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
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​Friday, 8th November, 2024: 10:00 – 15:00 ​
​City of Umhlathuze, Nseleni Community Hall, Richards Bay ​
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​Saturday, 9th November 2024: 10:00 – 15:00 ​
​Msunduzi Local Municipality Ward 15, Community Hall at Embhali, Pietermaritzburg
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​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.”

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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. ​ ​
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​(ENDS)