South Africa Defends Ban On Cigarettes To Fight COVID-19

The decision to uphold the ban on the sale of cigarettes as the fight against COVID-19 continues, has many citizens fired up and wondering if government is not encroaching on civil liberties.

“People think that government is trying to force things down their throat,” says Dr Catherine Egbe, a specialist scientist of the Alcohol, Tobacco and Other Drug Research Unit, at the South African Medical Research Council (SAMRC).

Civil liberties, which form part of our daily lives, are hardly given a second thought in most circumstances. However, the arrival of COVID-19 has most people wondering if their lives will ever return to a version of “normal”.

Among the civil liberties that some may be feeling have been taken away from them, is the continued ban on the sale of cigarettes and related products.

Speaking to SAnews, Dr Egbe said the decision by government to continue with the ban was made in the interest of South Africans.

“We’re not being imprisoned. We are just trying to be careful, and I must say the big reason the decision has been taken by government is because of emerging information. [Information] is showing that there’s a high link that those that have progressed from mild or moderate symptoms of COVID-19 to severe and critical symptoms of COVID-19, have a higher likelihood of being smokers than non-smokers,” she said.

The spread of what has become a worldwide epidemic has led many countries around the world, including South Africa, to put in place national lockdowns in a bid to stop the spread of the virus.

This month, South Africa moved from Level 5, down to less harsh lockdown restrictions under Level 4.

At a recent media briefing, government announced that the decision to keep the cigarette ban in place was taken to preserve the health of South Africans.

In his first weekly newsletter for the month of May, President Cyril Ramaphosa said an earlier decision by government to allow the sale of cigarettes in Level 4 of the lockdown was rescinded after the National Coronavirus Command Council (NCCC) consulted medical experts and various roleplayers.

The President said this after sections of society implied that Cooperative Governance and Traditional Affairs Minister Nkosazana Dlamini-Zuma had arbitrarily gazetted the ban.

Acknowledging much public comment around the extension, President Ramaphosa highlighted that the continued ban was a collective decision that was made, following careful consideration and discussion.

“Every regulation we have put in place has been carefully considered. Along the way there has been consultation with medical experts, various constituencies and different industries,” said the President.

The President’s comments came as the Fair Trade Independent Tobacco Association (Fita) approached the North Gauteng High Court in Pretoria.

The association, which is an independent non-profit company formed by Southern African cigarette manufacturers demanding a fair trading environment, approached the court with an urgent application to have the ban lifted.

Egbe said the notion that government is overreaching its role in upholding the ban is not accurate.

“I think that some people may be over-reacting. If its smokers saying this I would understand that some of them are going through the stress of trying to quit. Frankly, a lot of disinformation is being pushed by the tobacco industry. I support what government has done because we have a very dire situation in South Africa at the moment,” she said.

In a country with a high prevalence of HIV and Aids, Tuberculosis, substance abuse and alcoholism among others, Egbo believes that government made the right call.

“COVID-19 is a respiratory disease. Before the pandemic, it had already been established that tobacco causes many respiratory diseases, including chronic obstructive pulmonary disease (COPD) and asthma, among others.”

She said government is using the data at its disposal to take precautionary measures to continue to protect South Africa from experiencing the scenes witnessed in countries like Italy.

“I think it’s the right decision on government’s part. It’s not a permanent ban, people must remember that,” she said.

Currently South Africa has a limited number of ventilators and should the number of those needing ventilators spike during the pandemic, the country will find itself in a corner and not be able to help those who need aid.

“We have a little over 3000 ventilators. Imagine if those above 65 years who are smokers, happen to need ventilators. We will need over 10 000 ventilators only for that group alone. That is one of the things that government is trying to avoid. We hope that people will see this as a good reason to quit smoking,” she said.

According to the South African Demographic and Health Survey, about 22% of the population aged above 15 are smokers.

Executive Director of the National Council Against Smoking (NCAS) Savera Kalideen said a number of civil society organisations support the temporary ban on tobacco products.

“Our rationale for that is that the COVID-19 pandemic is an extraordinary health situation that we are going through as a country and globally as well.”

She said research on the pandemic is showing that smokers are more likely to have a more severe form of the disease than non-smokers if they contract it.

“We’ve heard from the Minister of Health Zweli Mkhize that the health profile of many of the people who have died in South Africa from COVID-19 is linked to some of the comorbidities that they had, including issues like diabetes, high blood pressure and cardiovascular diseases. Those diseases themselves, their onset are worsened by tobacco consumption.”

