How South Africa's tobacco bill might impact the continent's public health

TimesLIVE

3 days ago

Could South Africa's proposed smoking regulations have unintended consequences for the rest of Africa? A leading Kenyan doctor believes so.
Dr Vivian Manyeki, a public health physician and epidemiologist at Kenyatta National Hospital, the largest referral hospital in East and Central Africa, said the Tobacco Products and Electronic Delivery Systems Control Bill carries major implications for the region and could set a precedent for the rest of 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 next scheduled hearing is on Monday.
'The adoption of tobacco harm reduction policies is lacking on the African continent when compared to high-income regions such as the UK, New Zealand and parts of Europe.
'The UK, for example, integrates harm reduction into national tobacco control policies and has sponsored programmes aimed at moving smokers to less harmful products.
'Afforded the least attention is Africa, with abstinence and cessation 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 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 and focusing more on mitigation.'
She listed examples such as seat belts in cars, which do not stop people from driving, but they do make it much less likely someone will die or be hurt in a crash.
Helmets allow people to ride a bike or motorcycle but lower the risk of head injury, and water treatment and chlorination allows people to 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 allows you to have sex while lowering your risk of getting HIV, sexually transmitted illnesses and an unwanted pregnancy. Sugar-free or low-fat substitutes mean people continue to consume fatty and sweet foods, but the 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 use, 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 nicotine addiction is the primary reason individuals smoke. Studies have revealed those addicted to smoking tobacco are at a higher risk of conditions such as cancer, heart disease and respiratory illness.'
She said harm reduction approaches are effective to save lives due to their flexible frameworks but 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 vaping is 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 to face 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 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.'