The South African public is largely uninformed when it comes to vaping and vaping-related issues. In the extreme, the public labors under the unfounded belief that vaping poses the same dangers as tobacco smoking. Unfortunately, the same applies to policy makers, who are either oblivious to the science of vaping, or willfully disregard the growing body of evidence which clearly shows that vaping is a harm reduced alternative to smoking. At our recently held Webinar, it became clear that the South African health community has not gotten to grips with the fast-evolving body of knowledge on vaping and its potential to aid in tobacco harm reduction. This is unlike in countries such as the UK where the public health community has been at the forefront of research into vaping as a harm reduced alternative to smoking.
The lack of information and knowledge in South Africa is principally due to the Department of Health (DoH / the Department), as the custodian of vaping policy in the country, not paying enough attention to vaping and has mostly opted to avoid direct engagement with the vaping community. The Department has also, it seems, taken a view that vaping should not be distinguished from smoking, as in their erred view, it is merely a gateway into smoking. This is despite very little evidence for this contention being produced, either in South Africa or internationally. The reluctance to engage on the science behind vaping from those tasked with developing policies for vaping in the country is concerning; for it is through rational discussions among all the stakeholders that common solutions to smoking-related harm can be found.
Based on previous pronouncements by the Department, it is clear that the government views vaping as being as dangerous to people’s health as smoking. Thus, they attempt to tarnish the image of the industry before it is able to position itself as a viable alternative to smoking.
It is important to note that vaping advocates have never dismissed the possibility of some harms resulting from vaping. For this reason, the industry has been very vigilant in curbing youth access to vaping products. The industry has been very clear that nicotine is an addictive substance and that those who do not smoke should not vape. However, the industry is also clear that for people who already smoke, the choice to move away from tobacco in favour of electronic nicotine products is a wise one. This is also the explicit position of the British government which has deemed electronic nicotine products to be a far superior alternative to smoking; one that can wean smokers off their harmful habit.
The permissive stance by UK authorities has seen smoking rates in the UK decline over the years and allowed for technological innovation in the vaping industry. According to the UK’s Office for National Statistics, the number of adult smokers in the UK declined by 5% (1.6 million smokers) from 2011 to 2019, with close to 50 000 adults taking up vaping per year in the same period. Public Health England (PHE), has done a great job in providing smokers and the public with clear, evidence based and accurate information on the relative harm of nicotine, e-cigarettes and other nicotine delivery systems. This has enabled informed decision-making.
Whilst PHE’s stance is based on clear and available evidence, the same cannot be said of DoH. It would be beneficial to the vaping industry, health community and smokers if the Department were as transparent regarding the studies or evidence it has relied on to inform its views on vaping and its perceived harm. In the absence of such transparency from the DoH, vaping in South Africa will forever be the subject of ideological arguments, rather than evidence-based discussions.
Though DoH’s disdain for smoking is well founded, its harm reduction strategy leaves a lot to be desired. Attempting to pin smokers to submission and forcing them to quit is not a proven winning strategy. If it were that simple, there would be no one smoking today. As seen with the ban on the sale of tobacco and Electronic Vaping Products (EVPs) during the lockdown, which the government was hoping would encourage people to consider quitting, most individuals were willing to access cigarettes through the illicit market than to simply quit. What smokers need is for government to provide them with the tools by maximising the availability of less harmful alternatives to smoking. If the DoH was more willing to engage on the science of vaping, it would realise the role it could play in tobacco harm reduction and, in turn, assist in guiding DoH’s strategies in reducing the prevalence of smoking in South Africa.