SA GOVERNMENT IS MISSING AN OPPORTUNITY

In its understandable desire to stamp out smoking, government is rushing headlong to lump vaping and smoking in the same bill. Two years after the publication of the Control of Tobacco Products and Nicotine Delivery Systems Bill, government has indicated that it is almost ready to proceed with tabling the Bill for Cabinet consideration quoted in Business Day of 20 October 2020, the Department of Health intends to table the Bill before the end of 2020 for approval.

It seems however, that government has not used the intervening period since the publication of the Bill to acquaint itself with the entirety of the fast-evolving body of knowledge about the harm profile of vaping products. Instead, it appears government has used the time simply to confirm its heavy bias against Electronic Vapour Products (EVPs). This is evident from the insistence that smoking, and vaping should be regulated in the same way, despite the vast differences in the harm profile of the two products. 

Like most governments across the world, the South African government is displaying its penchant for reliance on old knowledge in a fast-evolving field. Quite surprisingly, it reveals the level to which dogma and ideology play an inflated role in driving policy making. A reasonable and evidence-based policy framework surely demands that government should act with enthusiasm in embracing technological interventions that can support the fight against smoking. Yet, surprisingly, government and the anti-tobacco lobby seems to exist in an echo chamber where anything short of an idealised smoke-free world is heresy. This is disappointing given the harm associated with tobacco use.

It is troubling that government has given into an ideological posture on vaping. The result of this is that unfortunately far fewer smokers will move to vaping due to lack of information and unreasonable restrictions on information dissemination which could assist smokers make up their minds about the dangers of smoking. In an unfortunately biased world in which vaping and smoking are seen as interchangeable, many more smokers will see no incentive in migrating their nicotine fix from a product known to be harmful to one which meets their need for nicotine with 95% less harm.

Vaping advocates across the world and medical researchers in the field of smoking accept that there is potential harm associated with vaping. For this reason, it makes absolutely no sense for non-smokers to take up the habit. However, for existing adult smokers, it offers a less harmful alternative, which millions around the world have used to wean themselves off their addiction on combustible tobacco. 

The obsession with getting smokers to quit cold turkey is a pipe dream for many smokers. So called support programmes offered by anti-tobacco lobbyists and health authorities have failed to yield the massive gains that many had hoped for when tobacco control legislation first came into effect. Though many people have quit the habit, it is a sad fact that many have taken up the habit in the same period. In South Africa, lockdown restrictions on the sale of tobacco products has worsened the problem of illicit trade which, due to their cheap pricing, potentially makes tobacco accessible to minors. It will take many years and copious resources to reverse this problem. 

Countries such as the UK and Sweden have long since realised that a differentiated approach in regulating non-tobacco sources of nicotine could be a tool to exit many smokers out of combustible tobacco within a short space of time. For this reason, Sweden has one of the lowest rates of smoking in the world because the country embraced oral nicotine pouches. The UK has seen millions of its smokers quit smoking in favour of vaping. These are real achievements to be celebrated in the fight against smoking. 

Arguments about a fictional gateway into smoking have since been debunked by public health authorities in Europe, the UK and to some extent, the US. Evidence consistently points out that though young people may experiment with vaping, the majority never progress to tobacco use. In fact, many studies such as that produced by Action on Smoking and Health (ASH) UK have shown that young people who would have otherwise taken up smoking may have been spared the health consequences through the availability of less harmful alternatives such as vaping. South Africa will have to ensure that its regulation is carefully crafted to discourage young people from taking up vaping. This can be easily achieved through appropriate messaging and education but more effectively by working together with the industry.

A point which seems to escape the Department of Health is that stringent regulation of vaping will only confirm the place of smoking as the leading source of nicotine for millions of smokers. The incessant misrepresentation of scientific evidence about vaping is playing in the mind of many smokers who are reluctant to take up vaping because, they have been led to believe, it is either the same as, or even worse than, smoking. This is a perverse, but predictable outcome of the ideological approach that health authorities in South Africa are taking, rather than a considered conversation which evaluates vaping on a harm spectrum with appropriate messaging about its potential dangers. 

The Department of Health would do well to go beyond the realm of its fellow travellers to incorporate other views as it seeks to design appropriate regulation for vaping. It is of no benefit to millions of South African smokers for the Department to take a myopic approach to an issue so fundamental for the health of the nation. Above all, government should take a measured, scientific, and accurately assessed approach to regulating the industry.