South Africa’s parliament is scrutinising new tobacco and nicotine legislation that would throttle harm reduction approaches for its citizens. South Africa has a high prevalence of smoking (25.8% – see chart), especially among men, and low rates of vape use (2.2%). Yet the legislation is designed to obstruct South African citizens from switching from high-risk cigarettes to low-risk vape products.
Source: GATS factsheet, 2022
Why is there such hostility to a strategy that could work especially well in South Africa? Harm reduction relies on consumers and producers acting in their own interests and at their own expense to radically reduce disease risks and improve their welfare and wellbeing. It does not require significant public expenditure or public sector capabilities. The post below, (1) includes links to our analysis of the Bill, (2) raises concerns about the role of foreign influencing operations, and (3) ends with a call for greater transparency.
1. Consultation response
We know of three main tactics promoted by imperious international NGOs and unaccountable foundations in their worldwide war against tobacco harm reduction:
- Prohibition and partial prohibition
- Regulate the same as or more strictly than cigarettes
- Medicalisation and prescription models
The first and second approaches run through the South African draft legislation. The South African group Vaping Saved My Life summarises here:
Our commentary on the draft legislation
- The draft Bill is here: B33-2022 (PDF).
- Consultation details: here (closes 4 September 2023.
- Our 16-page section-by-section response is here: Written submission on the Tobacco Products and Electronic Delivery Systems Control Bill.
Covering email below:
Dr KL Jacobs, MP
Chairperson of the Portfolio Committee on HealthFor the attention of Ms. Vuyokazi Majalamba
By email: [email protected]31 August 2023
Dear Ms. Majalamba,
Please find attached and linked a detailed comment (16 pages) on the Tobacco Products and Electronic Delivery Systems Control Bill [B33 – 2022] from four international experts in tobacco and nicotine policy and science. We have no relevant conflicts of interest, and no issues arise under Article 5.3 of the Framework Convention on Tobacco Control.
In summary…1. We have significant concerns about the Bill as written. It does not differentiate sufficiently between high-risk smoked products and much lower-risk smoke-free products. As written, it appears hostile to the opportunity to reduce tobacco-related harm by encouraging smokers to switch from cigarettes to much lower-risk products.
2. We believe the Bill will likely cause more harm than good, promote the cigarette trade, sustain continued but avoidable high levels of smoking, add to the disease and welfare burden of smoking, encourage dangerous workarounds, and nurture criminal supply chains.
3. Public health in South Africa would be better served by risk-proportionate legislation that encourages and facilitates switching from cigarettes to low-risk smoke-free alternatives while providing safeguards and consumer protection.
We would welcome the opportunity to give oral testimony online, and depending on the schedule, in person if possible.
From the covering email.
David Abrams
New York University
Clive Bates
Counterfactual Consulting, London
Ray Niaura
New York University
David Sweanor
University of Ottawa
2. Transparency and foreign influence
In our response above, we did not raise the question of who has been drafting and influencing the legal text. However, it reads to me like the drafting has been captured by American anti-vaping, abstinence-only interests. However, I can’t say this for sure, as it is always difficult to know who is really influencing what. The best that we can do is press for more transparency.
Examples of foreign influence
First, the most active and well-resourced activist group in South Africa working on the Bill is the Protect Our Next coalition. Though presented as a “citizen-led initiative”, it includes America’s largest and most aggressive anti-harm-reduction organisation, the Campaign for Tobacco-Free Kids.
This CTFK’s international influencing operations are funded by US-based billionaire private foundations.
Our global tobacco control advocacy is supported by the Bloomberg Initiative to Reduce Tobacco Use in low- and middle-income countries, and the Bill & Melinda Gates Foundation, which funds our tobacco control efforts in Africa.
Annual Report 2022
There is nothing necessarily wrong with this, but its role does need to be more transparent. Especially as the leadership in this “citizen-led” group has strong contacts with the Campaign for Tobacco-Free Kids and American tobacco control more generally.
Citizen-led?
The figure below appends LinkedIn information to the key players list on the top line of the coalition’s Our Experts web page. You can’t just call something “citizen-led” if it is led by people who are aligned with or employed by a foreign influencing operation.
Again, there is nothing necessarily wrong here, and it is good for people to gain international experience. However, when an advocacy coalition is described as “citizen-led,” it’s important to know what they mean by that, who is leading the initiative, and what incentives they have.
The Protect Our Next coalition doesn’t seem to have a bad word to say about the Bill. See #passthetobaccocontrolbill and About Us for examples of its enthusiasm for the Bill and impatience for implementation. The Bill is just as they want it – that suggests to me that they were closely involved in its development.
