to a healthier life.
Key Research Findings
The research from University College London highlights that:
Why quitting completely is crucial
Gradually cutting down is not enough. Research shows that reducing cigarette intake often leads to deeper inhalation or more frequent smoking to maintain nicotine levels, increasing exposure to harmful toxins. Only complete cessation restores health and adds years to life expectancy.
10-11 years of life expectancy can be regained.
Consequently risk of diseases such as heart attacks, strokes, and cancer decrease significantly.
Improved quality of life, free from the health and financial burdens of smoking.
NCAS offers support to help you quit:
Call: 011 720 3145
WhatsApp: 072 766 4812
Quitting smoking not only saves lives but also saves money. The average South African smoker spends R7,300 annually on cigarettes-funds that could be used for healthcare, education, or family needs. Quitting also protects loved ones from the dangers of secondhand smoke which increases the risk of heart disease and cancer.
As South Africa faces a smoking prevalence rate of 29.4%, the highest in Africa, NCAS urges both smokers and the government to act. The passage of the Tobacco Products and Electronic Delivery Systems Control Bill is critical to creating a supportive environment for quitting and reducing tobacco use.
Let 2025 be the year you quit smoking for good.
National Council Against Smoking
Dr. Sharon Nyatsanza
Deputy DirectorEmail: sharon@againstsmoking.org.za
The public hearings on the Tobacco Products and Electronic Delivery Systems Control Bill in KwaZulu-Natal took place from November 8-10, 2024. These hearings were part of the final stage of public input before the bill moves forward in the legislative process. The hearings were held in Richards Bay, Pietermaritzburg, and Durban North.
An Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM) study shows smoking rates are rising in KwaZulu-Natal, surging from 14% to 20% between 2017 and 2021.
Measures in the new Bill are set to reduce tobacco use, dangerous exposure to second-hand tobacco smoke as well as the initiation of tobacco use by young people. Key proposals include making indoor public places and certain outdoor areas 100% smoke-free, banning cigarette and e-cigarette vending machines, implementing plain packaging with graphic health warnings, and regulating electronic nicotine delivery systems.
Overall, the hearings provided a platform for diverse opinions, reflecting the importance of public participation in the legislative process, says Zanele Mthembu, Country Lead for the Campaign for Tobacco-Free Kids and Convenor of Protect our Next, a partnership of health, research, and community organisations in support of the Bill.
During the hearings, there was again significant support for the Bill, with many participants emphasising the health concerns, negative economic impact of tobacco and need for stricter regulations to protect non-smokers and vulnerable groups from second-hand smoke. A good number of speakers expressed views on behalf of their communities, such as Pastor Luthuli from Verulam who voiced support for the Bill and advocated for more community education. “This collective community spirit in support of the Bill is applauded and it speaks to the devastating impact of tobacco felt by communities and the importance of the bill in saving lives.”
However, Mthembu lamented the fundamental misunderstanding of the proposed legislation and the broader issues at stake held by some opponents of the bill. “Many young people are clearly influenced by industry misinformation. We face a significant task in educating and raising awareness to prevent another generation from becoming addicted to tobacco and nicotine,” she stressed.
The regulation of e-cigarettes and related products remains a point of contention and misinformation.
“An advocate of harm reduction spoke as if the Bill includes an outright ban on e-cigarettes, which it does not. Instead, the bill seeks to protect youth from targeted marketing by the vaping industry,” Mthembu clarified. “Regulating the packaging of e-cigarettes and ingredients in e-liquids also does not bar adult access.”
More than misinformation, there seems to be effort to mislead. “Certain “harm-reduction” doctors claimed that nicotine is non-toxic, a blatant lie. Beyond being addictive, nicotine is a ‘naturally occurring toxic chemical’ as defined by the CDC,” says Mthembu.
Some young participants cited economic and job impacts from marketing restrictions as their reasons for opposing the Bill, advocating on behalf of those seeking opportunities in the tobacco industries, as well as vendors making a living from selling tobacco. Sanele Zulu of the South African Tobacco Free Youth Forum emphasises that tobacco control policy will lead to more jobs because there will be net employment gains due to expenditure in other goods and services. “As more people stop smoking, spending will be reallocated to other goods and services. Those funds can be channelled towards building industries that do not market addiction and will add more value to the health of the nation.”
An opposer argued that plain packaging would stifle creative job opportunities for design students, another that increased travel expenses for smokers needing to travel to buy cigarettes to further justify his opposition to the bill. Lorraine Govender of the Cancer Association of South Africa (CANSA) notes that design companies do not only work for the tobacco industry, and says that graphic health warnings on plain packaging would still require design experts.
