As Parliament continues to discuss the merits of electronic cigarettes as “safer” alternatives to tobacco and the need for a multitude of vape flavours, immeasurable harm is befalling our children. Photo: Rainier Ridao/Unsplash
Let me be clear upfront. I am not a tobacco policy person, nor am I a tobacco economics person. I am a pulmonologist who treats people with tobacco-related lung disease. I am a researcher who studies the impact of tobacco, nicotine and electronic cigarettes on health. I run the only government hospital smoking cessation clinic in the country.
I spend a lot of time referring cancer patients and those struggling to breathe because of severe emphysema (a lung disease that makes it hard to breathe because the air sacs in your lungs are damaged and can’t work properly) to palliative care (care for people in the last stages of a chronic illness) — the years of smoking finally caught up with them, and the damage is so bad that trying to keep someone comfortable is about all we can do.
I first wrote about electronic cigarettes in 2013, arguing that strict rules were needed, given the complete lack of regulation and potential for a new generation of users. My first talk to a high school on vaping was in 2014; in just the past month, I’ve visited a junior school and two high schools because of the worrying rise in teenage vaping.
Why does SA have no rules for vapes?
Right now, e-cigarettes aren’t regulated at all in South Africa. Frightening when you consider that out of the 25 000 high school learners we surveyed in South Africa, roughly 17% vape, while we found almost half of some schools’ matrics were using vapes.
The Tobacco Products and Electronic Delivery Systems Control Bill, which will regulate e-cigarettes with the same rules used for traditional tobacco products, has been before Parliament since 2018. It still has not passed.
And, as the 2025 Global Tobacco Industry Interference Index, which was released this week, points out, such delays are strongly influenced by the tobacco industry “trying to find ways to stay in the addiction business”.
Big Tobacco does this by “sabotaging regulation, rebranding itself as innovative and part of the solution and promoting its investments to policymakers”.
The index looks into what extent governments allow the tobacco industry to interfere with policymaking. Of the 100 countries surveyed, 52 perform better than South Africa, meaning they block interference better than us.
South Africa needs tighter policies on how and where tobacco products are allowed to be sold and marketed, including standardised packaging, firmer regulations on illegal cigarettes and banning single stick sales that the Bill proposes. All these measures make it more difficult to get hold of tobacco, increasing the chances of people wanting to stop, which we can help with.
Stopping smoking is only a bad idea for those who sell tobacco. Unfortunately, there are lots of them who earn a very good (industry executives) and not so good (informal traders) income from tobacco sales. These individuals and groups are aggressively pushing back against tobacco reforms contained in this Bill.
Up in vapour
My concern is that whilst we argue and debate the merits/harms/societal/financial impacts of these measures, our children’s lives are going up in a cloud of vapour.
The explosion of vaping amongst teenagers in South Africa is a direct fallout from a free-for-all industry actively marketing thousands of enticing flavours in e-cigarettes, which are highly addictive nicotine delivery systems.
For context, we can compare this situation to the impact of alcohol legislation regulating the sale of alcohol. It’s true that alcohol regulations meant to halt sales to under-18s don’t stop all high school students from getting access to it. But if 61% of high school learners who were using alcohol were so highly dependent on it that they weren’t able to get through a day without it — which we identified in our vaping study as the addiction rate of high school learners who were using vapes — we’d be demanding stricter alcohol regulations.
There is no logical reason why anyone under the age of 18 or 21 who has never smoked a tobacco cigarette should be presented with an electronic cigarette and told that it’s harmless. Nicotine is addictive; propylene glycol (the smoke part) is a respiratory irritant, which means it can damage your breathing system; vegetable glycerine (one of the main ingredients in vape juice), when heated, is chemically altered to become acrolein and acetaldehyde, known carcinogens (substances which can cause cancer); and many of the flavourants in vapes have been shown to be harmful.
There is no justification for being able to buy addictive and damaging vape products with your home delivery burger and chips.
The industry has been promoting the “harm reduction” (that vapes can help you quit traditional cigarettes)/“vaping saved my life” mantra based on the facts that tobacco is so deadly and vaping is “safer”. Surely the same people cannot, with any good conscience, suggest that 12- or 13-year-olds should be addicted to nicotine.
Jumping off a wall is only “safer” if you are already jumping off a high wall or planning on doing so — it is not “safer”, or even safe, if you are on the ground and have no plans to jump at all.
Less talk, more action
The tobacco and healthcare industries have vastly opposed views on the need for a well-performing electronic cigarette market in South Africa. It took over 50 years to “prove” that tobacco causes lung cancer. Do we really need to condemn another generation to a similar addictive fate?
To prevent uptake in non-smokers who never intended to smoke tobacco, communication matters: the industry pushing a narrative of harmless, fun flavour vaping as a safe option does not convey the risks to youth and adult non-smokers.
During our research, we heard many reports from high school staff of 16-year-olds being given vape pens for their birthday, presumably from parents who see vaping as a harmless pastime. High schoolers who vaped also reported far fewer safety concerns than those who did not.
Those in power must ban the marketing and sales of electronic cigarettes and other similar products, such as nicotine pouches, to those under 18 (under 21 would be even better).
This must be done now; we have already waited too long. Do not let the vociferous arguments around adult rights and tobacco in this Bill distract you from the crisis that is befalling our youth with vaping and nicotine product addiction.
Richard van Zyl-Smit is a pulmonologist and professor of pulmonology in the department of medicine at the University of Cape Town and Groote Schuur Hospital. He is also a principal investigator at UCT’s Lung Institute.
This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.