SA’s double defeat — smoking up, vaping left unchecked

Every year, on 31 May, the world observes World No Tobacco Day. It is a reminder that tobacco still causes about seven million premature deaths globally each year. Behind every one of those 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 fight against combustible tobacco. The World Health Organization (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 now even considering a tobacco “endgame”, typically defined as a situation where smoking prevalence is so low (often below 5%) that addressing tobacco use is no longer regarded as an urgent public health priority.

The United Kingdom 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 this 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 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 learned to reinvent and repackage its products to hook the young.

For hardened smokers who cannot quit, vaping may offer some value as a cessation tool, though the evidence of this is still 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

SA 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, meanwhile, has spread rapidly among South African youth. A 2024 study across 52 South African high schools found that nearly 17% of learners currently vape.

Among those who do, 38% vape every day, and more than half vape on four or more days a week. Around 88% reported using devices containing nicotine, and 47% said they vape 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 may already be seriously dependent on nicotine.

An outdated and unregulated legal framework

Both failures share a common thread: SA’s legal framework has not kept up. The Tobacco Products Control Act dates from 1993, was last meaningfully amended in 2008, and is now a generation behind the global frontier of tobacco control. The health warnings on cigarette packs date from the mid-1990s, indoor smoking is still permitted in designated areas in many establishments, and point-of-sale tobacco advertising is rampant. The tools that have driven smoking down elsewhere are simply not being used effectively here.

Additionally, outside of a small excise tax, no regulations apply to e-cigarettes. This 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, modernising SA’s tobacco laws and bringing e-cigarettes under regulation for the first time. It is strongly opposed by the tobacco and vaping industries, and that opposition is itself revealing. Strong, well-implemented legislation reduces smoking and vaping. That is good for public health and bad for industry profits.

Rogue industry behaviour facilitated by government

Price is the single most effective tool for reducing smoking, especially among young people, who are most price-sensitive. SA has effectively disarmed itself on this front.

Since 2010, tobacco excise has risen only with inflation, leaving cigarettes no less affordable in real terms for a decade and a half. The National Treasury’s reluctance to push harder reflects a ballooning illicit market that now accounts for around 60% of cigarettes sold in SA. This market was seeded by the 2014 dismantling of specialised SARS units pursuing illicit manufacturers, then supercharged by the government’s ill-considered tobacco sales ban in 2020, which drove legal smokers into the illicit market en masse. Many never came back.

The result is a self-reinforcing trap. Cheap, untaxed cigarettes remain widely available, including to teenagers. The new SARS commissioner’s planned Track-and-Trace system for cigarettes is a meaningful step toward restoring the credibility of excise policy. It is early days, but it is the first serious signal in years that the state intends to reclaim ground it has long since ceded.

A choice for the government

The question for the South African government is whether it will prioritise the health of South Africans or keep pandering to industries whose business model depends on disguising addiction as flavour, innovation and choice.

This is not only a health issue; it is an economic and developmental one. For the millions of South Africans already smoking, every year of policy inertia means more premature deaths, more bereaved families, and mounting pressure on an already stretched public health system.

For the young South Africans now being drawn into nicotine addiction through vaping, it means a health-harming habit that can last a lifetime. On both fronts, the country is paying in deepening cycles of poor health, and a non-communicable disease burden it can ill afford. DM

Sam Filby is a Research Officer at the Research Unit on the Economics of Excisable Products (REEP) at the University of Cape Town. Professor Corné van Walbeek is the Director of REEP.