South Africa’s Tobacco Products and Electronic Delivery Systems Control Bill, currently in parliament, seeks to regulate e-cigarettes for the first time.  With profits to lose, the new bill has been strongly opposed by the tobacco and e-cigarette industries, which are galvanising their efforts to oppose the bill as it makes its way through Parliament. Misinformation from the e-cigarette industry leads to public confusion about the risks and perceived benefits of using e-cigarettes.

Public health experts and school educators are particularly concerned about the rising use of e-cigarettes among young people, as well as marketing and flavours clearly designed for the youth.  The Global Adult Tobacco Survey South Africa ( GATS SA) found that e-cigarette use was highest among people aged between 15 and 24 years, at 3.1%, compared with the overall prevalence of 2.2%. When a young person is exposed to nicotine, they become addicted even more quickly than adults and experience worse health impacts, including for their developing brains.

The drive to regulate e-cigarettes is strongly supported by many health organisations, researchers, scientists and members of society who are concerned about the risks of using these products and believe that tobacco companies are promoting e-cigarettes as a means to secure new nicotine-addicted markets.

However, the pro-vaping contingent in South Africa stands behind the widely debunked claims that e-cigarettes are 95% safer than cigarettes, maintaining that they are mainly a tool designed to help adult smokers to quit. They also drive perceptions that the new Bill will prevent access to e-cigarettes for adults who would like to use them to help quit tobacco, again untrue. Economic arguments centre around new regulation and taxation wiping out a fledgling industry, albeit an industry based on a highly addictive drug.

What separates fact from fiction in this debate? Here are some of the myths perpetrated, and the evidence-based truth that counters them. 

1. MYTH: E-cigarettes are 95% safer than smoking tobacco

The frequently cited claim by Public Health England (PHE) that vaping is 95% safer than smoking tobacco has been criticised as misleading and flawed (see this  2015 editorial in The Lancet). The study was based on a method that used no empirical data, only informant opinion. This is not a scientifically accepted method used for informing public health policy when other data are available. The researchers were further compromised by a conflict of interest due to their ties with the industry. 

There is no scientifically accepted evidence that e-cigarettes are 95% safer.  In fact, there is now considerable evidence that e-cigarettes have introduced new toxic hazards and risks into the act of nicotine-dosing, and have accentuated the problems associated with nicotine as a toxic agent.

2. MYTH: E-cigarettes are not harmful to health

Emerging studies show many of the same acute biological effects in the airways that have been documented in smokers, as well as concerning completely new changes.  E-cigarettes create entirely new health risks, which are not present with traditional cigarettes.

For example, fine and ultrafine particles released in the vapour can more easily be deposited into the deeper parts of the respiratory system than the smoke from cigarettes. This leads to an increased risk of a user developing a cardiovascular disease or non-cancer lung disease. A University of San Francisco study in 2018 reported that daily use of e-cigarettes almost doubled the likelihood of a heart attack.

A study from the University of North Carolina School of Medicine published in the American Journal of Respiratory and Critical Care Medicine found an unusually high volume of bronchial epithelial cells in the sputum of fourth-generation e-cigarette users, which are often markers of airway injury. Findings in this study suggest immune systems in these users are abnormally suppressed, pointing to possible new impacts on the immune system from these specific devices that require further research.

Research from the Keck School of Medicine in the United States has found that DNA damage levels to oral epithelial cells are similar in vapers and smokers.  This is associated with an increased risk for many types of chronic disease, including cancer and inflammatory diseases.  The devices and flavours that are most popular among youth vapers are the ones that are associated with the most DNA damage. Vapers who used pods had the highest levels of DNA damage, followed by those who used mods. In terms of flavours, sweet-flavoured vapes were linked to the highest levels of DNA damage, followed by mint/menthol- and fruit-flavoured vapes.

Increasing cases of nicotine poisoning have been reported among children who consume e-liquids left unattended. Reports show that as little as a quarter of a teaspoon of e-liquid can poison a child.

