Public health experts disagree with the vaping industry’s argument that imposing a sin tax will lead to a similar path of Aids denialism
The intended vaping tax would represent a major blow to South African vaping consumers and smokers seeking less harmful alternatives to smoking. Such a tax would make smokers less likely to make the essential switch to less harmful alternatives due to price.
On 15 December 2021, the treasury published a discussion paper titled Taxation of Electronic Nicotine and Non-Nicotine Delivery Systems (ENDS), after the minister of finance said in his 2020 February budget speech that the treasury would start the process to introduce an excise duty on electronic vapour products.
In the paper, treasury notes that though the market for ENDS is still in its infancy in many developing countries such as South Africa, in other markets, the growth in the consumption of these products has been observed among the youth, which raises concerns about its effect on youths starting smoking. There are concerns about the potential of ENDS to undermine global tobacco control efforts and public health in general, considering that ENDS are not entirely harmless.
To curb the growth of ENDS, the treasury notes that other governments across the globe have started a process of regulating the consumption and use of ENDS through tax and non-tax measures. It also notes that several countries have already started implementing tax measures on ENDS in the form of a specific excise duty and/or an ad valorem (according to value) duty.
It is important to note that the treasury’s proposed tax represents a missed opportunity to deal, once and for all, with smoking in South Africa. The tax will have an undesirable impact on smokers’ ability to access less harmful alternatives for nicotine to combustible tobacco. This works against the goal of ensuring a reduction in tobacco consumption.
The reduced-harm profile of ENDS has been established through multiple studies. Both the UK’s Royal College of Physicians and Public Health England have found that, although not completely safe, vaping is 95% less harmful than smoking. The UK government has gone to the extent of evaluating the provision of ENDS as a National Health Insurance benefit for smokers wishing to reduce their exposure to tobacco harm. This is because of the recognition that smoking is one of the most difficult habits to jettison. It is also born of the realisation that traditional quit methods, such as going cold turkey or using nicotine replacement therapy such as gum or patches, do not have even half the success rate of vaping products in assisting smokers to quit smoking.
The intended vaping tax would represent a major blow to South African vaping consumers and smokers seeking less harmful alternatives to smoking. Such a tax will make smokers less likely to make the essential switch to less harmful alternatives due to price. Such a tax would make ENDS unaffordable for poor smokers, who are the majority of smokers in the country.
Writing for News24, Sifiso Skenjana makes the point that a vaping tax will lead to public health inequity, as the tax is more likely to deter poor smokers from taking up vaping than it is to discourage middle- to high-income smokers from doing so. This will perpetuate South Africa’s high inequality and disadvantage poor smokers, who form the bulk of South Africa’s smoking population.
The treasury seems to have fallen for the disinformation campaign of the department of health, perpetuated in concert with the Council Against Smoking, which relies on one-sided studies about the health effects of vaping. In the main, these studies fail to acknowledge the fundamental differences between smoking and vaping, particularly in their harm profile.
In the telling of these two, any non-pharmaceutical nicotine consumption is, by definition, undesirable, even if it has the potential to reduce the harmful exposure of smokers. This shows criminal disdain for the health of smokers, who always seem to come last in considerations about tobacco control policies. This disdain was clearly demonstrated during a May 2021 webinar hosted by Protect Our Next on World No Tobacco Day, where a health department representative said the following in her closing statement: “… as South Africa we are among the countries which may run short of oxygen, [so] it’s actually very painful that oxygen will be used for smokers when it should be used for other conditions”. It is this logic that generally informs the creation of policy proposals that do not account for the needs and rights of smokers. Dr Kgosi Letlape, cofounder of the Africa Harm Reduction Alliance, once said: “The smoker matters … We must not forget the smokers. They have rights too, and we should be offering alternatives.”
The tax proposal goes on at some length about the potential of young people to get addicted to nicotine through vaping. Almost nowhere does it discuss the data behind this fear. There is no attempt to say how many young people vape, how many are former smokers, how many have progressed to smoking through vaping, and how many were diverted from taking up smoking by vaping.
No effort is made to evaluate how many smokers would be discouraged from vaping because of the added tax, what this means for public health and how this merely entrenches tobacco as the go-to product for people who are already addicted to nicotine.
The treasury also relies on a gross mischaracterisation of the harms of nicotine, once more with reference to young people, and without reference to addicted smokers. Though there are studies that have found nicotine can have a detrimental impact on the brain development of adolescents, none have found nicotine to be harmful to the health of smokers. The majority of evidence concerning the harms of nicotine is based on animal studies. In large part, the scientific consensus is that nicotine is a mild stimulant similar to caffeine in potency. Nicotine does not cause cancer: it is the other 7 000 chemicals released during combustion that lead to cancers and other non-communicable diseases. Michael Russell, “the father of tobacco harm reduction”, is often quoted as saying: “People smoke for the nicotine, but they die from the tar.”
A tax on ENDS will not assist South Africa to lower its smoking rates, especially if this occurs prior to the country adopting a well researched regulatory position in the form of legislation that defines the legal place of ENDS. To impose such a tax now is tantamount to depriving South African smokers and vapers of an opportunity to collectively define the place of ENDS, with the government, in the fight to reduce smoking. Government must be sensible; tobacco harm reduction is a sensible strategy to reduce harm to smokers. Quit or die approaches do not have a place in a democracy such as ours.