E-cigarette Use and Regulation in South Africa: a Synthesis of Evidence in Response to Industry Efforts to Undermine Product Regulation

Purpose of Review: This narrative review of the published scientific literature on e-cigarettes in South Africa examines and responds to reports commissioned by the e-cigarette industry about proposed regulations in South Africa. Recent Findings: The results of a nationally representative study suggest that the number of e-cigarette users is much larger than the number provided by the industry-commissioned reports. Contrary to industry claims, e-cigarettes are more expensive than regular cigarettes and the proposed regulation, the Control of Tobacco Products and Electronic Delivery Systems Bill, which aims to regulate e-cigarettes as tobacco products rather than as medicines would benefit public health. Furthermore, the government’s proposed tax on e-cigarettes would generate much-needed revenue for the government and reduce e-cigarette uptake by youths. Summary: E-cigarettes were introduced to the South African markets about a decade ago. E-cigarette consumption has grown exponentially without a commensurate decrease in cigarette smoking. Yet, e-cigarettes are not yet regulated as tobacco products as the e-cigarette industry continues to aggressively lobby against the passing of a proposed legislation that would have achieved this. This legislation, the “Control of tobacco products and electronic delivery systems bill”, is yet to be passed into law over 4 years after its inception. This narrative review was conducted on peer-reviewed South African literature on e-cigarettes up to December 2021, supplemented by a search of the grey literature, government publications, and industry-commissioned reports. We found that reports commissioned by the e-cigarette industry misrepresented the potential impact of restricting e-cigarette advertisements and promotions. Furthermore, by underestimating the prevalence of e-cigarette use in the population, these reports also attenuated the revenue-generating ability of potential e-cigarette excise taxes as proposed by the South African National Treasury Department. The regulation of e-cigarettes would benefit public health in South Africa.