Siphesihle Gwambe of the South African Medical Research Council adds that the sale and use of cigarettes are not being banned by the bill, and there is no part of the bill which will prevent those who currently sell cigarettes from doing so. Retailers only have to ensure that they are not advertising their products and targeting youth to get hooked on nicotine.
A point emerged around preserving cultural traditions around tobacco, such as the use of snuff in public spaces. Mthembu clarified, “The bill does not prevent snuff use in public spaces or for traditional purposes; however, it’s important to acknowledge the cancer risks associated with snuff, which contains over 3,000 chemicals, including 28 carcinogens.”
Most arguments from those opposing the Bill neglect the devastating health impacts of tobacco products that also have a major impact on our economy, says Mthembu. Tobacco costs South Africa R42 billion per year in treating tobacco-related illnesses and in lost productivity.
Prof Lekan Ayo-Yusuf, Director of the National Council Against Smoking (NCAS) and Chairperson: School of Health Systems and Public Health, University of Pretoria says the Tobacco Control Bill can make a vital contribution to curbing healthcare costs and improving standards of living, with benefits only increasing over time. “As a major risk factor for non-communicable diseases, tobacco use adds enormously to the economic and human resources costs of the NHI. Measures in the new Bill can prevent harm, death, and disability from NCDs by closing legislative gaps and properly regulating emerging products like e-cigarettes. Enacting the Bill will be a win for public health and the economy.”
”These hearings show the critical need for the Tobacco Products and Electronic Delivery Systems Control Bill,” says Dr. Sharon Nyatsanza, Deputy Director of the National Council Against Smoking (NCAS). “They reveal how industry misinformation attempts to obscure the health crisis posed by tobacco, reinforcing the necessity for robust regulation to protect South Africa’s future generations.”
Provincial Public Hearings on the Tobacco Products and Electronic Delivery Systems Control Bill are taking place from 8-10 November. Currently in the parliamentary process, the bill is vital draft legislation that seeks to protect the health of all South Africans by regulating the use, packaging, and marketing of tobacco and electronic delivery systems, including e-cigarettes.
KZN Schedule
Friday, 8th November, 2024: 10:00 – 15:00
City of Umhlathuze, Nseleni Community Hall, Richards Bay
Saturday, 9th November 2024: 10:00 – 15:00
Msunduzi Local Municipality Ward 15, Community Hall at Embhali, Pietermaritzburg
Sunday, 10th November 2024: 10:00 – 15:00
eThekwini Metropolitan Municipality, Greenwood Park Community Hall, Durban North
With the Northern Cape completed last weekend, KwaZulu-Natal is the only remaining province yet to participate in Public Hearings as the new Government of National Unity continues the process started before the May 2024 elections. Consultations must be completed for the Bill to pass into the next phase of oral presentations under the auspices of the Health Committee, deliberation and then going to the National Assembly for adoption.
Community response
Lorraine Govender, National Manager: Health Programmes at CANSA says the response to the Bill in the Northern Cape was overwhelmingly positive as people spoke out about the need to protect South African communities and the youth. “It was alarming to hear of the concerns people raised on the prevalence of tobacco use in their communities.Their comments echo the sentiments of communities around the country – we need this Bill, and we need it now. We expect the comments in KwaZulu-Natal will be similar.”
Those in support said the provisions of the Bill were in line with international best practice on the regulation of tobacco products, arguing that countries across the world have proved that it is possible to regulate tobacco products such as the use of plain packaging, use of graphics that highlight the dangers of consumption of tobacco products and the imposition of smoke free zones in the protection of vulnerable groups such as pregnant women, children and non-smokers.
“Just this week, we have seen the UK introduce its own Tobacco and Vapes Bill, outlining tougher measures to better protect the public, its National Health Service and the economy from the harms of smoking and vaping. Countries across the world have tightened regulations, and South Africa must not fall further behind,” says Dr Sharon Nyatsanza , Deputy Director of the National Council Against Smoking (NCAS). “It’s time that we embrace reforms that shift the focus of healthcare from sickness to prevention and address a major risk factor driving poor health – tobacco use. Strong tobacco control policy is central to reducing South Africa’s heavy burden of non-communicable diseases and will support sustainable implementation of our National Health Insurance.”
There were strong views that without the proposed regulations, non-smokers are being exposed to harmful second-hand smoke inhalation and that the speedy implementation of the Bill would help curb this challenge. They also argued that the contribution made by the tobacco industry to tax revenue doesn’t offset the cost of treating tobacco related diseases and the loss of manhours caused by both using the products and nursing those who have contracted such illnesses as a result of either using tobacco products or being exposed to tobacco smoke. They pointed out that the industry was mainly concerned with profit making and not public health.
