---
title: "Legislative limbo on e-cigarettes must end to close the information gap on health risks"
description: "A survey of South African e-cigarette users has found that conversion to traditional cigarette use had occurred in some people who had no prior history of smoking – but it also found a number of people had quit smoking through vaping. The regulation of e-cigarettes must be implemented urgently, with clear communication of the health risks inherent in their use."
type: "NewsArticle"
publisher: "Daily Maverick"
site: "https://www.dailymaverick.co.za"
section: "VAPING OP-ED"
author: "Kirsten van der Zee"
author_url: "https://www.dailymaverick.co.za/author/kirsten-van-der-zee/"
canonical_url: "https://www.dailymaverick.co.za/article/2023-07-10-legislative-limbo-on-e-cigarettes-must-end-to-close-the-information-gap-on-health-risks/"
published: "2023-07-10T20:55:21"
lang: "en-ZA"
word_count: 918
---

# Legislative limbo on e-cigarettes must end to close the information gap on health risks

> A survey of South African e-cigarette users has found that conversion to traditional cigarette use had occurred in some people who had no prior history of smoking – but it also found a number of people had quit smoking through vaping. The regulation of e-cigarettes must be implemented urgently, with clear communication of the health risks inherent in their use.

By Kirsten van der Zee · Published 10 July 2023, 22:55 SAST

## Key points
- In the 20 years since the first e-cigarette was invented, debates over its role in tobacco addiction and quitting have been raging, with different countries taking varied approaches to regulation - while South Africa's policy response has been slow, a recent survey suggests that 11.3% of urban South Africans have had a history of e-cigarette use, with 33% having never smoked cigarettes before.
- In the 20 years since its invention, e-cigarette use has become popular globally.
- The vaping industry offers a variety of products with a range of flavours.
- There is still much controversy around the product, with observers falling into two major camps.
- South Africa has been slow in its policy response to e-cigarettes, and an excise tax was only implemented in June 2023.

## Content

In the 20 years since the first e-cigarette was invented, it has become relatively commonplace to encounter a marshmallow-scented plume of vapour on a daily runaround.

E-cigarette use has become popular globally; a[recent study](https://archpublichealth.biomedcentral.com/articles/10.1186/s13690-022-00998-w#author-information) that looked at usage on four continents found that regular e-cigarette prevalence is around 11%, with prevalence higher among men than women. The study covered North America, Asia, Europe and Australia/Oceania, finding current vaping prevalence in these regions at 10%, 14%, 11% and 6%, respectively.

The vaping industry has evolved to offer a huge variety of products such as cig-a-likes, vape “pens”, box-sets and disposables. E-liquid flavours range from tobacco (*aromatic, rich*), fruit (*zesty lemon*, *watermelon chill*), menthol (*refreshing mint*), dessert (*unicorn jam,**custard surprise*) to many others (coffees, bakery, and so on).

There is still much controversy around the product.

Observers fall into two major camps. In one camp, e-cigarettes are viewed as a lifesaving alternative for cigarette smokers trapped in deadly tobacco addiction. This argument posits that, compared with regular cigarettes, e-cigarettes are a[less harmful](https://doi.org/10.1186/s12889-021-12103-x) way to deliver nicotine.

In the other camp, e-cigarettes are viewed as a dangerous gateway to tobacco for impressionable youths who might never have picked up the antiquated, offensive and socially unacceptable cigarette.

Opponents of e-cigarettes argue that they are specifically designed to entice young people to purchase them, given their exotic flavours and “hi-tech” feel.

Sceptics reiterate that, for non-cigarette smokers, vaping[introduces](https://doi.org/10.1186/s12889-021-12103-x) harm to health, and e-cigarettes have been used to[deliver other drugs](https://nij.ojp.gov/topics/articles/evolution-and-impact-electronic-cigarettes) such as forms of THC (the psychoactive component of marijuana), methamphetamine and others.

This divergence in thinking is also evident in how policymakers handle e-cigarettes globally. Some countries, like[the United Kingdom](https://www.bbc.com/news/uk-65235343), are banking on e-cigarettes being a tobacco-quitting aid, going so far as to freely distribute e-cigarettes to smokers. At the other extreme are countries that are taking a cautious approach, such[as Australia](https://www.theguardian.com/society/2023/may/03/australia-vaping-ban-import-vape-vapes-crackdown-what-we-know-and-dont-know-so-far), which recently banned the import of vapes.

To date, South Africa has been slow in its policy response to e-cigarettes.

