PRESS RELEASE
When ANC Treasurer-General and former Gauteng Health MEC Dr Gwen Ramokgopa took the podium at the Progressive Business Forum (PBF) Colloquium on the Promotion of a Healthy Lifestyle and Wellness recently, her message was as pragmatic as it was progressive: South Africa cannot afford to let ideology stand in the way of evidence.
Citing examples from public-health victories such as condom distribution during the HIV crisis, seatbelt laws, and reduced sugar and salt content in foods, Dr Ramokgopa framed harm reduction as a principle long embedded in South Africa’s health journey — and one that must now be extended to new and emerging areas of risk, including tobacco and substance use.
“We debated around whether we should give out free condoms, but we knew that harm would be reduced. We don’t ban the eating of bread,” she said. “We say, let’s reduce half in this way and that way. The seat belt was innovated by public health practitioners. They didn’t want to stop the use of vehicles, but they said, let’s reduce harm.”
Her argument was clear: harm reduction is not permissiveness — it’s progress. It’s a recognition that real people make real choices, and that health policy should help them make safer ones.
Building on that momentum, Dr Percy Mkhulu Selepe, Acting COO of the Gauteng Department of Health, issued a call that resonated across the room and beyond:
“As government, we are convinced that science must lead policy. We have to stimulate new ways of thinking about harm reduction, not only in theory, but in lived realisation.”
Those words marked a quiet but meaningful turning point. For decades, public-health debates in South Africa have been driven by moral arguments and political instinct. The colloquium, however, revealed a growing appetite among government and researchers to replace ideology with evidence and to recognise that harm reduction, not punishment, saves lives.
Selepe’s statement challenges South Africa’s tendency to treat substance use as a moral failing rather than a health issue. Whether the subject is tobacco, alcohol, or other drugs, evidence shows that punitive policies drive problems underground, while compassionate, data-driven approaches reduce harm and rebuild trust.
“We have not funded anything on harm reduction”
At the same event, Professor Monique Marks, a harm reduction activist, reminded policymakers that while harm reduction is widely discussed, it remains largely unfunded in South Africa:
“There is not a single government-provided harm reduction program in the country — all of them are in non-profit or non-governmental spaces. We have funded supply reduction and demand reduction, but nothing that truly meets people where they are.”
Marks’ statement laid bare the contradiction between South Africa’s progressive rhetoric and its entrenched abstinence-based approach. “We need to recognise that people use substances for complex reasons,” she added. “Punishing or shaming them has never worked. Meeting people where they are, with compassion and evidence-based options, does.”
Her point is not ideological, it’s mathematical. Every smoker who switches from combustible cigarettes to a scientifically validated, regulated smoke-free alternative dramatically reduces exposure to harmful toxins. For a health system under strain, that shift could mean fewer hospitalisations, lower costs, and more lives saved.
Without budgetary and policy support, harm reduction remains an idea rather than a practice. And yet, as global examples show, from Portugal’s decriminalisation model to the UK’s safer nicotine product regulation, science-led harm reduction saves lives, lowers health costs, and strengthens public trust.
Harm reduction: the next frontier
Echoing Marks’ call for government to invest in harm reduction science, Gastroenterologist Professor Obedy Mwantembe urged that future research, including African-led studies, should explore the nuanced effects of nicotine and other lifestyle factors on disease.
He emphasised that obesity, inactivity, alcohol, and smoking are all key modifiable risks which require interdisciplinary collaboration and modern communication tools to drive behavioural change.
At the same time, Professor Tivani Mashamba-Thompson, Deputy Dean at the University of Pretoria’s Faculty of Health Sciences, said harm reduction must include infectious disease prevention and treatment. Harm reduction services such as those targeting injection drug users must include screening and treatment for HCV, which remains a neglected area in public health planning.
“When we talk about harm reduction, it is not only about behavioural change; it’s also about biomedical interventions that prevent the spread of infections like HIV and Hepatitis C. We must integrate HCV testing and care into our harm reduction programmes. When people come for help, we cannot separate their addiction from their infection risk.”
She repeatedly stressed that policy must be guided by local science rather than imported models, and that African research institutions must lead data generation on harm reduction including for infectious diseases like HCV.
While tobacco remains South Africa’s most stubborn and costly addiction, killing thousands of citizens a year, our national conversation still revolves around abstinence alone.
Mashamba-Thompson said that while quitting completely is the ultimate goal, many users struggle with cessation.
“Safer alternatives such as nicotine-replacement therapies, e-cigarettes, or other regulated smoke-free products can significantly reduce harm.”
Science plus compassion equals progress
All three academics underscored that stigma remains one of the biggest obstacles. Fear of judgment keeps people from seeking help. The antidote, said Mashamba-Thompson, is empathy:
“Harm reduction is not only about reducing immediate risk, it’s also about dismantling stigma, rebuilding trust, and ensuring that no population is left behind while easing the burden on our health systems.”
Dr Selepe’s insistence that policy must follow science is therefore more than a bureaucratic slogan – it is a moral imperative. Science tells us what works; compassion tells us how to make it work for real people.
If Gauteng’s stance becomes national practice, South Africa could finally modernise its approach to public health. It would mean funding harm-reduction programmes, regulating safer nicotine products rather than banning them, and partnering with communities instead of policing them.
Dr Ramokgopa emphasised that the issue extends beyond individual choices to national wellbeing:
“The disease burden in our country, in our continent and in the world is too heavy for any economy to carry,” she said. “Better health contributes to positive growth. The role of these platforms is to ensure that we all communicate and talk together.”
Her words serve as a reminder that collaboration between science, policy and society is not optional but essential if South Africa is to lighten its health burden and unlock its full human potential.
The alternative, moral grandstanding and outdated legislation, keeps millions trapped in cycles of illness and exclusion.
The PBF colloquium closed with a collective call to act: researchers, policymakers, and civil-society leaders must collaborate to design policies that are scientifically sound, socially just, and human-centred.
As Professor Marks puts it:
“We have to stop pretending that harm reduction is radical — it’s not. It’s evidence-based, it’s cost-effective, and it saves lives. Around the world, governments are leading this work. In South Africa, civil society is carrying it alone.”