Communities highlighted that the electronic delivery systems have unknown chemicals that may be harmful to the health of the people. Young people agreed with the Bill’s intention to deter people, especially children and youth from initiating the use of tobacco and e-cigarette products and being exposed to their harmful constituents.
Parents welcomed the provision of the Bill for additional requirements to prevent access to tobacco products by children. Also, some participants welcomed the total ban of the sale of cigarettes through vending machines as this will reduce the probability of access to tobacco products for children and the underage youth.
There has been notable public endorsement for smoke-free zones, with citizens recognising their importance in protecting non-smokers. Additionally, clauses in the bill around the regulation of advertising, electronic delivery systems, and the introduction of standardised packaging have all received strong support, says Nyatsanza. “It’s now time for citizens in KWaZulu-Natal to take this opportunity to voice their support for the important measures in this Bill,” she says.
Legislation for a healthier society
Measures in the new Bill close loopholes in the Tobacco Products Control Act of 1993, as amended, and are set to reduce tobacco use, exposure to second-hand tobacco smoke as well as the initiation of tobacco use by young people. It brings South Africa’s domestic legislation closer to full implementation of the WHO Framework Convention on Tobacco Control (FCTC), a global standard.”
The proposed legislative and policy changes seek to introduce the following:
(a) indoor public places and certain outdoor areas will be designated 100 per cent smoke-free;
(b) a ban on the sale of cigarettes through vending machines;
(c) plain packaging with graphic health warnings and pictorials;
(d) a ban on display at point of sale; and
(e) the regulation and control of electronic nicotine delivery systems and non-nicotine delivery systems.
SA must address high rates of tobacco use
The 2021 Global Adult Tobacco Survey-South Africa (GATS-SA) reveals high rates of tobacco use in the country, the highest of African countries surveyed using the GATS methodology. This highlights the urgent need to pass the Bill as soon as possible, says lead investigator of GATS-SA, Dr. Catherine Egbe, Senior Specialist Scientist at the South African Medical Research Council (SAMRC)’s Mental Health, Alcohol, Substance Use and Tobacco Research Unit (MASTRU).
GATS-SA results show that 29,4% of the those aged 15years+, equating to 12,7 million people, use tobacco, exposing themselves (and their loved ones) to severe health risks such as cancer, cardiovascular diseases, and respiratory disorders.
KZN smoking rates increasing
In Kwa-Zulu Natal, GATS-SA shows the smoking prevalence at 21.7%. An Africa Centre for Tobacco Industry Monitoring and Policy Research study published in the SAMJ using a similar approach and sampling showed that smoking rates in KZN had actually increased significantly from 14% to 20% between 2017/18 and 2021.
E-cigarettes taking hold
Dr. Egbe says e-cigarette use among youth is also on the rise, raising concerns about nicotine addiction and long-term health implications especially for young people whose brain development can be impacted by nicotine. According to a national SAMRC university study, one in four university students aged 18 to 24 years (26%) reported current use of e-cigarettes, while almost 40% reported ever use. The study indicates significant exposure to advertising and marketing of these products among young people, with 77.8% exposed to e-cigarette marketing. Students exposed to marketing were three times as likely to use the products.
Youth advocate from the South African Tobacco-Free Youth Forum, Lesego Mateme, says, “It’s clear that the youth are the targets of the aggressive marketing tactics of the tobacco and e-cigarette industries. We fervently advocate for comprehensive bans on tobacco advertising, promotion, and sponsorship across all media, including digital platforms. Tobacco and emerging tobacco products should be viewed as threats to our generation.”
Support for legislation should not be swayed by Tobacco Industry misinformation
“The support across eight provinces to date for this vital tobacco control legislation underlines the value people place on their health,” says Zanele Mthembu, Campaign for Tobacco-Free Kids Country Lead for South Africa and the Convenor of Protect our Next.
“We know the tobacco industry is well-versed on levers to delay the Bill. Thus far, their tactics have not succeeded. We applaud the Parliamentary Health Committee for standing firm and resolute on their Constitutional mandate to Protect and Promote public health and to follow the spirit of the WHO Framework Convention on Tobacco Control (FCTC. Amongst other things, the FCTC calls on governments to protect public health policies against the tobacco industry interference ( Article 5.3). We are confident that even with this Bill, public health objectives will supersede tobacco industry interests.”
QUESTIONS:
Experts from Protect our Next provided clarification on concerns and questions raised by communities.