The new Control of Tobacco and Electronic Delivery Systems Bill will make it easier for South Africans to choose smoke-free lives, regulate the danger of e-cigarettes and decrease the impact of second-hand smoke on the majority of the population, who are non-smokers. Why is it taking time to implement?
It’s time for our people and our government to show leadership in implementing global best practice to curb the onslaught of big tobacco.
Protect Our Next: About Us
The reference to ‘global best practice’ is a warning signal. Legislation should be designed for the circumstances, institutional capability, and culture of the country. It looks to me like they are trying to establish ‘model legislation’ that they can promote in low- and middle-income countries (LMICs) and have found a government willing to give them what they want. The reference to big tobacco is a distraction to make their anti-vaping crusade look respectable.
American billionaire foundations have also become close to the Department of Health, funding the GATS survey I mentioned above (see the graphic at the start of this post). See the Global Adult Tobacco Survey 2021 fact sheet (except below)
Again, there is nothing necessarily wrong with a foundation or anyone funding a survey like this, and it is important to have good data – and, as above, I have made use of it. But it does mean that the government is benefiting from money from a billionaire-funded foundation that has a very hostile approach to tobacco harm reduction and low-risk alternatives to smoking.
In South Africa, GATS was conducted in 2021 as a household survey of persons 15 years of age or older by South African Medical Research Council, under the coordination of the National Department of Health
Global Adult Tobacco Survey 2021 fact sheet
It also means that the foundation and its proxies (such as CTFK) are likely to have easier access to the government. If the tobacco industry funded a neutral data survey like this, tobacco control activists would raise the alarm and accuse them of buying influence and access to decision-makers. Why would it be different for foreign foundations?
3. A call for transparency
Governments are supposed to be transparent about any engagement with the tobacco industry: see Guidance on FCTC Article 5.3 Principle 2.
Principle 2: Parties, when dealing with the tobacco industry or those working to further its interests, should be accountable and transparent.
WHO FCTC: Guidelines on Implementation of Article 5.3
Fair enough.
But why shouldn’t Parties to the FCTC also be transparent and accountable about the role of foreign influencing operations? Not least to their own citizens. There is no reason simply to assume that private billionaire-funded foreign foundations would act in the interest of South Africans rather than use South Africa to pursue their own agenda worldwide.
So I suggest three initiatives to improve transparency:
- Parliament insists on transparency about who is representing what interests when they engage with the government and legislators – just as they rightly do with the tobacco industry and commercial vested interests. Foreign funding from private foundations always creates a conflict of interest for civil society organisations.
- Parliament insists on a map of foreign influencing financial flows into South Africa regarding this bill – who is paid by whom to do what, and who is the ultimate source of funds. Who is bankrolling Protect Our Next, and with how much money?
- The government should provide a log of meetings and communications with anyone affiliated with a foreign influencing operation regarding the Bill. If this group is acting on behalf of citizens, then surely there can be no objection if citizens know what it is doing on their behalf.
South Africans, as much as anyone, deserve the best public health legislation, and for it to be drafted in their own interests based on the circumstances of South Africa. They should not become a test bed for extreme or ideologically motivated proposals promoted by unaccountable foreign activist organisations.
Update: how it works
In case anyone in South Africa is thankful for the involvement of American policy mercenaries in their public health politics, this comment from a veteran observer of the Campaign for Tobacco-Free Kids (TFK) should give pause for reflection:
The South African Protect Our Next group exactly follows the M.O. of the Campaign for Tobacco-Free Kids -run pop-up organizations that have appeared in every U.S. city and state that has introduced a vaping flavor ban in the years since Bloomberg Philanthropies dedicated $160 million in 2019 to promote flavor bans. In all the examples I’ve researched, TFK has been the driving force behind these “citizen-run” groups’ formation and activities. They write editorials for local politicians and influencers, recruit local news media as partners, and invariably bury the TFK name in a long list of (mostly local) supporters (insurance companies, hospitals, medical groups, school officials, etc.) on their professionally designed websites. The groups essentially go dark as soon as TFK stops actively working on a bill, either after passage or failure to pass.
Jim McDonald, Vaping 360. Private communication, 5 Sept 2023, published with permission.
This is typical of a certain type of international policy advocacy: the policy and law are the point, not the actual health, social, and economic outcomes. So don’t expect them to stick around to find out what happens in reality. Don’t expect them to take responsibility for growing illicit trade, higher-than-necessary smoking rates, or harms arising from the excessive measures and penalties. Don’t expect the Bloomberg-funded organisations to fund meaningful evaluations, other than to count the number of MPOWER measures in law. Because that’s not what they ever do.
If you doubt that, ask what they are doing to evaluate the prohibition of vaping and heated tobacco in India. Or any anti-harm-reduction policies the Bloomberg-funded complex has supported anywhere.