The path to a smoke-free SA: Follow the Swedish model

More than one in four South African adults are smokers, up from 16.2% in 2012. That’s according to the 2021 Global Adult Tobacco Survey undertaken by the South African Medical Research Council.

That trend runs counter to most countries in the world, where smoking is on the way out. Much of the blame for that should be laid squarely at the feet of the government, which banned the sale of tobacco products for five months in 2020 at the outbreak of Covid-19. 

That destroyed the sales of big tobacco companies like British American Tobacco (BAT) and Philip Morris and transformed tobacco into arguably the country’s largest black market. 

It’s clear that the 2020 tobacco ban did not work and, in fact, may have contributed to the increase in rates of smoking. Smokers could buy freely on the black market, switching to cheaper brands on which no excise duty was paid. Illicit cigarettes poured across the border, as they do today, and can readily still be found in spaza shops and smaller grocery stores across the country.

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By some estimates, 70% of all cigarettes sold in SA are illicit, which means the SA Revenue Service (Sars) collects zero excise duties on these sales, representing a loss of R20 billion a year to the fiscus, according to Tax Justice SA (TJSA).

Tobacco bill

The next phase in the war on smokers is the Tobacco Products and Electronic Delivery Systems Control Bill (the tobacco control bill), which is getting serious push-back from the tobacco and vaping sectors, for ignoring scientific evidence reportedly showing the harm-reduction benefits of smoking alternatives such as electronic cigarettes and using nicotine pouches.

At a media presentation on Tuesday, Philip Morris SA director for external affairs Neetesh Ramjee said the so-called tobacco control bill makes no distinction between these less harmful alternatives and cigarettes. “It’s the burning of tobacco and inhaling of smoke, rather than nicotine itself, that is harmful to health. In our submission to parliament on this bill, we have presented a large amount of scientific evidence to support this claim.”

Read: Backlash against new tobacco bill gets white hot

Among the changes introduced under the new bill, retailers will have to conceal cigarette displays from public eyes, cigarettes must be sold in plain packets, and online sales of tobacco and vaping products will be prohibited – as will smoking indoors and in public places. Heavy penalties will be imposed for violations. Health warnings will have to be posted on less harmful alternatives, creating the impression that they carry the same risk.

The Swedish model

Sweden has effectively become smoke-free, after dropping below a 5% tobacco smoker prevalence rate. It did this by promoting harm minimisation strategies such as e-cigarettes and nicotine pouches. The health benefits are remarkable: Sweden has 41% less cancer than other European countries and the lowest percentage of tobacco-related illness in Europe.

Several other countries, such as the UK, New Zealand, Germany, Greece and Japan, have adopted similar policies, with the UK targeting ‘smoke-free status’ by 2030.

The stated objective of the tobacco control bill is to improve the health of South Africans, but it appears to lack any substantial appreciation of the growing body of independent research pointing to the benefits of harm reduction strategies such as nicotine pouches and e-vapes.

In its submission to parliament, Philip Morris argued that harm reduction can be accelerated by giving adult smokers information and access to less harmful smoke-free products.

Cigarettes belong in museums

If smoke-free products are the future, what does this mean for companies like Philip Morris? 

In May this year, Jacek Olczak, CEO of Philip Morris International, boldly claimed that the company’s mission is to reduce smoking by replacing cigarettes with less harmful alternatives. “Cigarettes belong in museums,” he added.

Read: Philip Morris enters US smokeless market with $16bn deal

Buhle Binta, head of scientific engagement at Philip Morris SA, said the objective is to replace cigarettes with smoke-free products as quickly as possible. The combusted cigarettes do the most harm, whereas ‘heated’ or ‘non-combusted’ and smoke-free products have been shown to be far less damaging to health. This distinction needs to be recognised in the tobacco control bill, with a differentiated regulatory framework for smoke-free products, similar to the policies adopted in several other countries.

Not a gateway  

There is also evidence that smoke-free products are not a gateway to smoking, as some have claimed. 

“Regulation of tobacco and nicotine products should distinguish between the most harmful products [cigarettes] and less harmful alternatives [such as smoke-free products, including heated tobacco products],” said the Philip Morris submission to parliament.

Philip Morris sees its future in smoke-free products and has been transitioning into wellness and therapeutics. 

“The research shows that one out of 10 people will quit smoking voluntarily. The main problem we have with this bill is that it does not cater to the nine out of 10 people who will not quit on their own. We are saying there is a better way to achieve better health outcomes through a reduction in smoking prevalence,” said Ulreich Tromp, director of corporate affairs for southern Africa at Philip Morris.

If harm reduction is the goal of the authorities, then another obvious way to incentivise the switch to less harmful products is through lower excise duties – though that is a call Treasury will have to make.

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