E-cigarette producers argue for separate regulation
Producers of electronic delivery systems argue that the Bill in its current form does not set out a clear distinction between traditional tobacco products, like cigarettes, and electronic nicotine delivery systems, saying they are in support of regulation, but not as provided for in the Bill. They called for separate regulations addressing the unique vaping environment.
Dr. Catherine Egbe, Senior Specialist Scientist at the South African Medical Research Council (SAMRC) Mental Health, Alcohol, Substance Use and Tobacco Research Unit (MASTRU) explains that government cannot regulate each tobacco and nicotine product separately, for example snuff has nicotine and it is not smoked, but it is also not regulated separately in our current law.
“There are many precedents from around the world, of the regulation of cigarettes and other tobacco products as well as e-cigarettes in the same law,” says Egbe. “It is important to note that though similar products are in the same law, they are distinguished in the content of the law. In the Tobacco Products Control Act of 1993 as amended in 2008, the health warnings on snuff are different from those for cigarettes. E-cigarettes are also treated in a similar manner in this bill. There are provisions in the bill to cover various types of products in the market.”
“The call to have a separate law for each product is simply a stalling tactic typical of the industry who cares only about their profits and not public health. The bottom line is that these products are harmful, are not approved as cessation aids by SAHPRA, are completely unregulated in South Africa and indiscriminately marketed, and are causing a growing epidemic of nicotine addiction among our youth.”
Concerns on job losses and the impact on the tobacco industry
Prof Lekan Ayo-Yusuf, Director of the National Council Against Smoking (NCAS) and Head of the School of Health Systems and Public Health at the University of Pretoria, says the evidence across multiple studies is clear: not only does stronger tobacco control legislation not harm the economy or cause job losses, it could actually stimulate job creation in other sectors, generate government revenues, and reduce the economic costs associated with tobacco use.
“Studies show that a decrease in spending on tobacco is usually associated with an increase in expenditure on other goods and services in the economy, creating jobs in these sectors,” says Ayo-Yusuf. “If people stop smoking, the revenue from excise taxes on tobacco and related products doesn’t disappear, people spend the money on other things instead. This could then help other industries grow, creating healthier jobs and a more sustainable economy. It’s high time we challenged the misleading narrative pushed by the tobacco industry and embraced policies that promote both public health and economic prosperity. Remember, a sick nation is a poor nation.”
Impact on illicit trade
While concerns that measures in the Bill could potentially drive more illicit trade are frequently raised by the tobacco industry, this is a criminal issue that the government is committed to addressing, working closely with law enforcement and customs agencies to detect and prevent illegal activities related to tobacco products, says Prof Ayo-Yusuf. “The tobacco industry has been accused of complicity in large-scale illicit trading. While it is a major criminal concern, the tobacco industry uses the over-exaggeration of illicit trade problem to manipulate public opinion and to oppose further increases in tobacco excise tax. Ultimately, we need strong tobacco control measures, increased taxes and a focus on addressing illicit trade.”
Minister’s role in regulations
The Minister of Health will have significant powers in setting regulations pertaining to flavours, packaging, and smoke-free areas. “The purpose of these regulations will be to make tobacco products less appealing, particularly to younger consumers, and to protect non-smokers from second-hand smoke,” says Lorraine Govender of CANSA. “The regulations will be published for public comments and enable the Minister to implement the law.”
Online sale of tobacco products
Selling tobacco products online will be regulated under the new Bill, says Dr Sharon Nyatsanza , Deputy Director of the National Council Against Smoking (NCAS).“Selling online is not criminalised, but it does require adherence to strict guidelines. Enforcement will be carried out by relevant government agencies and will include monitoring online activity.”
Sale of single cigarettes
“Concerns are being voiced over whether the Bill will impose stricter regulations on the sale of individual cigarettes, and how this will impact hawkers and small businesses,” says Dr Nyatsanza. “Under this proposed legislation, the sale of single cigarettes will be prohibited. The aim is to prevent impulsive purchases and to make smoking less accessible, particularly for young people. It is a vital step to curtail underage smoking and smoking rates overall.”
Lodging complaints about smoking
Dr Nyatsanza says citizens can lodge complaints about smoking to their local health department or to the National Council Against Smoking. “We receive many complaints about smoking, for example where secondhand smoke is affecting others in a complex. The Bill is important, as it provides clear legal guidelines and regulates this exposure to secondhand smoke more stringently.”
Support for quitting smoking
The government will need to increase support for cessation aids and ways to quit smoking, says Dr Nyatsanza. This includes improvements to health services, improving access to cessation aids, and launching public education campaigns. Those seeking help to quit smoking can call the National Quitline at +27 11 720 3145 or WhatsApp on +27 72 766 4812 for assistance.
