PRESS RELEASE from Wellness Collective
South Africa’s Tobacco Products and Electronic Delivery Systems Control Bill carries major implications for the region and could set a precedent for the rest of Africa.
This is according to Dr Vivian Manyeki, a public health physician and epidemiologist at Kenyatta National Hospital, the largest referral hospital in East and Central Africa.
Manyeki, a speaker at the recent Wellness Collective in Johannesburg — a forum aimed at shifting South Africa from selling harm to promoting wellness — said while the Bill addresses gaps in youth access control and advertising, it risks placing combustible cigarettes and significantly less harmful nicotine products under the same strict regulations.
“If passed in its current form, the Bill may unintentionally discourage smokers from switching to safer alternatives, thereby undermining public health goals and counteracting objectives of harm reduction advocates. This could make it too costly and complicated for smokers to shift to much safer options. A sensible policy would ensure strict regulation on the protection of youth, clearly communicate the risks involved, and most importantly, support, not restrict, nicotine smokers transitioning to safer options,” she said.
Manyeki’s comments come as Parliament continues public hearings on the Bill.
“The adoption of tobacco harm reduction policies is lacking on the African continent when compared to high-income regions like the UK, New Zealand, and parts of Europe. The UK, for example, integrates harm reduction into national tobacco control policies and has sponsored programs aimed at moving smokers to less harmful products.”
“Afforded the least attention is Africa, with abstinence and cessation still viewed as the only viable pathways to nicotine harm reduction? There is also no room for harm reduction products,” she said.
Manyeki said the available policies were “backwards, steered by the burden of precautionary political frameworks stifling creativity and, at times, misinformed narratives about safer nicotine products.”
“The result is that the opportunity to mitigate the growing burden of tobacco-related deaths, which is increasingly emerging from low and middle-income countries, is stifled,” she added.
She said there must be a clear understanding of harm reduction. “The process of minimising the negative impact of health behaviours through focused public policy action is referred to as harm reduction. Unlike more conventional frameworks, this reduces the health, social, and economic burdens in public health by not necessarily eliminating the behaviours, focusing more on mitigation.”
She listed everyday examples such as seatbelts in cars, which do not stop people from driving, but they do make it much less likely that someone will die or get hurt in a crash. Helmets allow people to still ride a bike or motorcycle but it lowers the risk of head injury, while water treatment and chlorination allows people to still drink water, but treating it lowers the chance of getting sick.
“Sunscreen does not keep you from being in the sun, but it does lower your risk of skin damage and cancer. Using condoms lets you have sex while lowering your risk of getting HIV, STIs, and an unwanted pregnancy. Sugar-free or low-fat substitutes. People continue to consume fatty or sweet foods, but their health effects are lessened. Road bumps and speed limits lessen the frequency and severity of accidents, but do not stop driving.”
“In the case of tobacco usage, harm reduction refers to the use of e-cigarettes, pouches, and heated tobacco products to smoke less dangerous nicotine alternatives to combustible cigarettes. Supporting evidence demonstrates that nicotine addiction is the primary reason why individuals smoke. However, studies have further revealed that those addicted to smoking tobacco are at a higher risk of conditions such as cancer, heart disease, and respiratory illness,” explained Manyeki.
She added that harm reduction approaches are effective in saving lives due to their flexible frameworks, however, they face resistance. “There are several factors that contribute to the limited acceptance of tobacco harm reduction, such as misinformation and risk misperception. Surveys show over and over that a lot of people, even health professionals, think that vaping is just as bad or worse than smoking. There is also regulatory inertia. Policymakers often choose to ban innovative concepts instead of exploring them because they are reluctant of industry influence or unintended consequences.”
“There is also mistrust of the tobacco industry, given that cigarette companies have done bad things in the past, many people in public health are wary of any new product, no matter how harmful it is. There is also insufficient research in Africa. Most harm reduction evidence comes from high-income countries, which means there isn’t enough data from low-income countries, which in turn creates a gap in locally relevant data to guide decision-making.”
Manyeki said the key is to make appropriate regulations. “These will make sure products are safe and of good quality, curtail young people from using them, and educate citizens about the potential hazards. Lives are lost, productivity goes down, and healthcare resources are drained when nothing is done. Tobacco harm reduction is not about letting the tobacco industry off the hook; it’s about giving smokers a chance to have a healthier future.”
