No e-cigarette has been approved as safe or effective by the US Food and Drug Administration for smoking cessation. (Photo:/ iStock) 
Despite the millions of deaths caused by its products each year and the impact on countless others whose health is irreparably damaged, the tobacco industry continues to aggressively push its propaganda targeting governments and enticing consumers to accept new forms of harmful tobacco and nicotine products, while attempting to delay legislation to regulate them.
These products are misleadingly marketed as “safer” alternatives to traditional tobacco. By repackaging harm under the guise of innovation, the industry seeks to keep users hooked while recruiting new generations to nicotine addiction.
Having now accepted the undeniable evidence of the deadly consequences of tobacco use after many years of denial, the industry now claims to support efforts to help people quit smoking. However, its actions tell a different story. It continues to manufacture more than five trillion cigarettes annually and is actively expanding its operations, particularly in low- and middle-income countries.
A key tobacco industry tactic to mislead regulators while attracting new users is the introduction of new tobacco and nicotine products. These include heated tobacco products, vapes (e-cigarettes), snus and oral nicotine pouches.
These products represent the future of the industry – an insidious plan to replace the millions who die or become ill from traditional tobacco use, and those who succeed in quitting for good, ensuring the continued flow of profits at the expense of human lives.
The latest wave of so-called harm reduction products are marketed as tools to help those unwilling or unable to quit smoking. However, the industry often downplays a critical fact: these products contain nicotine, a highly addictive substance derived from tobacco or synthetically produced in the lab, for which there are claims placing it at the same level as cocaine and heroin due to the high risk of addiction and speed with which it gets to the brain.
Exposure to nicotine, particularly during adolescence, can interfere with brain development, causing long-term harm and a possible lifetime of addiction.
Contrary to industry rhetoric, no nicotine product is harmless. No e-cigarette has been approved as safe or effective by the US Food and Drug Administration for smoking cessation.
E-cigarettes (vapes) deliver nicotine through an aerosolised liquid often flavoured to attract younger users. Nicotine salts used in some of these products allow for faster absorption of nicotine into the bloodstream, making them particularly potent and even more addictive. Flavours are added to mask emissions and reduce the harshness of inhalation, also making it easier for young people to initiate and continue to use these products.
These products contain dangerous ingredients like formaldehyde, diacetyl, acrolein – a chemical known to cause irreversible lung damage – and heavy metals like lead. Using electronic nicotine delivery systems (ENDS), which allow consumers to increase the temperature, creates an opening for even more dangerous chemicals to be produced as the e-liquid is aerosolised.
Snus, a smokeless tobacco product, contains harmful substances such as heavy metals, polyaromatic hydrocarbons, and tobacco-specific nitrosamines. Studies have linked frequent snus use to a threefold increase in throat cancer risk and a doubled risk of pancreatic cancer. Snus also has a detrimental impact on oral health, being strongly associated with gum bleeding.
As research mounts on the negative health impacts of e-cigarettes, the World Health Organization asserts that these products are not harmless and should be regulated with the same stringency as traditional tobacco products, if not banned outright. Countries that have effectively regulated access to ENDS, such as Australia, or banned e-cigarettes, such as Uganda and Brazil, have achieved better protection of the young population from initiating use than those that have embraced them with fewer restrictions, such as England.
South African research echoes global concerns about e-cigarettes acting as a gateway to tobacco use, particularly among young people. A study conducted by the University of Cape Town among those who have used both cigarettes and e-cigarettes found that about 77% of them have either returned to smoking cigarettes alone or become dual users of both e-cigarettes and traditional cigarettes. About 56% were found to use both.
Research also shows that, rather than helping South African smokers quit, e-cigarettes may actually reduce long-term quit rates and increase nicotine dependence. Studies concur that many users of e-cigarettes continue to smoke conventional cigarettes, rather than using e-cigarettes as a replacement. This dual use not only maintains nicotine dependence but also exacerbates the health risks associated with smoking, since users are exposed to harmful chemicals from both types of products. Dual use has been found to be more dangerous than using either product.
Ultimately, the tobacco industry’s claims of harm reduction are nothing more than a smokescreen to sustain its profits, regardless of the human cost. Whether through traditional cigarettes or new nicotine products, the dangers of tobacco and nicotine remain unchanged. It is crucial to remain vigilant against the industry’s relentless efforts to prioritise profits over people’s lives, and tobacco control legislations must evolve to keep pace.
Passing the Tobacco Products and Electronic Delivery Systems Control Bill in South Africa is an urgent necessity. This legislation will close critical loopholes, regulate harmful products and send a strong message that the health and wellbeing of our citizens, especially our young people, take precedence over the profit-driven motives of the tobacco industry. We cannot afford to delay any longer. DM
Professor Catherine Egbe is a senior specialist scientist in the Mental Health, Alcohol, Substance Use and Tobacco Research Unit (Mastru) at the South African Medical Research Council (SAMRC).