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Daily Maverick
6 days ago
- Health
- Daily Maverick
If your cigarette box isn't disgusting, it's not doing its job
A throat ulcer. Bloody urine. A sick baby. That's what smokers in other countries see. In South Africa? For now, it's a tiny black box. 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 stop people from smoking, according to the World Health Organization'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South Africa – along with Lesotho – has the highest proportion of adults who smoke daily in Africa, our warnings are outdated.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, such as 'Danger: Smoking causes cancer' and 'Warning: Don't smoke around children', but none shows images. There are also no warning regulations for e-cigarette packaging, which often have fruity flavours wrapped in colourful pictures that targets young people, says Lekan Ayo-Yusuf, a 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 young people – 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 text such as '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. 'The colour of the pack makes a difference' Under South Africa's proposed anti-smoking legislation, all cigarette packs sold in the country will carry plain packaging and graphic warnings. Tobacco products will be wrapped in a uniform plain colour chosen by the health minister and must have warnings that cover at least 65% of the front and back. Cigarette packs must show messages about the harms of smoking or benefits of quitting, information about what the product contains and emits, and include pictures or graphics that show the health risks. 'Our tests show that around 80% works well… but the Bill is very good and will change the whole tobacco and nicotine control landscape,' says Ayo-Yusuf. Local research among university students showed that plain packaging with a 75% graphic warning lowered how much satisfaction smokers get from cigarettes. Non-smokers were also least likely to want to try a plain pack compared with a branded one. 'The colour of the pack makes a difference,' says Ayo-Yusuf. 'South Africans look at their pack in making a brand choice, and that choice is linked to what we call the expected sensory experience [how satisfying smoking is], which leads to smoking more cigarettes a day.' The rules on packaging and warnings won't stop at cigarettes. They will also apply to nicotine products like e-cigarettes (or vapes) – devices that heat a liquid containing flavourings such as gummy bear or cherry peach lemon in colourful packaging that appeals to children. While they are marketed as 'less harmful' than cigarettes, because they don't burn tobacco, they are still addictive and can cause lung damage. Plain packaging makes e-cigarettes less appealing to young people. In a 2023 survey of 2,469 adolescents (11 to 18 years old) in Great Britain, researchers found that among those who had never smoked before, 40% said they had no interest in trying e-cigarettes shown in plain green packaging – compared with 33% for branded packs. Nevertheless, plain packaging has become one of the main targets of the tobacco industry's pushback against the Bill. Big Tobacco strikes back The Tobacco Bill has been in the making since 2018 but only got to Parliament in December 2022 after years of contention. Because South Africa's rules on advertising tobacco are strict, Big Tobacco relies on packaging as a marketing tool. The industry claims that if every box of cigarettes has the same plain packaging, smokers won't be able to tell legal from counterfeit cigarettes, which will promote illicit trade. When cigarettes are produced illegally with fake trademarks or sold to customers before taxes are paid on the goods, it is seen as illicit trade. While companies have long exaggerated how big the illicit market is, a 2023 study in South African Crime Quarterly found it mostly involves legitimate local manufacturers who dodge taxes while still producing branded cigarettes. 'Currently, they're already producing these cigarettes and not paying taxes. Even if [all the boxes look the same] it's not going to make it any worse or less,' says Ayo-Yusuf. The industry also argues that the Bill is a missed opportunity to get people to stop smoking cigarettes, because it groups 'less-harmful new categories of nicotine products' with traditional cigarettes – even though studies show they aren't harm-free. But Ayo-Yusuf says their protests are premature; the detailed regulations that spell out exactly which warnings will apply to which products will only come later. For example, current rules list eight warning texts that must alternate on cigarette packs, while smokeless tobacco products only carry one about oral cancer. 'They are jumping ahead by claiming you can't regulate vapes the same way as cigarettes. The regulation could say that cigarette packs must have a graphic of a sick baby, while vapes show an image of someone chained to addiction.' In a Parliamentary hearing last month, the industry continued to double down during public comment on the Bill, saying that applying the same packaging rules on all nicotine products is too strict and should instead be tested gradually. Once the hearings end, it will be up to the National Assembly to pass, amend or reject the Bill before it finally goes to the National Council of Provinces and then the President to be signed into law.
TimesLIVE
10-07-2025
- Health
- TimesLIVE
If your cigarette box isn't disgusting, it's not doing its job
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.
