South Africa: SA Cannot End TB While Tobacco and Nicotine Addiction Go Unchecked

If South Africa is serious about ending TB, protecting people living with HIV, and safeguarding the next generation from nicotine addiction, Parliament must finally pass the Tobacco Products and Electronic Delivery Systems Control Bill, argues Professor Lekan Ayo-Yusuf, as we mark World No Tobacco Day on May 31.

South Africa has made enormous progress in helping people living with HIV survive and live longer lives. But with that success comes the new challenge of preventing and managing chronic diseases that continue to shorten lives unnecessarily. One of the biggest, and most overlooked, threats is tobacco and nicotine addiction.

This matters not only because smoking causes cancer, heart disease and stroke. Smoking also increases the risk of developing tuberculosis (TB), worsens treatment outcomes, and increases the risk of death from TB.

A seminal report from the World Health Organization and many other studies, including work involving South African researchers, have shown that tobacco smoke and nicotine weaken the immune responses needed to fight TB infection. Emerging evidence suggests that nicotine exposure from e-cigarettes and vaping products may have similar harmful effects on the body's ability to respond to infections.

This is particularly worrying in South Africa, where TB and HIV remain deeply intertwined public health crises. In fact, a recent simulation study suggests that among virologically suppressed people with HIV in South Africa, tobacco smoking decreases life expectancy more than HIV.

Yet instead of urgent action to reduce nicotine addiction, South Africa has witnessed an explosion of vape shops, social media marketing, flavoured disposable vapes laced with high levels of highly addictive nicotine salt, and products designed to appeal directly to young people.

The tobacco and vaping industries insist these products are about "harm reduction". But we have to question what kind of harm reduction strategies recruit teenagers who never smoked in the first place?

Over the past 15 years, few would dispute that South Africa has effectively become a natural experiment in unregulated nicotine product expansion. The results are alarming. Data from South African surveys show rising cigarette and hubbly smoking and rising vaping among young adults, with many people now smoking cigarettes and vaping rather than switching completely away from cigarettes.

There is a strong case to be made that this directly undermines the claim that these products are reducing harm at a population level.

Importantly, the Tobacco Products and Electronic De