Local public health researchers want the government to revive legislation intended to regulate e-cigarettes, saying they are being heavily marketed to young people as a means to stop smoking, but don’t help people kick the habit for good.
They want the government to pass the Control of Tobacco and Electronic Delivery Systems Bill into law urgently.
“This bill would put South Africa back on track as one of the leading countries on tobacco control in the continent,” Professor Lekan Ayo-Yusuf, director of the Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM) at the Sefako Makgatho Health Sciences University (SMU) said this week.
“It will also save lives and cut down on health expenditure if implemented. At a time when the nation is moving to the NHI, this bill will complement it by protecting more people from contracting tobacco related diseases, thus reducing their reliance on the NHI in the long run.”
Two years have passed since the bill was closed for public comments during which time, Ayo-Yusuf believes the e-cigarette industry has further taken hold in South Africa.
“I’m not sure we can say for sure why the delay has been prolonged, but it is partly expected, considering that the e-cigarette manufacturers and the tobacco industry have been lobbying government not to pass the bill.”
The call to urgently regulate e-cigarettes follows a series of recent studies conducted by Atim, the University of Pretoria and the South African Medical Research Council (SAMRC).
The studies assessed local e-cigarette use, evaluated the effectiveness of e-cigarettes as cessation aids, and analysed the costs.
Geospatial mapping was used to understand the distribution of vape shops across South Africa and how this may impact youth usage.
One of the studies 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.
Ayo-Yusuf believes the location of vape shops near colleges and universities is strategic to recruit the youth and get them hooked on nicotine.
A key finding from one of the studies was the substantial prevalence of e-cigarette use by South Africans older than 16 years. Overall, 2.71% of adults, or 1.09 million people, used e-cigarettes daily or occasionally during 2018.
The majority of current e-cigarette users (97.5%) were concurrently regularly smoking cigarettes.
Dr Israel Agaku of the University of Pretoria said its study had found “that living near a vape shop was associated with using an e-cigarette in the past or currently”.
“These important findings justify the regulation of lifestyle advertising targeted at the youth and the limitation of access to these products by children.”
One of the studies also found that e-cigarette smoking was not effective for long term quitting of cigarettes.
“From our study, we found that on a short-term basis (which we categorised as less than one month), e-cigarettes were found to be effective,” said Ayo-Yusuf. “However, for more than one month up to 12 months, they were not found to be effective.
“So, if someone is looking for a tool to stop smoking, you wouldn’t go for what would only help you for a month, and then you relapse. For smokers who want to quit, there are other evidence-based and effective means to assist them.”
A cost study also revealed that using e-cigarettes turned out to be more costly than smoking cigarettes when comparing daily users of both products over a one-year period.
The annual cost associated with daily use was R6 693 for manufactured cigarettes and up to R19 780.83 for e-cigarettes.
Findings from this study show that implementing excise taxes on e-cigarettes at 75% of the cigarette excise tax rate could generate annual revenue of up to R2.20 billion. “Untaxed for more than a decade in South Africa, e-cigarettes will only be taxed from this year, at a rate of 75% of the tax on tobacco,” said Dr Catherine Egbe of SAMRC.
“This will likely reduce initiation by youth and provide additional revenue to cover the health and economic harms they cause while contributing to funding the National Health Insurance,” she added.
Ayo-Yusuf added that there were many major health risks associated with vaping.
“It took decades to establish the health risks of cigarettes. So e-cigarettes have been used for too short a period to sufficiently determine the full health risk, especially those associated with long-term use compared with conventional cigarette smoking.
“However, although the amount of toxins in e-cigarettes is significantly lower than that of conventional cigarettes, these lower amounts do not make them safe, as the tobacco and e-cigarette industry would like the public to believe.”
He said well-researched studies on short-term health effects indicate that e-cigarette smoking causes some harm to the body through reduced immune response, damage to the cells lining the blood vessels, and also injury to the lung tissues (may cause the so-called ‘pop-corn-lung’).
“The study of the health risks of e-cigarettes is complicated by the fact that there are different types out there, and because they are not regulated, there is no full knowledge of the exact contents of the different e-liquids. Hence, the need for regulation.”
The Vapour Products Association of South Africa (Vpasa) say they would welcome the passing of the Control of Tobacco and Electronic Delivery Systems Bill, but they want to see the addition or separation of regulations governing harm-reduced products, specifically electronic vapour products (EVPs).
“Despite the findings of the study cited, organisations such as Public Health England (PHE) have also published scientific evidence showing that EVPs are 95% less harmful than combustible cigarettes,” Vpasa CEO Asanda Gcoyi said.
“In light of this and other research across the globe that have all reached the same conclusion, South Africa needs to get on board to the fact that there is still much work to be done to effectively educate consumers about less harmful alternatives to cigarettes that will be better for their overall health.”
Gcoyi said they wouldn’t comment on the recent study on e-cigarettes because they needed to study the findings and the affiliationo f the authors.
Asked what Vpasa had made of claims that e-cigarettes are more expensive than smoking cigarettes, Gcoyi said: “In the current climate, where illegal cigarettes are readily available, this is highly probable.
“However, studies such as Canback Consulting’s “Analysing the market of vaping and its economic impact in South Africa” show that, in the long term, EVPs are more cost-effective, especially when used as a harm reduction tool.
“Additionally, according to “Smoking and quitting behaviour during lockdown South Africa” by the University of Cape Town (UCT) and the Research Unit on the Economics of Excisable Products (REEP), cigarette prices have been fuelled by the illicit trade to the point that, while not as exorbitant as during the ban on tobacco and related products imposed by the government during Levels 5 and 4 of the lockdown, still far outstrip the costs of EVPs.”
Vpasa also believes that EVPs are less harmful to the health of current vapers and smokers seeking products that are less harmful than combustible cigarettes.
“It is not our position that EVPs are smoking cessation tools.”
Gcoyi added that Vpasa would also soon launch a campaign that focused on youth access prevention to EVPs as part of their broader campaign, We Are Not Tobacco (WANT).
“It is Vpasa’s belief that discouraging youth from using EVPs is a critical issue,” said Gcoyi.