Implementation and enforcement of the Bill
The Bill will be implemented and enforced through a combination of governmental agencies and law enforcement. More specific details will be finalised once the Bill is passed into law, but the emphasis will be on effective, fair, and consistent enforcement, says Zanele Mthembu, Campaign for Tobacco-Free Kids Country Lead for South Africa and the Convenor of Protect our Next.
The cost of implementation and taxpayer money
Although implementation may require some funding, it’s important to note that the cost to taxpayers will be substantially less than the cost of treating tobacco-related illnesses, says Mthembu. The cost to the economy of tobacco-related illness, death and lost productivity is in the region of R42 billion per year.
(ENDS)
Protect our Next calls for urgent e-cigarette regulation in South Africa
A groundbreaking new study conducted by researchers at the Keck School of Medicine, University of Southern California (USC) has provided evidence to show the genetic impact of vaping and smoking. Their study sample included youth aged between 21 and 27 years who were either exclusive vapers or exclusive smokers or neither used both products. This is the first genome-wide comparison between vapers and smokers and the study reveals that both groups did not only exhibit similar DNA changes linked to disease risk, including changes in a key gene that suppresses cancer, but also found some toxins in vapers which were not present in smokers. These findings have prompted Protect our Next partner organisations including the Cancer Association of South Africa (CANSA) and the South African Medical Research Council (SAMRC) to call for the urgent regulation of e-cigarettes under the proposed Tobacco Products and Electronic Delivery Systems Control Bill, currently in Parliament.
The study, led by Dr. Stella Tommasi, involved a comprehensive analysis of DNA methylation—a chemical modification of DNA that can turn genes “on” or “off” in cheek cells. According to Prof. Glantz (Professor Emeritus at the University of California San Francisco Centre for Tobacco Control and Education), DNA methylation is vital to the normal functioning of cells but it can lead to cancer and other diseases if it goes awry.
Key findings from the study include:
“Essentially, the research examines how vaping compares to smoking in healthy young individuals by looking at changes in their oral cells,” explains Lorraine Govender, National Manager Health Promotion at CANSA. “Both groups share patterns related to important genes that are involved in regulating cell functions and cancer. The new study found that DNA methylation in vapers, much like in smokers, can contribute to the development of diseases such as cancer. “
A significant finding is that in both vapers and smokers, DMR was found within a gene (HIC1) which suppresses tumours and this has been linked to various cancers including cancers linked with tobacco use. “This suggests that both vapers and smokers face future disease risks related to their DNA changes, which has important implications for public health and highlights the urgent need for stricter regulations on tobacco products and e-cigarettes.”
It is significant that more than half of the DMRs found in vapers were not detected in smokers, Govender says. “You may think you’re using a safer product, but in reality you’re adding a whole new set of harmful toxins, many of which are not even found in tobacco cigarettes. This also increases your risk of serious diseases including cancer. You may only see the results of your actions many years later, but when facing cancer and chemo, you may wish you hadn’t taken that risk,” she warned.
Dr. Catherine Egbe, Senior Specialist Scientist in the Mental Health, Alcohol, Substance Use and Tobacco Research Unit (MASTRU) at SAMRC highlights the increasing use of e-cigarettes in South Africa. Recent SAMRC national university study led by Dr Egbe reveal current prevalence of e-cigarette use among students aged 18 to 24 years to be 26.3% (28.7% among males and 24.1% among females) and of that, 12.5% of students (15.4% among males and 9.8% among females) use e-cigarettes on a daily basis.
The SAMRC study further shows significant exposure to tobacco and e-cigarette marketing among young people, particularly university students – advertising which would be controlled by the new Bill if passed into law. “Aggressive marketing tactics target young impressionable minds, with products like e-cigarettes and hookah being falsely marketed as less harmful alternatives to conventional cigarettes, without information about any health effects that may be associated with the use of these products. Egbe maintained that “for tobacco and nicotine products, exposure to less toxins does not mean exposure to less harm, as clearly shown by the USC study.” The SAMRC study also found that students exposed to advertising are up to four times more likely to use these products, therefore increasing their possibility of developing health issues later in life” Egbe added.
Protect Our Next partner organisations urge policymakers to expedite the passage of the Tobacco Products and Electronic Delivery Systems Control Bill. “This legislation aims to regulate e-cigarettes and reduce their burgeoning uptake among South Africa’s youth, safeguarding future generations from the harmful effects of nicotine and other toxic substances,” says Egbe. “This law is now long overdue.”
