Government has a responsibility to enable harm reduction rather than just urge South Africans to stop risky behaviours, former chairperson of Parliament’s Portfolio Committee on Health Sibongiseni Dhlomo said.
Speaking at The Wellness Collective, a gathering focused on shifting South Africa from selling harm to promoting wellness, in Johannesburg on Tuesday, Dhlomo said harm reduction was already embedded in many of government’s health interventions, from distributing condoms and antiretroviral treatment to needle-exchange programmes for people who inject drugs.
His comments come as Parliament prepares to begin clause-by-clause deliberations on the Tobacco Products and Electronic Delivery Systems Control Bill after the Portfolio Committee on Health’s adoption of a motion of desirability in June, moving it into its next legislative phase.
Dhlomo said government had a duty to reduce harm wherever possible, even when eliminating risk appeared unrealistic.
“Government doesn’t simply tell people not to have sex. It provides condoms, antiretroviral treatment and education. That’s harm reduction.”
He said the same principle applied to people who inject drugs, where providing clean needles and syringes helped prevent the spread of HIV and hepatitis while encouraging people to seek treatment.
According to Dhlomo, the tobacco message should be approached no differently.
“If someone cannot or will not stop using nicotine, should we encourage them to continue smoking cigarettes, or should we support them in switching to a less harmful alternative?” he asked.
He said public consultation during the development of tobacco legislation had also changed policymakers’ understanding of nicotine products.
As chairperson of Parliament’s Portfolio Committee on Health at the time, Dhlomo said lawmakers travelled to 27 municipalities with more than 7,900 people attending, received more than 40,000 written submissions and heard presentations from 52 organisations before refining the legislation.
“The policy we ended up with was different from where we started because we listened to the evidence and to the public,” he said.
Dhlomo said consultations with scientists, industry and public health experts had demonstrated that policy should distinguish between combustible tobacco products and non-combustible nicotine products.
“I was one of the people who initially viewed all nicotine products in the same way. It was only after hearing from experts that I better understood concepts such as the continuum of risk and why different products may require different regulatory approaches.”
Keynote speaker at the event, Gauteng Health MEC Faith Mazibuko said harm reduction recognised that lasting behavioural change often happened gradually.
“Harm reduction is about reducing preventable harm while helping people move towards healthier choices. It recognises that change does not always happen overnight, but every positive step towards better health matters.”
She said government was already applying that approach across several public health interventions.
“Government has applied this approach across many areas of public health, from encouraging healthier diets and responsible alcohol use to promoting safer sexual practices and protecting people from preventable diseases.
“The message we carry is that prevention works, and every healthier choice contributes to building a healthier society.”
Turning to tobacco, Mazibuko said the same principles applied.
“The healthiest decision anyone can make is never to start smoking. For those who smoke, quitting completely remains the best option. However, we recognise that nicotine addiction is complex, and many people require support and guidance on their journey towards quitting.”
“Healthcare professionals continue to encourage behavioural counselling, approved cessation medicines and other evidence-based interventions to support people who want to stop smoking. For adults who are unable to quit immediately, public health approaches must continue to focus on reducing harm while encouraging cessation.”
Former Gauteng Health MEC and specialist gynaecologist Dr Bandile Masuku, who shared a panel with Dhlomo, said harm reduction was a concept South Africans already understood.
“When you get into your car, you put on your seatbelt. Wearing a seatbelt doesn’t eliminate the risk of being in an accident, but it significantly reduces the risk of serious injury or death. That’s harm reduction.”
He agreed that government should place greater emphasis on harm reduction.
“Government also has a role to play by creating policies that encourage healthier living.”
Buhle Binta, Head of Scientific Engagement for Sub-Saharan Africa at Philip Morris International, explained that rather than ignoring the reality that many people continue to smoke, harm reduction focused on encouraging smokers to switch completely to less harmful, non-combustible alternatives.
“Globally, there are still more than one billion people who smoke, according to World Health Organisation estimates. In South Africa, there are around 11 million smokers. Those are people who continue to use combustible cigarettes, and we know smoking remains one of the leading causes of preventable disease and death.”
“The best choice is always to quit smoking completely. That’s the position we encourage. If you don’t smoke, don’t start.”
“However, for adults who would otherwise continue smoking and are unwilling or unable to quit, the conversation shifts to harm reduction. The idea is to meet people where they are and help them move away from the most harmful products.”
Binta said science should remain at the centre of policy discussions.
“Ultimately, science should guide these conversations. The evidence must continue to be evaluated, openly debated and communicated through appropriate regulatory frameworks and public education so that adult consumers can make informed decisions.”
