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Does re-thinking the regulation of tobacco and nicotine products have the potential to transform public health in South Africa? Would a dispensation on reduced harm products help South African smokers who continue to smoke and in what way? Would such a regulation really encourage smokers to switch to less harmful alternatives? A panel consisting of Professor Solomon Rataemane, Head of Department of Psychiatry at Sefako Makgatho Health Sciences University, Dr Kgosi Letlape, an ophthalmologist in private practice and health activist and co-founder of the African Harm Reduction Alliance, Marcelo Nico, Managing Director at Philip Morris Southern Africa and Indian Ocean Islands, Professor Daniel Malan, Director for Corporate Governance at Stellenbosch University and Coenraad Bezuidenhout, Managing Director of Public Affairs and Government Relations Advisory at FTI Consulting debate the issue. The second segment of a panel discussion looking at harm reduction in tobacco control policy.
Click here for Part One – Looking at harm reduction in tobacco control policy
Coenraad Bezuidenhout: I want to get to the UK and US example, where there’s has been a bit of a broader view and some accommodation made for reduced harm products To what extent does UK and US set an example for a market like South Africa?
Dr Letlape: We need the robustness of a communications strategy of how we communicate to the public truthfully to and in a language that the public can understand.
Prof Rataemane: You have two scenarios where robust science can influence policy – there is now the notion of trying to reduce the nicotine content in the alternative products and allow them into the market. The second issue in terms on the regulation, I think there’s crust of the matter, is in terms of taxation, do you want to regulate e-cigarettes the same way as normal cigarettes?
If you have identified the fact that tobacco has problematic elements that can cause cancer and the alternative products deliver nicotine in a much cleaner way, should you really be having the same level of taxation? Can you strike a balance somewhere, so that you are providing a healthier lifestyle, you getting healthier people, getting less admission of people in hospital and on the other hand the industry still survives.
I think government does not want self-regulation by the tobacco industry; they want some kind of involvement in terms of regulating use of these alternative products.
What we need to teach our government is that these products are much better, much different compared to ordinary tobacco, but you have to find studies that can demonstrate that this is a fact.
Coenraad Bezuidenhout: Should government just be a receiver of the information or should it try and create a more condensed environment for robust information and science, get input from the consumers, input from commercial interests, what are the steps to take?
Prof Malan: I don’t think government should only be a recipient of information, it should participate in discussions in the spirit of stakeholder engagement, and it should sit with the private sector and civil society and continue those conversations.
One of the clear needs that we have at the moment is the simply for accurate information to be available. There’s lot of scientific information about the health impact of the reduced harm products that somehow doesn’t really get through to all the different stakeholders. We need that pragmatic approach to get everybody around the table – for government to say we will do our own research as well as we will receive information. But if there is convincing evidence even coming from the industry itself, that can be audited or validated by external experts, then I think all that information should be taken into account.
Dr Letlape: What we cannot do is to translate what was used for the toxic product and just cut and paste it to the less harmful product.
The policy framework should then be based on the evidence available on the less harmful product. So you then follow the route of public health England that looked at the evidence around the e-cigarette and make the recommendation in terms of that policy. You should look at the WHO, there’s evidence now about snus, but nobody is talking about snus. Snus has tremendous advantages over all these other things, access, costs. We need to create regulatory framework that looks at less harmful products and ensure that we cover all LSMs. I don’t want this debate to be focused on middle class and technology that is expensive, when there is a smokeless tobacco that should be made available.
Coenraad Bezuidenhout: Marcelo Nico I would like to create an opportunity for you to respond to that in general.
Marcelo: Absolutely, what we need is the regulatory framework that will encourage smokers to switch from combustibles and more harmful products to alternatives that can reduce harm.Â
As the tobacco industry, we need to develop these products, develop the science and make it public and correlate the verification of these findings. It is also about verifying the science that is available, as well as allocating all of our commercial efforts to communicating to the smokers that there are already alternatives.
To give an example, now in South Africa – inside our pack of cigarettes there is an insert informing the smoker that there are alternatives to smoking, so I think that these are some of the things that we can do too as the industry to accelerate this. Develop the product, develop the science, make it public, have these debates, allocate majority of the commercial efforts to this. But of course we need these debates; we need as well the regulatory framework that will encourage smokers to switch. We need to be able to inform smokers that there alternatives available, we absolutely agree combustibles need to be treated in a framework and alternatives need to be treated differently.
All the alternatives – we talked about e-cigarettes – heat-not-burn is another technology available and snus and other smokeless products – we need to be able to communicate the science to the smokers, the ones that will continue to smoke – that there are alternatives that are less harmful. As an industry, we have this role to play, to develop the products and to commercialise the products and to engage in the discussions on the regulatory framework.
Click here for Part Three – How to promote harm reduction in policy making