First genome-wide study reveals similar DNA changes in vapers and smokers linked to cancer risk
Protect our Next calls for urgent e-cigarette regulation in South Africa
A groundbreaking new study conducted by researchers at the Keck School of Medicine, University of Southern California (USC) has provided evidence to show the genetic impact of vaping and smoking. Their study sample included youth aged between 21 and 27 years who were either exclusive vapers or exclusive smokers or neither used both products. This is the first genome-wide comparison between vapers and smokers and the study reveals that both groups did not only exhibit similar DNA changes linked to disease risk, including changes in a key gene that suppresses cancer, but also found some toxins in vapers which were not present in smokers. These findings have prompted Protect our Next partner organisations including the Cancer Association of South Africa (CANSA) and the South African Medical Research Council (SAMRC) to call for the urgent regulation of e-cigarettes under the proposed Tobacco Products and Electronic Delivery Systems Control Bill, currently in Parliament.
The study, led by Dr. Stella Tommasi, involved a comprehensive analysis of DNA methylation—a chemical modification of DNA that can turn genes “on” or “off” in cheek cells. According to Prof. Glantz (Professor Emeritus at the University of California San Francisco Centre for Tobacco Control and Education), DNA methylation is vital to the normal functioning of cells but it can lead to cancer and other diseases if it goes awry.
Key findings from the study include:
“Essentially, the research examines how vaping compares to smoking in healthy young individuals by looking at changes in their oral cells,” explains Lorraine Govender, National Manager Health Promotion at CANSA. “Both groups share patterns related to important genes that are involved in regulating cell functions and cancer. The new study found that DNA methylation in vapers, much like in smokers, can contribute to the development of diseases such as cancer. “
A significant finding is that in both vapers and smokers, DMR was found within a gene (HIC1) which suppresses tumours and this has been linked to various cancers including cancers linked with tobacco use. “This suggests that both vapers and smokers face future disease risks related to their DNA changes, which has important implications for public health and highlights the urgent need for stricter regulations on tobacco products and e-cigarettes.”
It is significant that more than half of the DMRs found in vapers were not detected in smokers, Govender says. “You may think you’re using a safer product, but in reality you’re adding a whole new set of harmful toxins, many of which are not even found in tobacco cigarettes. This also increases your risk of serious diseases including cancer. You may only see the results of your actions many years later, but when facing cancer and chemo, you may wish you hadn’t taken that risk,” she warned.
Dr. Catherine Egbe, Senior Specialist Scientist in the Mental Health, Alcohol, Substance Use and Tobacco Research Unit (MASTRU) at SAMRC highlights the increasing use of e-cigarettes in South Africa. Recent SAMRC national university study led by Dr Egbe reveal current prevalence of e-cigarette use among students aged 18 to 24 years to be 26.3% (28.7% among males and 24.1% among females) and of that, 12.5% of students (15.4% among males and 9.8% among females) use e-cigarettes on a daily basis.
The SAMRC study further shows significant exposure to tobacco and e-cigarette marketing among young people, particularly university students – advertising which would be controlled by the new Bill if passed into law. “Aggressive marketing tactics target young impressionable minds, with products like e-cigarettes and hookah being falsely marketed as less harmful alternatives to conventional cigarettes, without information about any health effects that may be associated with the use of these products. Egbe maintained that “for tobacco and nicotine products, exposure to less toxins does not mean exposure to less harm, as clearly shown by the USC study.” The SAMRC study also found that students exposed to advertising are up to four times more likely to use these products, therefore increasing their possibility of developing health issues later in life” Egbe added.
Protect Our Next partner organisations urge policymakers to expedite the passage of the Tobacco Products and Electronic Delivery Systems Control Bill. “This legislation aims to regulate e-cigarettes and reduce their burgeoning uptake among South Africa’s youth, safeguarding future generations from the harmful effects of nicotine and other toxic substances,” says Egbe. “This law is now long overdue.”
South Africa is battling a non-communicable disease (NCD) crisis that must be addressed through better tobacco control policy, say South Africa’s health organisations forming part of tobacco control advocacy partnership Protect our Next. The organisations, including the National Council Against Smoking (NCAS), the Cancer Association of South Africa (CANSA), the South African Medical Research Council (SAMRC), the Heart and Stroke Foundation South Africa (HSFSA), the South African Tobacco Free Youth Forum (SATFYF) and The Africa Centre For Tobacco Industry Monitoring and Policy Research (ATIM) have welcomed news that the National Assembly has resumed proceedings on the Tobacco Products and Electronic Delivery Systems Control Bill as a vital step forward for public health, saying this legislation aimed at reducing tobacco use is central to addressing the NCD burden and will support sustainable implementation of South Africa’s National Health Insurance.
