Original opinion piece: Business Times
Date: 18 August 2024
As a former smoker, I often get asked how I managed to kick the habit after 20 years and 40 cigarettes a day. It wasn’t easy. I had been desperate to quit, with many failed attempts.
My father’s passing from a smoking-induced heart attack in his early 50s came as a serious shock and was the biggest catalyst in my journey to become smoke-free. What helped me finally reach my goal was an innovation I stumbled across over 10 years ago – vaping.
I had attempted electronic cigarettes on two occasions in my long and frustrating journey, which were unsuccessful. Both were early-generation products prone to leaking, had poor battery life and were too weak to replace the “fix” I received from a combustible cigarette. It was the third, a very different product with a removal battery and the ability to change the strength and flavour of the e-liquids that got me off cigarettes within 3 days. Unbeknownst at the time, this experience provided my first lesson in becoming a tobacco harm reduction activist – one does not fit all, variety and choice matter!
It needs to be understood that my introduction and switching to vaping occurred outside any knowledge of scientific research on the topic. The release of scientific reviews from the UK and the USA between 2015[i]and 2018[ii] provided my second and biggest lesson on vaping. This was when I grasped the concept of tobacco harm reduction.
Although complete abstinence should be the goal, we need to acknowledge that for the 67%[iii]of South Africans who smoke and have expressed a desire to quit, it would be a bridge too far to cross for many. According to research[iv], for every person who managed to quit smoking without assistance, 24 will fail. The percentages of success increase slightly when support and pharmaceutical aids are introduced into the quit attempt but leave most on the same life-threatening trajectory. Unfortunately, smoking cessation support is all but absent in the government health system, leaving most to a wholly unsuccessful “cold turkey” approach.
There are 11.1 million South Africansiii over 15 who smoke regularly. It’s a fallacy to think we can wake up one morning and find that all of them have decided to quit in unison and will succeed. Perhaps that is what policymakers in government believe when they formulate draconian anti-tobacco laws and ever-increasing excise duties. The reality is they don’t and only serve to coerce the majority as participants into the growing and potentially more harmful illicit market. These are the unintended yet predictable consequences of irrational lawmaking free from recent historical lessons – the 2020 sales ban[v].
If we really want more people to quit smoking, we must have serious discussions about people-centric cessation strategies and tobacco harm reduction – a reference to policies, programmes and practices aimed at minimising the adverse health, social and legal effects of risky behaviours.
Publicly available statistics show there has been a significant increase in the smoking rate across all age groups in the country over the last decade. As the rate of smoking increases, so does trade in illicit cigarettes, which not only poses a greater challenge to public health but circumnavigates current and future tobacco regulations.
Figures released in 2022iii show that 2.2% of South Africans used vapingproducts. While it’s been proven that vaping is a less harmful alternative to combustible tobacco that could help reduce smoking – there is a misconception out there that the activity is equally or more harmful than smoking, as a consequence of constant misinformed messages spread in the media. Nothing could be further from the truth. Currently vaping is not only the most popular way to quit smoking but has been proven through population studies and randomised control trials to be the most successful method in achieving smoking cessation.
However, the Tobacco Products and Electronic Nicotine Delivery System Control Bill, currently before Parliament, is a poorly conceived piece of proposed legislation that doesn’t recognise the significant difference in risk profiles[vi] between combustible tobacco and vaping products. It treats both products as equivalent, meeting the same restrictions and reinforcing the now dangerous misconception[vii] around vaping. This is not to say that vaping is risk-free or should be free of regulation, but instead, be based on scientific evidence and recognise its potential to save millions of lives whilst limiting youth access.
The bill will prohibit, restrict, ostracise and entrench further stigma on smokers and those who have chosen a safer alternative. It does not provide solutions, and if passed in its present format, will have a major impact on human lives and human rights. The reality is that a lot more smokers can be encouraged to take up vaping if they are exposed to the truth about the inherent benefits and relative risks of this alternative.
But restrictive anti-tobacco laws, high excises taxes on vaping products and non-existent cessation support[viii] are making it difficult for smokers to make the better choice.
In 2022[ix], the UK Office for Health Improvement and Disparities reiterated its assessment contained in a report it released in 2015, that vaping posed only a small fraction of the risk of smoking and the statement “95% less harmful” was broadly accurate. According to their findings, smoking is at least 20 times more harmful to users than vaping. These findings, coupled with the results from the Cochrane Systematic Review[x] proving the effectiveness of vaping in helping smokers quit, prompted the UK Government to introduce the “Swap to Stop”[xi] initiative in 2023. The first of its kind will see one million UK smokers provided with a vaping kit and support.