The burden of diseases like diabetes together with COVID-19 lend themselves to South Africa’s health system being placed under tremendous strain.

“We believe that upholding the ban on tobacco sales during the lockdown is a good thing for public health,” said Kalideen.

While many around the country continue to sign a petition calling on government to lift the ban, Egbe poured cold water on the perception that the ban will bring about a spike in the illicit cigarette market.

“I think that the industry is the one pushing that narrative. We’ve always had problems with illicit tobacco in the country. I know that government has been trying to take some measures to curb that. Information from a study conducted by the HSRC [Human Sciences Research Council] shows that only about 12% of people are going to buy illicit cigarettes.”

She said profiteering should not be placed first at the expense of the wellbeing of people.

“Another thing that people need to understand is that when it says illicit cigarette, it doesn’t mean fake cigarette, it means it’s a cigarette that tax was not paid on. It means cigarettes that are cheap,” she said.

Dr Egbe’s comments were echoed by former NCAS Executive Director and tobacco control expert, Dr Yussuf Salojee, who said the costs of tobacco use on the economy are far greater than taxes paid by the industry.

“Its ordinary smokers who pay those taxes. My view is that the ban on cigarette sales and the lockdown will encourage millions of South Africans to stop smoking. The demand for illegal cigarettes will go down,” he said.

Kalideen highlighted that government has room to improve communication on the continued ban.

“I think there should have been better communication on the health motivation for why the ban on tobacco and alcohol. There’s room for better communication. There’s room for that communication to come from people that the population will trust such as health experts, the President and the Minister of Health,” she said.

Salojee was encouraged by the ban.

“The government’s programme is about saving people’s lives and preventing an excessive burden on the national health system. The government’s policy is sensible, rational and is to the benefit of the majority of South Africans,” he said.

Meanwhile, Kalideen emphasised the need for empathy for those who like to puff on a “ciggie” or two.

“They must also use a lot of empathy. The enforcement of the ban has not always been within human rights and legal framework and we cannot run away from that as a country. There had been incidents where people have been treated very badly and their rights not respected,” said Kalideen.

On her thoughts of when the ban should be lifted, Dr Egbe said this could be lifted at a lower scale of the lockdown.

“What we would say is that scientifically the ban should only be lifted at around Level 2 of the lockdown, when we have moderate viral spread and high readiness on the part of the health system.

“Then we should be safe, meaning that the system is ready to take in a slight spike, which is manageable by our health system. Personally, I would say around level 2,” she said.

All three are of the view that the ban provides an opportunity for smokers to wave a final au revoir to their cigarette butt and ashtray.

 “If they’re finding that they really need the nicotine that’s in the cigarette or tobacco products that they use, nicotine replacement therapies are still available in pharmacies and it’s still legal. So they will still get the nicotine drug that they are dependent on without the thousands of harmful chemicals that they would get without the use of cigarettes, e-cigarettes, hookahs or snuff,” said Kalideen.

In addition, the NCAS quit line is available 011 720 3145 while the Cancer Association of South Africa (CANSA) also runs an online programme, which provides support and information for smokers who would like to stop smoking on http://www.ekickbutt.org.za/.

 “We’d also like to remind them that COVID-19 impacts lungs and their respiratory system. If they are able to stay away from cigarettes, even if just for this period, it would have benefits for them so that if they do contract the disease, they will be stronger to deal with it,” she said.

Commenting on the draft Control of Tobacco Products and Electronic Delivery Systems Bill published in May 2018, Kalideen said the bill strengthens the country’s regulations.

The bill proposes new smoking laws including the removal of designated smoking areas in public places.

Kalideen said the current ban responds to the current health pandemic adding that cigarettes remain legal in South Africa.

“The bill is strengthening our regulations, protecting both the smoker and the non-smoker. The bill will introduce the regulation of e-cigarettes which are not regulated at the moment,” she explained.

While e-cigarette smoking in the country is relatively low and the percentage of those who use snuff was only at around 6%, Dr Salojee urged government to pass the bill.

“Many people know that smoking is bad, but they don’t know really how bad it is,” said Salojee.

With the race to find a cure for the virus on, government’s efforts to save lives amidst the COVID-19 pandemic is no smokescreen.