Instead of weaning existing smokers off tobacco, cigarette alternatives - like vaping - are wooing young South African consumers.

This was one of the findings of the Global Adult Tobacco Survey in South Africa (GATS-SA), which was presented at at a seminar hosted by the South African Medical Research Council (SAMRC) held on Thursday, 12 August 2020, on the draft legislation.

The survey comes as the government and the South African public at large consider the Control of Tobacco and Electronic Delivery Systems Bill. The Bill seeks to impose regulations on alternatives to combustible cigarettes such as vaping products and heating systems, including a ban on marketing, vending machines and public use indoors or outdoors.

Anti-tobacco organisations have vowed to support the Bill and any other measures that the government can introduce to make it as hard as possible for people to access tobacco alternatives.

The Bill was introduced in 2013 but is listed as a 2018 Bill because it was renamed and updated with restrictions on tobacco product alternatives. It will be making its way to Parliament later this year, according to Department of Health officials.

GATS-SA conducted its research by surveying 6 311 people, aged 15 and older, throughout the country with a response rate of 92%.

A business of pied pipers?

GATS-SA specialist scientist Dr Catherine Egbe said there was a 23.9% prevalence of manufactured cigarette consumption around the country. Among emerging products, hookah had a 3.1% prevalence while e-cigarettes had a 2.2% prevalence, which was highest among young consumers, she said.

"We hear the industry say that their products help wean smokers off of cigarettes. But it appears that they are merely switching addictions. If you have the highest prevalence of cigarette consumption among people between the ages of 45 and 64, you should see the rise among that age group in these alternatives. What you see is, these new products are targeting the youth," Egbe said.

Egbe added that 74.4% of respondents said they were exposed to some or other form of smoke in places of public gathering, such as pubs, bars, and restaurants. She said 88.4% of respondents believed that South Africa needed an all-out ban of smoking in places of work, especially indoors.

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Too lit to quit

Egbe said while 80% of cigarette smokers noticed the warning labels on cigarette cartons, only 35% of smokers in the survey considered quitting because of the labels. She said e-cigarettes were brightly coloured and prominently displayed in shopping malls.

"We have the electronic cigarette industry exploiting a policy vacuum to market and display products in this way. E-cigarette use is highest among those between the ages of 16 and 24. We asked about the duration of use and 21% reported that they have been using e-cigarettes for more than two years. Around 10% have used it over a year," she said.

She added that the report recommended smoking cessation using evidence-based approaches as the sector "contaminated" the discourse around their products. Young people, she said, needed to be "protected" from being "recruited" by producers of the new products.

Egbe said the Bill did not seek to kill the tobacco trade but sought to prevent the exploitation of the consumers, especially the young and those who never consumed cigarettes before encountering alternatives.

'Long overdue'

SAMRC alcohol, tobacco, and drug unit director Professor Charles Parry said the council would work to ensure that the government took the survey's findings on board as it continued to regulate the sector and its products.

"This research is long overdue and sets an important baseline against which the government policy and the Bill need to be measured. We hope to repeat the survey at regular intervals and do more research on youth consumption," Parry said.

'More regulation, not less'

Lorato Mahura from the Department of Health's health promotion unit said the Bill would make its way to the legislature soon.

Deputy director of the National Council Against Smoking Sharon Nyatsanza said the organisation wanted to see the tobacco industry taxed as high as 70%, in line with the World Health Organisation standard.

Zanele Mthembu from the Tobacco Free Kids SA said the regulation of vending machines and indoor smoking bans could be introduced even before the Bill is enacted. She reminded attendants that the Bill would repeal all previous legislation on tobacco products and it, therefore, needed to be comprehensive.

Megan Borole from Development Gateway said the survey also referred to the language that the sector used to name products, as the survey found no evidence that consumers were using these alternative products to help them quit.

While the tobacco alternatives sub-sector maintains that their alternative products are up to 95% less harmful than combustible cigarettes, even the industry acknowledges that these products have not proven to be completely harmless. They also acknowledge that these alternative products contain nicotine and, as such, remain highly addictive.

Another criticism of the tobacco alternatives was that they geared their products towards drawing younger customers and people who never smoked cigarettes before. The sub-sector is adamant that it only seeks to sell its alternatives to people who already smoke but cannot or do not wish to quit smoking.

Businesses in the tobacco alternatives sub-sector warned that taxes and regulations on their products would drive costs up for a product that is often more expensive to produce than combustible cigarettes, which could put jobs on the line if considered without due consultation.

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