“As a major risk factor for NCDs, tobacco use adds enormously to the economic and human resources costs of the NHI,” says Prof Lekan Ayo-Yusuf, Director of the National Council Against Smoking and Chairperson: School of Health Systems and Public Health, University of Pretoria. “These NCDs are chronic diseases resulting in increased costs to the health system in the long term – not just short-term costs to treat a single illness. These costs are subsidised by the taxpayer while the tobacco industry reaps the profit.”
Ayo-Yusuf says the fact that South Africans have a 50.9% chance of dying prematurely from NCDs, including cardiovascular disease, cancer, diabetes and chronic respiratory diseases (Statistics South Africa) points to an urgent need for better policies that support prevention and will reduce tobacco use. “Evidence from multiple countries shows that a reduction in tobacco use can rapidly decrease NCDs and related health-care costs,” says Ayo-Yusuf. “Strong tobacco control policy will keep the numbers of people needing healthcare for preventable NCDs down. For the NHI to be sustainable, numbers must be at a level where it is possible to provide good quality care to all that need it.”
About 84% of South Africans, equivalent to about 50 million, depend on the public health system. The 2021 Global Adult Tobacco Survey (GATS-SA) shows that over 12.7 (29.4%) million South Africans aged 15 years or older use tobacco. “This is the highest of any country in the region that has carried out a GATS survey, a critical alert for the government to prioritise addressing the tobacco use epidemic as a readily available solution to reducing heart disease, lung disease, cancer and other illnesses linked with tobacco use and exposure to tobacco smoke,” says Dr. Catherine Egbe, Senior Specialist Scientist of the Mental health, Alcohol, Substance use and Tobacco Research Unit at the South African Medical Research Council.
For example, lung cancer a major cause of cancer deaths in South Africa, and treatment is expensive, explains Lorraine Govender of CANSA. With global studies linking cigarette smoking to 80%-90% of lung cancer deaths, reducing smoking would have a major impact.
Cardiovascular disease is responsible for almost 1 in 6 deaths, killing more South Africans than of all the cancers combined. “Smoking is a significant contributor to cardiovascular disease (CVD), accounting for nearly 50% of heart disease cases in South Africa. The detrimental effects of smoking do not only impact the smoker; second-hand smoke also poses serious health risks to those around them, further amplifying the public health crisis,” says Professor Pamela Naidoo of the Heart and Stroke Foundation of South Africa.
Tobacco-related premature deaths through these NCDs and other tobacco-related diseases stifle South Africa’s economic development. Families lose income and suffer crippling healthcare costs. As tobacco smoking is currently estimated to cost South Africa R42 billion per year in treating tobacco-related illnesses and in lost productivity, reducing these costs is essential. Estimates show that the economic cost due to productivity losses arising from absenteeism, presenteeism and early retirement due to ill health in South Africa, largely from non-communicable diseases (NCDs), is expected to increase to 7.0% of GDP by 2030.
The WHO’s global business case for NCDs shows that if low- and low-middle income countries put in place the most cost-effective interventions for NCDs (including for both prevention and management), they will see a return of $7 per person for every $1 invested by 2030.
Ayo-Yusuf says the Tobacco Control Bill can make a vital contribution to curbing healthcare costs and improving standards of living, with benefits only increasing over time. ‘Investing in prevention and control of NCDs is essential for growth and development and, when carefully planned and implemented, is highly cost-effective.
“Measures in the new Bill can prevent harm, death, and disability from NCDs by closing legislative gaps and properly regulating emerging products like e-cigarettes. Enacting the bill will decrease exposure, deter youth initiation, and bring South Africa closer to fully implementing the WHO Framework Convention on Tobacco Control (FCTC). It will be a win for public health, the NHI, and the national economy.”
Tobacco control advocacy group Protect Our Next, representing South Africa’s leading health and community organisations, has welcomed the news announced by Parliament that the National Assembly will resume proceedings on the Control of Tobacco Products and Electronic Delivery Systems Bill as a vital step forward for public health in South Africa.
Protect our Next further welcomed leadership appointments, including Dr Aaron Motsoaledi as the Minister of Health, Dr Joe Phaahla in the Deputy Minister role and Dr. Sibongiseni Dhlomo as Chairperson of the Portfolio Committee on Health, urging the newly elected leaders to champion the speedy passing of the long-awaited Control of Tobacco Products and Electronic Delivery Systems Bill.