3. MYTH: E-cigarettes are the best way to quit smoking

Reviews of population-level evidence on the effectiveness of e-cigarettes as smoking cessation aids conclude that e-cigarettes do not help smokers quit, but instead are more likely to encourage them to continue to use both cigarettes and e-cigarettes if they are already smokers, or encourage young people to start using e-cigarettes if they are not smoking. A New England Journal of Medicine study found that 80% of users of e-cigarettes, who were using them to stop smoking, were still using e-cigarettes a year later, compared to only 9% of former smokers using conventional nicotine-replacement therapy to stop smoking.

Scientific evidence shows that other cessation methods are equally or indeed far more effective in helping smokers to quit and do not act as a gateway to introduce young people to smoking.

4. MYTH: The new Tobacco Control Bill will make e-cigarettes inaccessible to adult vapers

The Bill does not ban e-cigarettes and does not stop adults from accessing e-cigarettes.

The measures are designed to reduce and prevent use by young people and never-smokers. When children start using them, they are more likely to become nicotine addicts and transition to tobacco use, so without regulations we are just perpetuating the addiction cycle and creating a new generation of nicotine addicts.

5. MYTH: E-cigarettes are not a gateway to smoking

Studies have also shown that young people are increasingly progressing to smoking cigarettes after trying out electronic cigarettes. Global evidence suggests e-cigarettes are a gateway to the use of other tobacco products, especially among adolescents.  There is an epidemic of e-cigarette use among children in schools. Far from helping smokers to stop smoking, e-cigarettes appear to be very effective in recruiting new users to replace adults leaving the smoking population.

6. MYTH: Nicotine itself is not dangerous

Besides being highly addictive, when it comes to vaping, heating the e-cigarette liquid to 200oC has implications for carcinogenesis: e-cigarette liquid contains formaldehyde, which has been classified as a probable human carcinogen by the International Agency for Research on Cancer (IARC).

FACT: URGENT REGULATION IS NEEDED

Cigarettes were allowed to kill millions of people before they came under the radar of governments and the WHO.  However, thanks to modern research capabilities, the short-term health impact of e-cigarettes is already clear. While the long-term impact of e-cigarettes may only be known a decade from now, there is already enough evidence of harm for 107 countries globally to have chosen the path of regulating, or in some cases completely banning, e-cigarettes.

As the organisations of Protect Our Next, we believe it is imperative that e-cigarettes be regulated in South Africa as soon as possible. We welcome the inclusion of e-cigarettes, and the comprehensive proposals for their regulation, in the Tobacco Products and Electronic Delivery Systems Control Bill. We are hopeful that it will become law within the year 2023.

Protect our Next is reaching out to valued supporters as we reach a critical phase in the journey of the Control of Tobacco Products and Electronic Delivery Systems Bill to law.

This Bill is a vital step towards a tobacco-free South Africa – safeguarding the health of all South Africans by regulating the use, packaging and marketing of tobacco and electronic delivery systems such as e-cigarettes. 

PUBLIC SUBMISSIONS:

The deadline for public submissions to Parliament regarding the Bill is on 4 SEPTEMBER 2023.
Let’s make our collective voice heard to protect the health of our families, communities and country. 

Together, we can make a significant difference.

It’s time to say “YES” to the Tobacco Products and Electronic Delivery Systems Control Bill.

Add your voice here by 4 Sept: http://bit.ly/TCBill
E-mail: tobaccobill@parliament.gov.za 

(ENDS)

AUTHORS:

Authored by the organisations forming part of Protect our Next, represented by:

Dr Catherine Egbe, Specialist Scientist in the Mental Health, Alcohol, Substance use and Tobacco Research Unit (MASTRU) at the South African Medical Research Council (SAMRC)

Prof. Lekan Ayo-Yusuf, Director of the National Council Against Smoking (NCAS) and the Head of the School of Health Systems and Public Health at the University of Pretoria, Director of ATIM

Sharon Nyatsanza (PhD), Deputy Director, National Council Against Smoking (NCAS)

Sanele Zulu, Convenor: South African Tobacco Free Youth Forum

Lorraine Govender, National Manager, Health Promotion, CANSA

Zanele Mthembu, Public Health Policy and Development Consultant, Convenor: Protect our Next