If your cigarette box isn't disgusting, it's not doing its job

TimesLIVE

10-07-2025

In Bangladesh, cigarette packs show a photo of an ulcer on a throat or someone on a ventilator. Mexico's show bloody urine in a toilet or a woman with breast cancer.
In South Africa, a small black box reads: 'Warning: Smoking kills.'
When warning signs are big, graphic and swapped out regularly, they help stop people smoking, according to the World Health Organisation's (WHO) latest Global Tobacco Epidemic report, which focuses on these types of warning signs and anti-tobacco marketing.
Yet, despite the WHO finding that South Africa — along with Lesotho — has the highest proportion of adults who smoke daily in Africa, our warnings are outdated. The regulations, last updated in 1995, require health warnings that cover 15% of the front of a cigarette pack, far below the WHO's recommendation of at least 50%.
Local cigarette packs have eight different warning texts, like 'Danger: Smoking causes cancer' and 'Warning: Don't smoke around children', but none show images. There are also no warning regulations for e-cigarette packaging, which often has fruity flavours wrapped in colourful pictures that target the youth, says Lekan Ayo-Yusuf, public health expert from the University of Pretoria and a member of the WHO's study group on tobacco product regulation.
'We don't have graphic warnings [which is a problem because] many people can't read the text that's only in English, and we don't enforce laws around advertisement, particularly for e-cigarettes.'
That will change if parliament passes the Tobacco Products and Electronic Delivery Systems Control Bill, which would require all tobacco products (including e-cigarettes) to have plain packaging and a graphic warning that covers at least 65% of the front of packaging.
'Weak' text only warnings
The WHO recommends cigarette pack warnings as one of six ways to stop people from smoking, along with tracking tobacco use and raising taxes on it. These warnings should be graphic, in colour, cover at least half of the pack, alternate often to target different groups — such as pregnant women and the youth — and be printed in a country's main languages.
Picture warnings showing the harms of smoking, like blackened lungs or children in hospital beds, are harder to ignore than text warnings alone. That's because they keep people's attention, help develop negative emotions around cigarettes, like fear or disgust, and lessen the desire to start smoking or encourage quitting.
According to the WHO report, about 110 countries use cigarette graphic warnings, but 40 — including South Africa — still have 'weak' text-only labels or none at all.
Canada was the first to adopt graphic warnings in 2001, using images like rotten teeth and red eyes with texts like 'when you smoke it shows' to cover 50% of the front and back of cigarette packs. Nine months after their introduction, a survey of 432 smokers found that about one in five were smoking less.
Australia, which has been using graphic warnings since 2006, introduced plain packaging in 2012 to make health warnings work better and discourage smoking. Their cigarette packs also include health warnings and can't show branding apart from the product name. Combined with bans on public smoking and higher tobacco taxes, it has helped lower adult smoking.