“Their extensive experience and unwavering commitment to public health comes at a critical juncture in the fight against tobacco use. We are confident that their leadership will drive forward the substantial strides needed in tobacco control, ensuring stricter regulations,” says Zanele Mthembu, Country Co-ordinator for South Africa, Campaign for Tobacco Free Kids.
One of the responsibilities of the Portfolio Committee on Health under Dr. Dhlomo’s leadership is the passage of the new bill. Currently in the parliamentary process, the bill is a vital updated piece of legislation that will regulate the sale, advertising, and use of tobacco products and electronic delivery systems.
“Before elections, the first phase of public hearings was reaching conclusion, with only KwaZulu-Natal and the Northern Cape to go. It is now up to the new Government of National Unity to continue the process,” says Mthembu.”As advocates for public health, we urge the Portfolio Committee on Health to prioritise this Bill to safeguard the health of the nation.”
Legislation for a healthier society
Dr Sharon Nyatsanza of the National Council Against Smoking (NCAS) says the legislation represents a significant step towards promoting a healthier society. “Strong tobacco control policy is central to reducing South Africa’s heavy burden of non-communicable diseases and will support sustainable implementation of South Africa’s National Health Insurance. Measures in the new Bill close loopholes in the Tobacco Control Act of 1993 (as amended in 2008) and are set to reduce tobacco use, exposure to second-hand tobacco smoke as well as the initiation of tobacco use by young people. It brings South Africa’s domestic legislation closer to full implementation of the WHO Framework Convention on Tobacco Control (FCTC), a global standard.”
SA must address high rates of tobacco use
The 2021 Global Adult Tobacco Survey-South Africa (GATS-SA) reveals high rates of tobacco use in the country, the highest of African countries surveyed. This highlights the urgent need to pass the Bill as soon as possible, says lead investigator of GATS-SA, Dr. Catherine Egbe of the South African Medical Research Council (SAMRC) Mental Health, Alcohol, Substance Use and Tobacco Research Unit.
“GATS-SA indicates that 29,4% of the those aged 15years+, equating to 12,7 million people, use tobacco, exposing themselves to severe health risks such as cancer, cardiovascular diseases, and respiratory disorders. E-cigarette use among youth is also on the rise, raising concerns about nicotine addiction and long-term health implications especially for young people whose brains can be impacted by nicotine.”
E-cigarettes taking hold
According to a national SAMRC university study, one in four university students aged 18 to 24 years (26%) reported current use of e-cigarettes, while almost 40% reported ever use. The study indicates significant exposure to advertising and marketing of these products among young people, with 77.8% exposed to e-cigarette marketing. Students exposed to marketing were three times as likely to use the products.
Youth advocate from the South African Tobacco-Free Youth Forum, Lesego Mateme, says, “It’s clear that the youth are the targets of the aggressive marketing tactics of the tobacco and e-cigarette industries. We fervently advocate for comprehensive bans on tobacco advertising, promotion, and sponsorship across all media, including digital platforms. Tobacco and emerging tobacco products should be viewed as threats to our generation.”
Bill measures to curb tobacco and e-cigarette use
The SAMRC studies recommend implementing smoke-free laws, graphic health warnings, and total bans on tobacco advertising and promotion to reduce smoking initiation, as captured in the new bill.
The Bill will prohibit smoking and the use of e-cigarettes in enclosed public areas, such as restaurants, and in certain outdoor public places. It prohibits smoking and the use of electronic cigarettes in private dwellings used for commercial child care or education, and in cars carrying children under 18.
The Bill, when passed, will further introduce standardised packaging with pictorial health warnings on cigarette packages. Advertising of tobacco products, heated tobacco and electronic cigarettes at points of sale (tills) and the sale of these products through vending machines will also be banned.
Dr Egbe says that these measures are an effective strategy to reduce tobacco and e-cigarette use and should be urgently implemented, along with tax increases. “Our government has all the research available to support every evidence-based measure in the Bill, and should not be swayed by misinformation,” she says.
Protect Our Next organisations, including the National Council Against Smoking (NCAS), the Cancer Association of South Africa (CANSA), the South African Medical Research Council (SAMRC), the Heart and Stroke Foundation South Africa (HSFSA), the South African Tobacco Free Youth Forum (SATFYF) and The Africa Centre For Tobacco Industry Monitoring and Policy Research (ATIM), remain committed to seeing these measures that will advance public health implemented in South Africa.
“A sick nation is a poor nation,” says Mthembu. “Our communities want freedom from tobacco and the damage it causes to our health, our environment and our economy. We fully support Dr. Dhlomo and the Portfolio Committee on Health as they work to achieve this.”