The New Zealand Health Ministry acknowledged that while quitting smoking may be difficult, vaping offered a way to quit cigarettes by providing nicotine with fewer of the toxins that come from burning tobacco. This sudden course correct in 2019[xii] has not only seen the island nation experience accelerated declines[xiii] in smoking rates but has put them on path to becoming the 2nd country behind Sweden to be deemed smoke-free.
These critical facts alone should be enough to make SA lawmakers sit back and rethink their approach to regulating vaping products and use.
In 2021 it was estimated that 82 million[xiv] people worldwide have made the choice and have kicked the smoking habit for a safer alternative in vaping. Smokers in South Africa are being left behind. The misconceptions seen in public campaigns that purport and paint vaping as a more harmful practice than smoking disenfranchise a community, mostly vulnerable, from a solution that could provide a better health outcome.
If it becomes law, the Tobacco Products and Electronic Nicotine Delivery System Control Bill will impose restrictions that infringe on the rights of smokers to opt for less harmful alternatives to traditional tobacco. Because the Bill makes it illegal for vaping products to claim they are less harmful than other tobacco products – this truth will be kept from smokers, leaving millions of them without basic knowledge of this alternative.
Policymakers should allow us, consumers, to make our own choices. Let’s help smokers make the right choice. They should adopt the message, “If you don’t smoke, don’t vape. If you smoke, quit. If you are unable to quit, switch to a safer alternative like vaping.”
[i] E-cigarettes around 95% less harmful than tobacco estimates landmark review Link: https://www.gov.uk/government/news/e-cigarettes-around-95-less-harmful-than-tobacco-estimates-landmark-review
[ii] Public Health Consequences of E-Cigarettes Link: https://nap.nationalacademies.org/catalog/24952/public-health-consequences-of-e-cigarettes
[iii] First national Global Adult Tobacco Survey highlights the huge burden of tobacco use in SA Link: https://www.samrc.ac.za/press-releases/first-national-global-adult-tobacco-survey-highlights-huge-burden-tobacco-use-sa
[iv] Tobacco smoking: Health impact, prevalence, correlates and interventions Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5490618/#CIT0036
[v] Tobacco sales ban failed to encourage smokers to quit, UCT research shows Link: https://www.news.uct.ac.za/images/userfiles/downloads/media/2023_08_21_SalesBan.pdf
[vi] Harm Minimization and Tobacco Control: Reframing Societal Views of Nicotine Use to Rapidly Save Lives Links: http://dx.doi.org/10.1146/annurev-publhealth-040617-013849
[vii] Innovation Under Fire: A Global Alert on the Misperception Epidemic in Vaping Views Link: https://weareinnovation.global/opinion-poll-innovation-under-fire-a-global-alert-on-the-misperception-epidemic-in-vaping-views/
[viii] Bad habits: How the government can help you quit smoking — but isn’t Link: https://www.businesslive.co.za/fm/fm-fox/2023-03-17-bad-habits-how-the-government-can-help-you-quit-smoking-but-isnt/
[ix] Nicotine vaping in England: 2022 evidence update Link: https://www.gov.uk/government/publications/nicotine-vaping-in-england-2022-evidence-update
[x] Can electronic cigarettes help people stop smoking, and do they have any unwanted effects when used for this purpose? Link: https://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-and-do-they-have-any-unwanted-effects-when-used
[xi] Smokers urged to swap cigarettes for vapes in world first scheme Link: https://www.gov.uk/government/news/smokers-urged-to-swap-cigarettes-for-vapes-in-world-first-scheme
[xii] Supporting smokers to switch to significantly less harmful alternatives Link: https://www.health.govt.nz/about-ministry/information-releases/regulatory-impact-statements/supporting-smokers-switch-significantly-less-harmful-alternatives
[xiii] New Zealand’s smoking rates continue to decline Link: https://www.health.govt.nz/news-media/news-items/new-zealands-smoking-rates-continue-decline
[xiv] 82 million vapers worldwide in 2021: the GSTHR estimate Link: https://gsthr.org/resources/briefing-papers/82-million-vapers-worldwide-in-2021-the-gsthr-estimate/82-million-vapers-worldwide-in-2021-the-gsthr-estimate/
