Johannesburg – The African Tobacco Control Alliance (ATCA) has called for urgent regulation of e-cigarettes through the swift implementation of the Control of Tobacco Products and Electronic Delivery Systems Bill.
The non-profit, non-government, professional organisations are joined by South Africa’s public health organisations in calling for the implementation of the tobacco control bill, which requires that any enclosed public area is 100% smoke-free.
The bill will make certain outdoor public places smoke-free too, in a bid to provide protection for those who are involuntarily exposed to second-hand smoke.
ATCA executive secretary Leonce Sessou said global evidence revealed that e-cigarettes may create a new generation of young nicotine addicts and undermine progress in reducing tobacco use and nicotine addiction.
“South Africa’s response to this new public health threat will serve as an example of how other African countries could regulate e-cigarettes,” he said.
“Protecting Africa’s youth from nicotine addiction and possible subsequent lifelong tobacco use will promote the health, society and economy of Africa.”
ATCA joins the Protect our Next partner organisations, including the National Council Against Smoking (NCAS), CANSA, the SA Medical Research Council (SAMRC), the SA Tobacco Free Youth Forum (SATFYF) and the Heart and Stroke Foundation SA (HSFSA) in calling for urgency in the processing of the bill.
Dr Sharon Nyatsanza of NCAS said formerly a leading country in tobacco control, South Africa’s current law has become outdated in many areas, including the lack of regulation for novel products.
She said nearly four years have passed since the bill closed for public comments in August 2018, during which time the e-cigarette industry, currently largely unregulated, has further taken hold in South Africa.
“We are deeply disturbed that South Africa still has no restrictions in place to vet e-cigarettes sold in the country,” Nyatsanza said.
“There are no robust pre-market evaluations, no marketing, labelling or packaging requirements and South Africa is well behind in protecting the public.”
Nyatsanza added that as the World Health Organisation recommends, NCAS call for e-cigarettes be regulated, in order to prevent initiation by non-smokers, particularly the youth, to minimise the health risks to users and non-users, whilst allowing informed adult access.
Nyatsanza said the bill made it unlawful to use e-cigarettes where smoking tobacco products is prohibited.
This includes in schools, public transport and indoor public places.
“E-cigarette aerosol is not harmless vapour, it contains nicotine and toxic metals, which is also harmful to the health of non-users.”
“Everyone has the right to breathe clean air.
"If the use of e-cigarettes is allowed anywhere with no limitations, people are being denied their basic rights.”
When it comes to cessation, Nyatsanza added that unregulated e-cigarettes undermine the use of medically proven cessation aids.
“Studies conducted by Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM) show evidence of limited efficacy for long-term cessation.”
Unproven claims of cessation efficacy of e-cigarettes are harmful to public health. If children and non-smoking youth increasingly use e-cigarettes, any individual level cessation benefit from e-cigarettes, which is in any case contested by local studies, is eroded.
She said that South Africa recognises the importance of helping smokers to quit smoking, but requires all stopping smoking medications and aids to be registered.
“The e-cigarette industry has evaded these safeguards, by registering e-cigarettes as consumer products, yet making public claims that e-cigarettes help people to stop smoking.
“Clearly, the industry does not want to abide by public health safeguards and regulations, as it does not want to subject its products to the safety and approval systems for products designed to help people to quit smoking.
“With every delay in passing the bill, more children and young people are becoming addicted to new nicotine products, while the burden on the health system, environment and economy caused by tobacco and nicotine products continues to grow,” Nyatsanza said.
Meanwhile, Dr Catherine Egbe of SAMRC also highlighted the need for regulation to reduce health impacts.
“E-cigarette use has increasingly been recognised as a global public health problem, due to the health harms associated with its use.
“These include respiratory health problems, like the exacerbation of asthma, bronchitis, tuberculosis, HIV/Aids and chronic risks to cardiovascular and oral health, as well as the negative impact of nicotine exposure and addiction on adolescent brain development.”
Egbe added that the e-liquid in most e-cigarettes contains nicotine, the same addictive substance that is in regular cigarettes, cigars, hookah, and other tobacco products.
“‘However, nicotine levels are not the same in all types of e-cigarettes, and sometimes product labels do not list the true nicotine content.
“There is no one standard to determine how harmful e-cigarettes are.”
Egbe said that health harm varies based on a number of factors. This ranges from the level of nicotine, device type, ingredients used, battery type, how old the device is and importantly variations made by specific users and use patterns.
“Some users inhale more deeply, some use higher voltage, some use the devices more frequently. These factors can further exacerbate the health risks associated with the use of e-cigarettes.”
She also believes the Tobacco Control Bill is well-balanced.
“While the new Bill does not ban e-cigarette use by adults, it seeks to minimise e-cigarette use and the associated health impact, particularly e-cigarette use by children and non-smoking youth.
“It does this through regulating advertising, packaging and the different flavours that have been shown to encourage youth initiation, as well as limiting areas in which these products can be sold and used.”
She said that the proposed bill requires accurate health warnings and mandates proper labelling of the products; users must know the constituents of the products, their quantity and related risks.
Lorraine Govender of CANSA added that research revealed that attractive flavours and colours, alluring packaging, easy accessibility and advertising directly targeting the youth, including influencer advertising on social media, continues to encourage initiation.
“Failure to properly regulate e-cigarette marketing is a failure to protect children and young people from addiction and health harms caused by these products.”
And Public Health Policy and Development Consultant, Zanele Mthembu believes that every provision in the proposed Bill is well designed to prevent child and youth initiation.
“Research indicates that most smokers start at a young age, and that vapers are likely to progress to combustible cigarette smoking.
“Preventing early initiation will drastically reduce tobacco and nicotine use.”
Sanele Zulu of SATFYF said that while the e-cigarette industry believes youngsters and non-smokers are not being targeted to use e-cigarettes, the industry keeps opposing the proposed bill.
“Studies conducted by ATIM found that of the at least 240 vape shops in South Africa, 39% are within a 10km radius of a university or college campus, and 65.3% are within a 20km radius of a university or college campus,” Zulu said.