Following a heated election in May, South Africa assembled a new government this month that will lead the way on key policies for the country going forward. Health insurance and care have been a major point of discussion in this election cycle, indicating that consumers and patients put great value on public health policy as South Africa seeks to grow and prosper.
With close to a third of South Africans regularly using tobacco, the country faces a public health challenge that it should not combat with the policies of the past. A common knee-jerk reaction to tobacco use in South Africa and beyond has been a crackdown on the products themself, be that through taxation or even blanket bans (during the COVID-19 pandemic, the South African government banned the sale of tobacco). While there are consumers who are deterred by such invasive measures, they mostly risk backfiring due to the prevalence of illicit trade. Over half of cigarettes sold in South Africa in 2022 were off the black market, making it one of the biggest illicit cigarette markets in the world. This relativises all successes that officials outline in terms of tobacco control: while legal sales might regress after policy changes, they are quickly undone by black market sales, where cigarettes are not just cheaper but where they follow no age-gating and no quality control.
The new government in Pretoria will see the usual suspects argue for greater tobacco control in its mandate. Tobacco control advocates such as Patricia Lambert, Director of the International Legal Consortium at The Campaign for Tobacco-Free Kids and former legal advisor to the South African government, will present the government with their usual policy prescriptions: increase taxes, implement display bans, or banish smoking outright from more public places. One would think that the attempt to solve a problem with measures that haven’t worked in the past would not pass as good policy advice, but that hasn’t stopped Lambert from doing so in Ghana. What is fascinating is that in the piece for Modern Ghana, Lambert writes that a total ban on cigarettes would backfire, as did the prohibition of alcohol in the 1920s, but then continues by writing, “What needs to be done is to make the product very expensive”.
When the government makes cigarettes “very expensive”, what it does is create a quasi-prohibition, in which some consumers who are fortunate enough to have high-purchasing power are not effective, while those on lower incomes will do the exact thing she outlined in the argument she made about alcohol prohibition. In fact, during the prohibition, it wasn’t rich New York socialites who were affected the most since they were able to circumvent the law with money, but it was those on low incomes attempting to get a bottle of whiskey who fell victim to merciless law enforcement or the amateurish distilling techniques of bootleggers.
Olalekan Ayo-Yusuf is another candidate in advising the government misleadingly on tobacco control. As the Head of the School of Health Systems and Public Health at the University of Pretoria, he has argued for higher taxation and total bans on tobacco farming, effectively cutting off countless farmers from a secure source of revenue. He also prominently advocates for Nicotine Replacement Therapy (NRT) as a means to reduce smoking rates, ignoring that while NRT can help smokers quit their habit, it is only successful in a small minority of cases. The argument for NRT also undermines Ayo-Yusuf’s argument against vaping, which he opposes. NRT products, such as lozenges or chewing gums still contain nicotine, meaning the “R” in NRT doesn’t stand for replacing nicotine for something else, but replacing the nicotine delivery system from smoking tobacco to a less harmful alternative.
This is where tobacco harm reduction should come into play. Instead of listening to advocates who have been rehashing their arguments for decades and who are in the pocket of a New York billionaire, Michael Bloomberg, who is ideologically opposed to e-cigarettes, the new government should embrace vaping as a means to reduce the smoking rate. According to Public Health England, vaping is 95% less harmful than inhaling combustible tobacco and has been shown to be an effective method of smoking cessation.
Public health policy should be about doing the right thing for patients and consumers. The available scientific evidence clearly points towards vaping being a silver bullet for tobacco harm reduction. If the new government in Pretoria can rid itself of the voices of the past, it can lead the way in Africa for a reasoned approach to reducing the harm done by cigarettes.