The comprehensive[Control of Tobacco Products and Electronic Delivery Systems Bill](https://www.parliament.gov.za/bill/2307574) intends to regulate e-cigarettes as tobacco products, including prohibiting their use in all enclosed public places, workplaces and enclosed spaces where children are present.

However, the bill has been stuck in a legislative no man’s land since 2018 and is yet to be enacted. An excise tax on e-cigarettes was only implemented on 1 June 2023, at a rate of R2.90/ml of e-liquid.

#### **Survey**

In an effort to shed light on e-cigarette use in South Africa, the Development Gateway and the Research Unit on the Economics of Excisable Products conducted an e-cigarette survey in 2022 as part of the[Tobacco Control Data Initiative](https://southafrica.tobaccocontroldata.org/en/home/ecigarettes/).

The data are representative of adults (18 and older) living in urban South Africa (including metro and non-metro areas). Telephone interviews were conducted with 21,263 respondents, asking about their use of e-cigarettes and conventional cigarettes.

![(Graphic: Supplied)](https://cdn.dailymaverick.co.za/i/xAyA46U3pchR8SSy1a856FxXqwg=/200x100/smart/filters:strip_exif\(\)/file/dailymaverick/wp-content/uploads/2023/07/Screenshot-2023-07-10-at-15.05.58.jpg)

*(Graphic: Supplied)*

Among urban South African adults, 5.8% had experimented with e-cigarettes, 4% were current regular users at the time of the survey, and 1.5% were quitters. This equates to a total of 11.3% who had a history of e-cigarette use.

Regular e-cigarette use was highest among coloured people (8.3%), white people (7.7%) and Indians/Asian people (6.7%), and lowest among black people (2.7%). Males (5.4%) had a higher prevalence than females (2.6%). People living in middle- and high-income areas (5% and 6%, respectively) were more likely to vape than people living in low-income areas (3.1%).

![(Graphic: Supplied)](https://cdn.dailymaverick.co.za/i/R-ZlzUGq826Q_1rRE1S74giUZ7E=/200x100/smart/filters:strip_exif\(\)/file/dailymaverick/wp-content/uploads/2023/07/Screenshot-2023-07-10-at-15.06.35.jpg)

*(Graphic: Supplied)*

There were more young e-cigarette users in urban South Africa than older users. Prevalence in the 18 to 34 age group was substantially higher than in older groups, at between 6.2% and 7.7% (compared with between 1.5% and 3.7% for older groups). The median age that e-cigarette users tried their first vape was 26, and the median age that they started regularly using them was 28. Of current e-cigarette users, 33% had never been cigarette smokers.

![(Graphic: Supplied)](https://cdn.dailymaverick.co.za/i/1tJV9OM4dRp6SzSGSvMjja_RsWY=/200x100/smart/filters:strip_exif\(\)/file/dailymaverick/wp-content/uploads/2023/07/Screenshot-2023-07-10-at-15.06.44.jpg)

*(Graphic: Supplied)*

![(Graphic: Supplied)](https://cdn.dailymaverick.co.za/i/0LNyRqD2bYqhm0sk2PJnVGCirYw=/200x100/smart/filters:strip_exif\(\)/file/dailymaverick/wp-content/uploads/2023/07/Screenshot-2023-07-10-at-15.06.54.jpg)

*(Graphic: Supplied)*

Cigarette and e-cigarette users were grouped by the sequence in which respondents used each product. Of the vapers who had never smoked cigarettes before starting vaping, 19% later started cigarette smoking and 88% of these were still cigarette smokers at the time of the survey. The vapers who had not taken up cigarette smoking at the time of the survey (81%) were at risk of starting smoking later. For the group that had started smoking cigarettes, vaping likely played a role in their smoking initiation.

On the flip side, we looked at people for whom vaping may have played a role in cigarette quitting. Of people who smoked cigarettes, 17.3% were first cigarette smokers who later started vaping, and of these, 13% quit cigarette smoking. Of this group, 35% had also quit vaping at the time of the interview.

Ultimately, the data provide evidence that e-cigarettes are sometimes used as a cigarette-quitting device, but that vaping could also have led to cigarette uptake that might never have happened in the absence of e-cigarettes.

Vapers who have never been cigarette smokers are exposed to the[health risks](https://doi.org/10.1177%2F1179173X221087524) of vaping and may in future take up cigarette smoking.

Given this, the government should regulate e-cigarettes in a way that communicates their potential harm. The bill on e-cigarettes should be passed with haste. **DM**

*Kirsten van der Zee is a research officer at the Research Unit on the Economics of Excisable Products at the University of Cape Town.*