*This content is brought to you by Philip Morris South Africa
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 first segment of a panel discussion looking at harm reduction in tobacco control policy.
Coenraad Bezuidenhout: With us, today we have Professor Solomon Rataemane, Head of Department of Psychiatry at Sefako Makgatho Health Sciences University. We have Dr Kgosi Letlape, an ophthalmologist in private practice, a health activist and co-founder of the African Harm Reduction Alliance. We have Marcelo Nico, Managing Director at Philip Morris Southern Africa and Indian Ocean Islands. We have Professor Daniel Malan, Director for Corporate Governance at Stellenbosch University and I’m Coenraad Bezuidenhout, Managing Director of Public Affairs and Government Relations Advisory at FTI Consulting facilitating.
Perhaps we can start by looking at where South Africa is positioned currently in terms of global tobacco control policy and what are the opportunities that are emerging on the tobacco market that suggests we could look at tobacco differently?
Dr Letlape: I think the main problem with tobacco is that we have forgotten the smokers; it’s been about all the other participants, the producers, the government and the health department, health ministries, public health activists and we have forgotten that there is a human being in the middle of this and the human is not being assisted. I guess for the first time in a long time there are alternatives that can be offered to those humans –  with scientific data that prove the fact that alternatives are less harmful. You have the Swedish experiment, and I think the key issue that all of us that are mindful of right now is that combustion is the problem and that there are many non-combustible alternatives that are now available. It is an old saying that people smoke for the nicotine, but they are killed by the tar and we are now able to take that down and ensure that people can get nicotine in a less harmful way.
The biggest challenge is that we always known that, and that is why you have nicotine replacement therapies that have been established for more than 20 years, because we have recognised this in the medical field. I would urge policy makers to look at that space carefully, come up with policies that could promote innovation.
Coenraad Bezuidenhout: How important is the focus on nicotine versus other harmful substances in contemplating what the regulations need to achieve?
Prof Rataemane: I think we have to go to the basics in terms of what harm reduction is about, I don’t think for instance the department of health in this country is very aware of what nicotine is supposed to be doing and how it compares to other substances.
They are aware of smoking, they are aware of tobacco and they are aware of that there are a number of people who end up with lung cancer and so on because of heavy smoking maybe heavy drinking also and they don’t want assistance in terms of understanding the science behind any other products that are to be introduced to reduce harm.
What seems to be the problem is that policy makers want some consistency in terms of science but scientists are failing also to communicate that this are a gradual process.
Coenraad Bezuidenhout: What are the ethics involved in those with commercial interests in helping to achieve this consistency in science in providing the necessary assistance to the policy makers?
Prof Rataemane: Some studies that show that patients who switch over to safer products for delivering nicotine alternatives tend to experience their lives as much better, they can breathe better, work and function better. Â
However I think we need to have own studies in this country, to convince our policy makers. Alternatively we have to pull together studies that are done already in the world, for instance studies that are supported by the World Health Organisation and other organisations for instance in the UK. The Royal College of Physicians is very supportive of safer methods of delivering nicotine. So WHO will also assist us in the guidelines in terms of matters relating to smoking because they are supportive of safer methods of nicotine delivery. I think that data must be put together convincingly for government so that we follow those guidelines without looking at the business angle. I think that there’s always going to be the business angle, companies will have to survive, on the other hand you will save government lots of money by providing safer alternatives.
Prof Malan: Well, I think in the case of tobacco harm reduction, it will be unrealistic to think that policy can only be informed by the science because we have to acknowledge the fact that it is a complex area and there are ethical issues related to the industry and the way in which products are perceived.
I think the tobacco market itself will acknowledge that obviously it has tainted history in terms of the way in which it has previously dealt with the discussion about the impact of tobacco and of cigarettes. I think the more interesting one here is to talk about product itself: e-cigarettes and vaping, because the product has become powerful and significant in my understanding, because on one hand they are very different from cigarettes so there is scientific evidence that seems to be accepted globally that it is 95% less harmful than smoking cigarettes.
So from a regulatory point of view, I think we should go beyond the scientific evidence – that clearly is the key issue. We should continue to carefully scrutinise the scientific evidence. From the different stakeholders there should be an acknowledgement that – perhaps given the history of the industry in terms of regulation – one should expect a little bit more pushback against simply using the scientific evidence in basing the regulation purely on that.
Coenraad Bezuidenhout: Marcelo Nico, From your point of view or industry point of view, what do you see as missed opportunities that we need to explore to try get consumer insights to inform practical or progressive approach to harm reduction in South Africa?
Marcelo Nico: I think what we have in our hands is a unique opportunity, being that regulation is being discussed to bring harm reduction into the question as we talk about tobacco. As we have stated already, smoking by burning the tobacco is the most harmful way that you can use nicotine. Today thanks to the science and technology, there are alternatives that have been developed – that are significantly less harmful and that’s the debate we have around the table.
From an industry standpoint, we have, as Philip Morris developed ten years of science behind the products that we have on the market. We brought them to South Africa as the first market in Africa and our intention is to create a world free of smoke, we want to replace combustible cigarettes with smokeless devices. Â
Clearly the industry cannot do this itself; we have developed smokeless devices – the products, and we have developed the science and have submitted this to the USA’s FDA but that’s not enough. We need these debates and regulation as well that will encourage the switch, and consider the smokers. For those that will continue to use nicotine, we need to inform them that there are alternatives – today that they can use –  that keep burning tobacco and we can inform them that smokeless products have the ability to reduce the harm. I think they are the core of what we are debating here today.
Click here for Part Two –Â Global examples of harm reduction and lessons for SA