Daily Maverick
01-07-2025
- Health
- Daily Maverick
‘Vapes are safe alternatives to smoking' — and other lies they told us
A World Health Organization report released this week has some ideas on how to fight Big Tobacco's influence machine, just as an SA Bill regulating newer tobacco products has finally reached the health committee in Parliament. It's about time, says Lekan Ayo-Yusuf, a University of Pretoria professor who is a member of the WHO study group on tobacco product regulation. Smoking a cigarette on a plane was normal until tobacco control laws put a stop to it. The new normal: taking a puff on any of the latest electronic devices in a shopping centre where smoking isn't allowed. Big Tobacco is good at adapting. With fewer people smoking cigarettes globally, the industry has pivoted its playbook toward electronic devices like vapes and heated tobacco products (HTP). The World Health Organization's (WHO) Global Tobacco Epidemic report, which was released at this week's World Conference on Tobacco Control in Dublin, shows how graphic warnings on packaging and anti-tobacco campaigns can fight against the tobacco industry influence machine, including these new product lines. It is a timely release for South Africa. Our own Bill, meant to better regulate tobacco products, including new ones such as electronic delivery systems, is finally — nearly seven years after first being gazetted — in front of Parliament's health committee hearing oral submissions from stakeholders. The WHO report shows what we are up against. Pages from the playbook The report lays out how Big Tobacco's well-honed tactics — and some new ones — are being used to sell new products and keep legislation to slow sales down at bay. Among these are co-opting the term harm reduction — an evidence-based way to help lower the effects of drug use or risky behaviours on someone's health — to push the newer products as 'safer alternatives' to traditional cigarettes. The industry has also funded its own science to discredit existing independent research on its products, and pays the media to publish sponsored articles it has written, such as this one which appeared on TimesLIVE in November 2024, arguing there is sufficient evidence that electronic tobacco products are safe and effective harm-reduction tools, or this one published by News24 in January, boosting British American Tobacco-sponsored studies that underplay the potential harm of the chemical contained in electronic products, 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. The industry also exaggerates the size of the illicit market to keep taxes low, arguing that if government increases taxes on tobacco products, it will drive smuggling. It says plain packaging — which is what South Africa's current draft Bill calls for — will also increase illicit trade, although the WHO says it can actually help with enforcement by making illicit products easier to detect. In many countries, illicit trade can refer to counterfeit products or smuggled foreign cigarettes. But a 2023 study in the South African Crime Quarterly showed that in South Africa, it's more about legitimate domestic manufacturers who find ways to avoid paying proper taxes while producing branded cigarettes. Ayo-Yusuf agrees: 'It's got nothing to do with tobacco legislation and everything to do with the criminal element in the industry.' Where there's smoke E-cigarettes and vapes — electronic devices that heat a liquid containing additives and chemicals, which are often flavoured to appeal to children and adolescents — and HTPs, tobacco devices that electronically heat products that contain actual tobacco instead of burning it, are defined in our draft regulation as electronic delivery systems and tobacco devices. While some of the liquids don't contain nicotine, many do, making them no less addictive than cigarettes. In fact, inhaling the aerosol from vapes can cause lung damage and heart problems, while HTPs still emit 'tobacco smoke' with harmful chemicals — some at lower levels than cigarettes, others higher, and some not even found in cigarettes. Yet HTPs dodge tobacco rules in South Africa that bar the promotion of tobacco and public area smoking, even though they contain tobacco. 'They're violating the current tobacco laws in broad daylight,' says Ayo-Yusuf. 'You cannot market or promote tobacco products. But you see people smoking in public places and you have whole HTP stores and stands in shopping malls.' That's what the Bill is trying to put an end to. It will apply strict laws to newer devices: no use in public spaces; no advertising, online sales or claims that they're less harmful than cigarettes; and regulations will require graphic health warnings as well as plain packaging to deter people from using them. If it is passed in its current form, it will also be the end of fruit-flavoured vapes, which have been heavily marketed to children — only tobacco and menthol flavours will be allowed. We spoke to Ayo-Yusuf about the growing market for heated tobacco, harm reduction and how regulation can keep pace. This is an edited version of our conversation. Zano Kunene (ZK): How well does SA do in tobacco control? Lekan Ayo-Yusuf (LAY): Not well, relative to other countries in Africa and globally. The Bill is very good and will change the whole tobacco and nicotine control landscape, but we have been waiting [seven years for it]. Since it was introduced in 2018, we have seen the number of smokers grow from 9.5-million to 14.9-million in 2024. ZK: Which smoking products are tobacco companies pushing in SA? LAY: Vapes are a big one as we had 4.1% of people between 16 and 34 using [them] in 2018, and now we are sitting at 7.7%. Heated tobacco use is also increasing, which I've been monitoring since 2021, and using data from Nielsen to pick up on which products are being sold. ZK: What are HTPs and how do they differ from conventional cigarettes? LAY: Traditional cigarettes burn tobacco so you can inhale nicotine, which makes the brain release dopamine and makes you feel good, but comes with harmful chemicals from the tobacco and the paper. HTPs have a coil that is charged by a battery that heats a stick filled with tobacco leaves. The difference is that you do not have the chemicals that come from the burning process, otherwise you have everything else. ZK: Why does the industry call them harm reduction tools? LAY: The industry has jumped ahead to say they reduce harm, but what we actually know is it reduces exposure to harmful chemicals. In theory, they could lower harm over time, but it is not a linear process. Whether lowering toxins from 100 to 20, for example, is enough to reduce your harm from cardiovascular disease or cancer will take you a long time to find out. The industry says they are targeting smokers trying to quit. The easiest evidence for this would be a drop in cigarette smoking. But since e-cigarettes entered the market in 2010, there is no evidence showing that smoking has reduced.
TimesLIVE
27-06-2025
- Health
- TimesLIVE
Vapes are safe alternatives to smoking. And other lies they told us
Smoking a cigarette on a plane was normal until tobacco control laws put a stop to it. The new normal: taking a puff on any of the latest electronic devices in a shopping centre where smoking isn't allowed. Big Tobacco is good at adapting. With fewer people smoking cigarettes globally, the industry has pivoted the playbook towards electronic devices such as vapes and heated tobacco products (HTP). The World Health Organization's (WHO) Global Tobacco Epidemic report, which was released at this week's World Conference on Tobacco Control in Dublin, shows how graphic warnings on packaging and anti-tobacco campaigns can fight against the tobacco industry influence machine, including these new product lines. It is a timely release for South Africa. Our own bill, meant to better regulate tobacco products, including new ones such as electronic delivery systems, is finally — nearly seven years after first being gazetted — in front of parliament's health committee hearing oral submissions from stakeholders. The WHO report shows what we are up against. Pages from the playbook The report lays out how Big Tobacco's well-honed tactics — and some new ones — are being used to sell new products and keep legislation to slow sales down at bay. Among these are co-opting the term harm reduction — an evidence-based way to help lower the effects of drug use or risky behaviours on someone's health — to push the newer products as 'safer alternatives' to traditional cigarettes.
