Johannesburg - Still unregulated, e-cigarette products are patently marketed to South African children and are easily accessible. In shopping malls, colourful e-cigarette kiosks are in plain sight. Sleek designs and thousands of youth-friendly flavours increase product appeal and create a perception that these products are safe, fuelling youth e-cigarette uptake.
Advertising, use of attractive flavours, influencers and point-of-sale marketing that appeals to youth are well-known tactics that have been employed by tobacco companies to attract a young market and find “replacement” smokers to maintain their market share and profits – creating another generation addicted to nicotine.
While restrictions on these marketing avenues have been imposed on tobacco products, the introduction of e-cigarettes or vape products threatens to undo this progress, says Dr Sharon Nyatsanza, Deputy of the National Council against Smoking (NCAS).
Placing children at the centre of conversations on better regulation of these novel products is critical for public health, argue the Protect our Next partners, a coalition of South Africa’s leading health organisations, including NCAS.
Nyatsanza says that in the face of competing interests from multiple groups, child interests must remain a key concern and stopping tobacco and nicotine use in children before they start must occupy a central part of any public health strategy.
“A sustainable future for our youth is one free from nicotine addiction. Unfortunately, South Africa has lagged behind in protecting children from tobacco and nicotine industries, which continue to promote harmful products to young people.”
Nyatsanza says the FDA's request that vape company JUUL withdraws its products in the US could signal a dramatic shift in how regulators view e-cigarettes.
“Vaping remains a huge risk. Neurobiologically, children are much more vulnerable than adults to nicotine addiction, and those who start using nicotine at a young age have greater nicotine dependence than those who start later. The process of vaping highly addictive nicotine brings its own health risks, even for adults.”
The government would do well to ignore the lobbying by an industry whose interests are irreconcilable with public health interests, according to Nyatsanza. The top four e-cigarette manufacturers are major tobacco companies, showing an industry continuing to maximise profits from both new and old products at the expense of public health.
“Failure to properly regulate e-cigarettes ignores the harmful effects of these products, which are linked to severe health conditions, as well as risking the creation of a new generation of nicotine addicts,” says Nyatsanza. “Early exposure to nicotine paves a pathway to addiction of all kinds. The brain’s peak period for developing addiction is in adolescence.”
While the taxation of e-cigarettes is an important step forward, Nyatsanza says other urgently required measures include regulation of flavours which appeal to children and restrictions on e-cigarette advertising, promotion and sponsorship. Graphic health warnings and standardised packaging applied to e-cigarette products would also reduce the ability of the sleek designs to promote the products and create misperceptions about their safety.
These are some of the measures included in the Control of Tobacco and Electronic Delivery Systems Bill and will significantly contribute to reducing initiation, use among young people and addiction to e-cigarettes.
The vaping industry, led by the Vapour Products Association of South Africa (VPASA), is currently campaigning around underage use and self-regulation when it comes to not selling these products to under-18s. At the same time, VPASA continues to oppose moves to regulate vapour products in the same way as traditional cigarettes, arguing that doing so will deprive millions of South African adult smokers and nicotine users of a potentially less harmful alternative.
Not so, says Dr Catherine Egbe of the South African Medical Research Council.
“While the value of e-cigarettes for adult smokers is still contested, the regulations in the Bill do not ban or prohibit adult e-cigarette use. The regulations strike a delicate balance, limiting youth initiation while still allowing adult access. The Bill is in line with the World Health Organisation’s recommendation that e-cigarettes be regulated, and young people must be protected by legislation seeking to regulate e-cigarettes.”
E-cigarettes are not endorsed as cessation aids by the World Health Organization, and even South African e-cigarette companies do not officially categorise them as stop-smoking aids. They are registered as consumer products, explains Egbe.
“If they were registered as stop-smoking aids or tobacco substitutes, the Medicines Control Council classifies nicotine e-cigarettes as Schedule 3 products to be sold under a prescription, which does not suit the business objectives of the industry.”
The tobacco and e-cigarette industries cannot be trusted to self-regulate, and public health policy must be protected from the industry’s influence, says Egbe.
“The industry says it does not target children, but instead, it violates child rights by marketing and designing products which are blatantly attractive to children. If the industry is so against youth uptake, why are they so against having marketing that is clearly targeted towards a younger generation regulated? If the vaping industry is about protecting people’s health, why are they so against restricting vaping in public places where toxic aerosols could affect others?
While the industry seeks to avoid regulation, the opposite is needed; e-cigarette products actually require stricter regulation to match the sophistication and diversity of the products and ensure that other innovations the industry might come up with in the future to circumvent regulations such as synthetic nicotine, are covered.”
Does any benefit for adult smokers who significantly reduce their cigarette use outweigh the powerful risks for youth? “Only if e-cigarettes are regulated in a way that reduces youth access and youth exposure to marketing. Children must be protected. This is exactly what the new bill aims to do,” concludes Nyatsanza.