This month of August, the portfolio committee on health wrapped up its oral hearings on the Tobacco Products and Electronic Delivery Systems Control Bill. The committee hopes to finish processing the bill by the end of September, before sending it to the national assembly for approval.
What is interesting with most of the presentations heard by the committee in tail end of August were from anti-vaping/tobacco organisations that unsurprisingly advocated for harsher measures than what is already proposed in the bill, in the name of protecting future generations. Even more interesting was the organisations’ more concentration on gimmicks than substance, spending a lot of time on vilifying the tobacco industry and “exposés” than addressing the proposals of the bill based on scientific evidence. Based on the reactions from most of the members of the committee, they seem to have been sold on the gimmicks. However, gimmicks are not what law making in South Africa is about. There is nothing wrong with tugging at the heart strings of people to gain sympathy and emphasise a point, but when it comes to policy making, the point still has to be rational and backed by evidence.
Unsubstantiated Claims vs Available Evidence
A number of claims were made on the dangers of vaping, seeking to dispute the vast evidence that supports its contribution to tobacco harm reduction strategies.
Throughout the sessions, there were claims of vaping causing cardiovascular diseases, to support calls for vaping to be regulated the same as smoking. However, the organisations seem to rely on disputed studies that have found vaping to cause cardiovascular diseases. On the contrary, main studies that have made such claims, have since been retracted. In 2022, a Medical Journal retracted a study that linked vaping to cancer, as it failed to address the question of whether diagnoses were made before or after people started vaping, a minimum requirement for inferring causation. In 2020, the same issue led to the retraction of a Journal of the American Heart Association article that reported an association between vaping and heart attacks. Unsurprisingly, members of the committee did not press the organisations on their claims but were quite vociferous in asking for scientific evidence on vaping being less harmful than smoking.
Is Harm really Harm?
Another assertion that prevailed throughout the sessions and repeated often by some members of the committee, was the claim that harm is harm and vaping products were no better than combustible tobacco in terms of their effects on health. The anti-vaping brigade went on to claim that tobacco harm reduction is a tobacco industry creation, dismissing evidence from countries such as Sweden, New Zealand, and Britain, that have seen significant declines in their smoking rates, due to nicotine alternatives such as vapes.
What is surprising is that the South African government through the National Drug Master Plan (2019–2024), the Policy framework on the Prevention of and Treatment for Substance Use Disorders (2023), and the National Strategic Plan for HIV, TB and STIs (2023–2028) are centred on harm reduction services to assist drug users in recognition of the fact that quitting drug use is no mean feat and requires medical and psychological support. Measures punted by the strategies include needle and syringe programs (NSPs) and Opioid Agonist Therapy (OAT). The strategies also recommend launching campaigns to educate the public about drug use and harm reduction, aiming to reduce stigma and discrimination and using evidence-based interventions to identify effective harm reduction and treatment interventions to inform policy and practice. Why are the same measures not proposed for tobacco control is a surprising or could it be that the anti-vaping lobbyists with deep pockets and have the ear of the Department of Health carry undue influence on the department?
Youth Access as the trump card
The anti-vaping brigade uses young people’s access to vaping products as their calling card for vaping to be effectively banned. VPASA and those advocating for harm reduction measures in tobacco control, agree that at the moment, young people have fairly easy access to vaping products, due to the regulatory lacuna that exists. This will not be solved by simply banning the products or having them available only through subscription as they propose. Australia is an emerging case study that such a measure will not yield the desired result and may have the unintended consequence of creating an underground market that will be even harder to control. What is needed outside of regulation is a multistakeholder initiative to curb youth access to vaping products. Making it harder for adult smokers to access information and vaping products is not the answer.
In conclusion
It seems that some members of the committee have already made up their minds and were just going through the motions with the oral hearings. It is a great pity as law making in South Africa is premised on scientific evidence and not emotions. There is enough evidence for vaping and smoking not to be treated the same and it is hoped that the committee as a whole will evaluate all the submissions made in a rational manner, as the success or failure of the country’s tobacco control measures rests with them at the moment.
