South Africa can learn a lesson from smoke-free Sweden

South Africa stands at a crossroads in tobacco regulation, facing a proposed Tobacco Products and Electronic Delivery Systems Control Bill that mirrors failed prohibitionist approaches. Instead of fostering harm reduction, the bill mirrors outdated measures, hindering smokers’ ability to transition to safer alternatives like vaping. To emulate the success of Sweden, a pioneer in reducing smoking rates, South Africa must prioritise harm reduction strategies, embrace risk-appropriate nicotine regulation, and promote accessible, affordable, and acceptable smoke-free alternatives. The government should reconsider its draconian proposals and look to evidence-based, successful models for effective tobacco control.

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An anti-smoking strategy worth copying

By Ivo Vegter

South Africa should ditch outdated prohibitionist law and mimic what Sweden did to become the first smoke-free country in Europe.

If there is one thing the Health Department should have learnt from the ridiculous alcohol and tobacco bans during the pandemic lockdowns, it is that bans do not work.

The vast majority of smokers simply continued smoking, shelling out extraordinary amounts of money for a carton of third-rate cancer sticks.

A few smokers told me that they had been considering quitting, but they’d be damned if they would quit just because Dr. Zol banned tobacco. People don’t like being told what to do, being forced into corners, or being made to obey mindless rules.

At the time, I called the bans ‘a random act of cruelty by petty despots’. I wrote that prohibition doesn’t work, that bans caused black markets to boom, and that more than a year later, legal markets had still not recovered.

On pain of punishment

Our lawmakers, unfortunately, do not deal with reality. They do not care about what works. When they see something they do not like, their first instinct is to ban it, on pain of punishment.

I often reference this Thomas Sowell quotation: ‘When your response to everything that is wrong with the world is to say, “there ought to be a law,” you are saying that you hold freedom very cheap.’

Lawmakers ought to familiarise themselves with the work of this towering intellectual, starting with Basic Economics, written in plain English so anyone can understand it. He happens to be black, which may sweeten the deal for the African nationalists in Parliament.

When smokers choose to quit, they prefer to be guided, instead of coerced. They prefer to be free to choose among alternatives that they can evaluate for themselves, rather than being forced down a government-approved path.

Harm reduction

Yet instead of encouraging harm reduction and cessation options such as vaping that people actually enjoy, and incur only a small fraction of the health risk that smoking does, the South African government proposes to treat vapes like smoking tobacco itself, and making them near-impossible to market and sell.

In addition, the Tobacco Products and Electronic Delivery Systems Control Bill, currently before Parliament, aims to prohibit smoking and vaping in all indoor places open to the public or to workers, and many outdoor areas, including any outdoor area within a set distance of a door or window.

This distance could be as much as 50m, which will effectively outlaw smoking altogether in any high-density built areas like city centres, townships and informal settlements.

It also prohibits all advertising and marketing, including retail display, and mandates plain packaging, which means that smokers won’t be able to discriminate on the basis of quality, but only on the basis of price.

This also means that new competitors wishing to enter the perfectly legal business of tobacco sales will find themselves unable to promote their product or gain market share. This may well be a violation of the constitutional right to choose one’s trade, occupation, or profession freely.

Written for 1990

The Bill also prohibits the sale of tobacco products via the postal service, couriers, or the internet.

Now, remember that tobacco products are perfectly legal, and it is perfectly legal for adults to buy tobacco products. Why, then, these restrictions? The sole reason for these restrictions, and for the marketing and retail display bans, is to prevent minors from buying tobacco products.

The Bill’s drafters have completely ignored the fact that the same goal can be achieved in a far less intrusive and destructive manner, simply by requiring age verification.

Madoda Khuzwayo, CEO of Appto Liquor, says that the Bill was written for 1990, and not for a modern online retail environment where technology is able to ensure robust age verification systems to prevent the sale of tobacco products to young people.

‘Ecommerce has evolved significantly in the past two decades,’ says Khuzwayo. ‘As an online retailer catering to a closed group of customers, of legal age, who want to buy liquor or tobacco products, I can say with every conviction that our age-verification systems are more robust and effective than any brick-and-mortar establishment.’

His system requires ID or passport verification upon registration, uses a face recognition system to prevent children buying products with their parents’ devices, and requires an age-verification document to be presented again upon delivery.

The government’s draconian restrictions, which will substantially harm both retailers and consumers of tobacco products, are simply not necessary.

Smokeless tobacco and vapes

Perhaps the worst aspect of the Bill is that it proposes to treat vapes, and other harm-reduction products or cessation aids such as snus and heated tobacco devices, just like tobacco itself.

The reason for this draconian approach to smoking is not to reduce harm. It openly rejects the very notion of relative risk, or harm reduction, declaring all products defined as ‘tobacco products’ to be equally harmful.

The aim isn’t even to get people to stop smoking. It is to punish both smokers, and especially tobacco companies.

It wasn’t written in consultation with smokers, who surely are the impacted parties who ought to have been consulted by law.

It was written only in consultation with (and probably by) anti-tobacco lobbyists like the National Council Against Smoking. And they hate tobacco companies, with a passion.

These are the same NGOs that dominate proceedings at the UN Framework Convention on Tobacco Control (FCTC), which explicitly excludes affected parties such as smokers and tobacco companies, and unsurprisingly, supports and recommends draconian suppression of tobacco.

