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E-cigarettes must be regulated to better protect our youth

E-cigarettes first emerged in the US in 2007 and have continued to evolve, with the new generation products featuring sleek, high-tech designs. These products have seen large uptake by the youth and have resulted in skyrocketing youth addiction to nicotine. Data reveals about one in five high school students in the US used e-cigarettes in 2020, many of whom were not smokers in the first place. South Africa’s health experts forming part of the #protectournext movement are sounding the alarm,  concerned that this ‘e-cigarette epidemic’ will soon take hold in South Africa if e-cigarettes are not better regulated. 

“Until the new Control of Tobacco Products and Electronic Delivery Systems Bill is passed in South Africa,  e-cigarettes are in a legislative vacuum, and burgeoning in an unregulated environment,” says Dr Catherine Egbe of the South African Medical Research Council. 

While the electronic cigarette industry argues that e-cigarettes are a valuable smoking cessation tool for smokers, they are aggressively marketed to youth and non-smokers, says Egbe.  Most smokers start smoking in their teens, at a time when they are easily manipulated by aggressive marketing campaigns and feel the need to fit in with their peers. The tobacco and electronic cigarette industry marketing strategies exploit this. 

“It’s obvious that the popularity of these products is growing rapidly in South Africa, especially amongst the youth. Young people can be seen at the counters of sleek e-cigarette kiosks in malls all over the country. Large advertising banners featuring local artists and influencers with youth appeal hang in these centres, also heavily promoted on social media. Many small businesses dealing in ENDS/ENNDS products across the value chain have also cropped up online. Products can easily be sold and delivered to minors.”

New South African studies reveal that 39% of e-cigarette stores are within a 10km radius of a University or college campus, and 65.3% are within a 20km radius of a University or college campus. “We found that living near a vape shop was associated with using an e-cigarette in the past or currently,” says Prof Lekan Ayo-Yusuf of Sefako Makgatho Health Sciences University. “These important findings justify the regulation of lifestyle advertising targeted at the youth and the limitation of access to these products by children.”


Egbe says that e-cigarettes appeal to youth due to their flavouring, sleek high tech devices and ease of use, as there is less initial throat burning than there is with cigarettes. They are also easy to disguise.  However, with up to a pack of cigarettes worth of nicotine in a pod, young people can quickly find themselves inhaling and addicted to large amounts of nicotine, a dangerously addictive drug.“In young people, the amount of nicotine needed to establish an addiction has been estimated at around 5 mg a day, or roughly one-quarter of an e-cigarette pod.”

Egbe cautions that while the attractive bright colours and flavours, high-tech designs and friendly flavours such as ‘cream soda’, ‘bubble gum’ and ‘chocolate donut’ build the perception that these products are safe, a growing body of research indicates that they are not.  Nicotine is harmful to developing brains: younger users are more likely to become addicted, have more difficulty quitting and may be at higher risk for addiction to other substances in the future. 


Studies show e-cigarettes may be causing quantifiable injury to the small airways of the lungs and were associated with a number of inflammatory diseases of the respiratory system, like pneumonia and interstitial lung disease. The first study to link e-cigarette use to cancer was published in October 2019. Other studies also showcased impaired immune cell function in the lungs, raising questions about e-cigarette users’ susceptibility to bacterial and viral infections of the respiratory system. 


Limited or no information about health impacts is provided on the packaging of e-cigarettes, and often the ingredients are not listed to inform consumers about what they are using, says Egbe. “Surely consumers need to know what they are getting and whether it is safe — particularly from a product designed to deliver chemicals by frequent inhalation.”


While the basic technology behind e-cigarettes is consistent, there is enormous variability within the product category and there is no typical e-cigarette, says Egbe. The products include different ingredients, different hardware and deliver highly variable amounts of nicotine and potentially toxic chemicals, including heavy metals such as cadmium, lead, nickel, tin and copper. Nicotine levels in e-cigarettes are highly variable, with some reaching or exceeding levels found in combustible cigarettes.

Dr. Sharon Nyatsanza of the National Council Against Smoking explains that South Africa proposes to regulate e-cigarettes in the same way as tobacco cigarettes through the new Bill.  “Some of the essential regulations applicable to both combustible and e-cigarette products include new advertising restrictions at point of sale, the requirement for plain or standardised packaging and the banning of smoking or vaping areas in restaurants and public buildings.” 


When the Bill is passed, South Africa will join more than 90 other countries that regulate e-cigarettes. 

“The commercial interests of the tobacco and e-cigarette industries cannot be put above the health of our youth,” says Nyatsanza. “We call on government to act with speed to pass the Control for Tobacco Products and Electronic Delivery Systems Bill to ensure that the health of our youth is better protected.”








Topic: QUIT the e-cigarette lies! Plug the regulation gap.

Start Time : Jun 15, 2021 02:32 PM


Meeting Recording:


Access Passcode: #protectournext1


Presentations from the session can be accessed here:



Content / Speakers available for interview:

Debunking the e-cigarette myths 

Dr Catherine Egbe, Specialist Scientist: Alcohol, Tobacco and Other Drug Research Unit

South African Medical Research Council


E-cigarettes, nicotine and adolescent health 
Prof Richard van-Zyl Smit, Principal Investigator, University of Cape Town Lung Institute

Consultant Pulmonologist, Division of Pulmonology and Department of Medicine

University of Cape Town & Groote Schuur Hospital


New SA research on e-cigarettes and youth supports urgent need for regulation 

Prof Lekan Ayo-Yusuf, Deputy Vice-Chancellor – Research, Graduate Studies and Innovation 

Director, Africa Centre For Tobacco Industry Monitoring And Policy Research (ATIM)
Sefako Makgatho Health Sciences University


E-cigarettes and the Tobacco Control Bill 

Dr Sharon Nyatsanza, Project and Communications Manager
National Council Against Smoking (NCAS)




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Smoking is the single most preventable cause of death in the world. The World Health Organisation (WHO) says that in South Africa (SA) alone, smoking results in more than half of lung cancer deaths, 37% of chronic obstructive pulmonary disease deaths, and over 20% of cardiovascular deaths and tuberculosis (TB) deaths. Smoking-related TB deaths are especially prevalent in South Africa, due to a higher vulnerability of HIV-positive individuals to TB.  Because it attacks the lungs, the novel coronavirus (COVID-19) could be an especially serious threat to those who smoke or vape.

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 taking time to implement? Tobacco industry profits are at the expense of addicted smokers, their families, and public health.  Together, the National Council Against Smoking (NCAS), the Cancer Association of South Africa (CANSA) and the Heart and Stroke Foundation of South Africa are steadfast in campaigning for the new Bill to be passed. It’s time for our people and our government to show leadership in implementing global best practice to curb the onslaught of big tobacco. 

Zanele Mthembu, Public Health Development and Policy Consultant

Savera Kalideen, Executive Director of the National Council Against Smoking 

Sharon Nyatsanza, Project and Communications Manager, National Council Against Smoking 

Lorraine Govender, National Advocacy Co-Ordinator, Cancer Association of South Africa (CANSA)

Professor Pamela Naidoo, CEO, The Heart and Stroke Foundation of South Africa

Dr Catherine Egbe, Specialist Scientist: Alcohol, Tobacco and other Drug Research Unit, South African Medical Research Council

Tamaryn Brown
Connect Media for Cart Agency
+27 (0) 84 3510560

Nirvana Kishoon 
Cart Agency
+27 (0) 82 823 3167


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