South Africa’s double defeat – smoking up, vaping unchecked

Every year, on 31 May, the world observes World No-Tobacco Day. It is a reminder that tobacco causes about seven million premature deaths globally each year. Behind every one of the deaths is a family left wondering why their loved one could not stop smoking in time. The answer almost always comes back to the same thing: addiction. Nicotine is highly addictive. Some studies suggest that it rivals heroin. Most people who have quit smoking will testify that it was very difficult to do so. Many others have tried but have been unsuccessful. This year’s World No-Tobacco Day campaign, Unmasking the Appeal , poses an uncomfortable question: How does an industry that loses millions of customers to premature death every year keep recruiting their replacements? The answer, increasingly, is by targeting young people. Global progress, partly undone The world is winning the older fight against combustible tobacco. The World Health Organisation (WHO) estimates that 20% of people aged 15 and older used tobacco products in 2025, down from about 30% in 2000. This is the result of concerted efforts to denormalise smoking. Most countries have banned tobacco advertising and sponsorship, passed laws preventing smoking in indoor public places and substantially increased excise taxes to make cigarettes less affordable. Many have also introduced graphic pictorial health warnings on cigarette packs and a growing number have adopted plain packaging, which strips all colourful branding from packs apart from the product name. Some countries are even considering a tobacco “endgame”, typically defined as a situation in which smoking prevalence is so low (often below 5%) that addressing tobacco use is no longer regarded as a public health priority. The UK recently passed the Tobacco and Vapes Act , which stipulates that people born on or after 1 January 2009 may never legally buy tobacco products during their lifetime. In 2024, Canada became the first country to require cigarette manufacturers to print warning messages on every cigarette stick, not just on the packaging. But the progress in many countries is being offset by an industry that has reinvented itself. E-cigarettes, nicotine pouches and other novel products are marketed as innovative and less harmful alternatives to combustible cigarettes but their flavours, sleek designs and social media presence are calibrated for one purpose: recruiting a new generation of nicotine users. The WHO estimates that at least 15 million adolescents aged 13 to 15 are using e-cigarettes worldwide and in countries with available data, children are on average nine times more likely than adults to vape. This is not accidental. It is the result of an industry that has learnt to reinvent and repackage its products to hook the young. For hardened smokers who cannot quit, vaping might offer some value as a cessation tool , though the evidence remains contested . There is no equivalent justification for children and young adults who have never smoked to use these products. A habit that looks fashionable today is, for many young people, the beginning of a lifetime of addiction and adverse health outcomes. South Africa: the worst of both worlds South Africa is moving in the wrong direction on both tobacco and vaping. Cigarette smoking prevalence rose from below 20% in 2010 to about 24% in 2021. Vaping has spread rapidly among South African youth. A 2024 study across 52 South African high schools found that nearly 17% of learners vape. Among those who do, 38% vape every day and more than half vape on four or more days a week. About 88% reported using devices containing nicotine and 47% said they vaped within the first hour of waking, a pattern strongly suggestive of nicotine addiction. Based on learners’ vaping behaviour, the study estimates that up to 61% of the sampled high school learners who vape might be seriously dependent on nicotine. An outdated and unregulated legal framework Both failures share a common thread: South Africa’s legal framework has not kept up. The Tobacco Products Control Act dates from 1993, was last meaningfully amended in 2008, and is a generation behind the global frontier of tobacco control. The health warnings on cigarette packs date from the mid-1990s, indoor smoking is permitted in designated areas of many establishments and point-of-sale tobacco advertising is rampant. The tools that have driven smoking down elsewhere are not being used effectively here. Additionally, outside a small excise tax, no regulations apply to e-cigarettes. The regulatory vacuum allows aggressive vape-related marketing, particularly on social media and at retail outlets, to reach adolescents with minimal restriction. The Tobacco Products and Electronic Delivery Systems Control Bill, stalled since 2018, would close both gaps, modernise South Africa’s tobacco laws and bring e-cigarettes under regulation