Piggybacking on a trend

There isn’t even good research that establishes a causal connection between FCTC-recommended anti-tobacco regulations such as higher excise taxes and plain packaging, and the declining trend in smoking. It is likely that these prohibitionists are just piggybacking on a trend that they shouldn’t be taking credit for.

The boomers who used to smoked everywhere all the time, are aging and dying. Among them, the smokers die 10 or 20 years earlier than their peers, so most of them are probably already gone.

Generation X, which didn’t care less and engaged in self-destructive behaviour as if the world was going to end – which, to be fair, under mutually assured nuclear destruction was not just an angsty fantasy – is aging and starting to make smarter health choices.

Younger generations are drinking and smoking much less, and healthy lifestyles are all the rage, nowadays.

It is entirely plausible that lower smoking rates are simply a natural trend, and not an effect of government intervention.

Lowest smoking rate

What is empirically establishable is where people smoke the least. In Europe, that would be Sweden. It was the only European country to achieve the World Health Organisation (WHO) target of 20% smoking prevalence among adults in 2000.

At last count, in 2021, only 6% of its population smoked daily.

It now awaits new statistics, which could make Sweden the first country in the EU to reach 5%, the level below which a country is entitled to claim that it is ‘smoke-free’.

By contrast, the world average is 23%, and in the Euro area, it is even higher, at over 26%.

Sweden’s achievement in becoming smoke-free is unmatched in any other country that had a previously high smoking rate.

The key to Sweden’s success? It does have standard, but not draconian, prohibitions on smoking in public places, except in designated smoking rooms. It considered a plain-packaging law but found it to be an unconstitutional infringement on the rights of tobacco vendors.

What it did differently was to make smokeless alternatives to cigarettes – such as snus (oral tobacco pouches) and e-cigarettes or vapes – accessible, acceptable, and affordable.

In fact, if you consider vaping and snus as ‘tobacco use’, as the World Bank does, you get a rate of 24% in Sweden, which is roughly in line with the rest of Europe.

Health impact

The proof of the pudding is in the eating. Does the wider definition of tobacco use accord with reality, in that it measures comparable harms?

It does not. It is clear as a bell in Sweden’s health statistics that convincing smokers to switch to smoke-free products dramatically reduces harm.

Sweden boasts the lowest incidence of tobacco-related cancers anywhere in the EU. WHO data shows clearly that Sweden’s incidence of cancer is 41% lower than the rest of its European counterparts, corresponding to a 38% lower level of total cancer deaths. Sweden has a 39.6% lower rate of death of all tobacco-related diseases compared to the EU average.

Going smokeless works. Harm reduction works.

Yet South Africa’s health tyrants are taking the opposite route: they are making smokeless alternatives to cigarettes unacceptable, inaccessible and expensive.

Recommendations

Smoke-Free Sweden 2023, a lobby group that promotes harm reduction and smokeless alternatives to smoking, has, after consulting with dozens of experts in many countries on four continents, published seven recommendations:

  1. Harm reduction: Develop and embrace harm reduction strategies.
  2. Implement risk-appropriate nicotine regulation: The Swedish model has proven to be a highly effective approach to tobacco control, leading to significantly reduced smoking rates and associated health issues.
  3. Understand the life-saving benefits of the Smoke-Free Sweden model: Our research paper, Saving Lives Like Sweden, found that if every EU country followed Sweden’s approach and made safer alternatives affordable, acceptable and accessible to smokers, just under 3 million European lives could have been saved between 2000 and 2019.
  4. Promote the Swedish experience globally: Encourage the widespread adoption of the Swedish model in other regions, highlighting its success in reducing smoking prevalence and the associated health risks, and promote the Swedish experience at global fora such as the FCTC. This will contribute to the global efforts to reduce the harm caused by tobacco use.
  5. Focus on quitting, or at least switching to smoke-free alternatives, underpinned by clear information on relative risks: Experts have emphasised the unequivocal potential benefits of utilising alternative nicotine products as a harm reduction strategy. The WHO must take note, and commission official research into what has made Sweden smoke-free 17 years ahead of the EU target.
  6. Implement accurate risk communication: Policymakers at national, regional and global level should ensure that regulations make distinct risk-based differentiations between combustible and non-combustible nicotine products, so they cannot be treated equally. This approach will facilitate more accurate risk communication to consumers, enabling informed decision-making.
  7. Accessibility, Affordability and Acceptability: Governments should pursue policies that will allow smoke-free products to be accessible, acceptable and affordable. Policymakers should consider implementing policies that would allow these products to become more accessible and acceptable to smokers, including the use of regulated flavours.

Parliament should reject the new Tobacco Control Bill in its entirety. It should instruct the Health Department to go back to the drawing board, uninfluenced by the zealots at anti-smoking NGOs, and draw up a bill that is based on scientific data, a clear recognition of relative risks, and strategies that have proven to be successful in convincing smokers to quit.

If it isn’t up to the task of drafting a bill all by itself, it could do worse than simply copying and pasting Sweden’s tobacco legislation.

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*Ivo Vegter is a freelance journalist, columnist and speaker.

This article was first published by Daily Friend and is republished with permission

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