Tobacco ban: the South African lesson

In March 2020, the South African president declared a state of national disaster to address the Covid-19 outbreak. Between March 27 and August 17, the government temporarily suspended the sale of all tobacco and vaping products. A study published in Tobacco Control reversed this decision by analyzing smokers' behavior following the ban.[1].

Researchers conducted a self-administered online survey of more than 23,000 people, all smokers and over the age of 18. This survey is part of the scientific literature on the " endgame ", referring to different strategies aimed at ultimately reducing smoking to a marginal level, or even eliminating it. As the study highlights, this option being particularly " radical and unprecedented ", it is a question of seeking to identify the preconditions to be met to guarantee the effectiveness of such a measure.

Rising tobacco prices, the main reason for stopping

According to the study, 27% of the smokers surveyed attempted to quit smoking during the sales ban, a third of whom actually succeeded (33%). Thus, in total, 9% of smokers gave up smoking during the observed period. The increase in cigarette prices was the primary reason given for quitting attempts (57%). Indeed, the price of tobacco increased by approximately 250TP3T following the sales ban. For 14% of those who tried to quit smoking, the impossibility of finding cigarettes was cited. Finally, only 11% of those who tried to quit smoking said they did so because of the ban itself.

The sale of tobacco during its ban

Despite the decision to suspend the sale of tobacco and nicotine products, 93% of respondents reported purchasing cigarettes at the time of the ban. Before the ban, 70% of smokers purchased their tobacco through legal channels (tobacconists, retail outlets, gas stations, etc.). Purchasing methods changed significantly during the ban. For example, 27% of those who continued to purchase tobacco reported doing so through friends and family, 25% through small convenience stores, and 11% through street vendors. A smaller proportion reported other sales channels (WhatsApp, cafes, etc.).

South African market escapes tobacco giants

The sales ban also changed the tobacco market in South Africa. Before the decision, 75% of smokers reported smoking brands from the world's leading manufacturers, compared to only 17% at the time of the survey. British American Tobacco (BAT), Philip Morris International (PMI), and Japan Tobacco International (JTI) lost significant market share to local brands. Thus, 48% of cigarettes smoked in South Africa came from the manufacturer BAT before the ban, compared to only 8.7% during the ban. Conversely, this proportion more than doubled for the manufacturer Gold Leaf Tobacco, rising from 12.2% to 26.3%.

Indirect consequences of the ban

While illicit trade was already booming before the sales ban, both manufacturers and traders developed creative methods of illicit trade during the ban. Moreover, the relative fragmentation of the tobacco market, resulting in the rise of local players, could result in a general decline in tobacco prices, which is detrimental to public health. This shift in the center of gravity from multinationals to local producers will not necessarily translate into a better fight against tobacco interference. The world's leading manufacturers were already particularly discredited by the revelation of their attempts to interfere in the South African public debate.

A number of missing conditions for a successful ban

As the study authors point out, the conditions required for the success of the tobacco sales ban were not met. According to the scientific literature on the subject, a sales ban can only be implemented in a situation of low tobacco prevalence, with a smoking rate below 10%. In South Africa, this rate is estimated at 20%. Furthermore, current research suggests announcing the ban well before it comes into effect, allowing smokers to anticipate the measure and possibly support them in quitting. In South Africa, the ban was effective only two days after its public announcement, while smokers did not benefit from any additional support measures.

The need to control illicit trade

Beyond the issue of demand, the issue of supply was not sufficiently anticipated to ensure the success of the tobacco market ban. In particular, the study emphasizes the need for public authorities to be in a position to control illicit trade before banning the sale of tobacco products. The South African situation was far from meeting this fundamental condition. Indeed, the country has still not ratified the Protocol to Eliminate Illicit Trade in Tobacco Products, and dedicated special units were even suspended in 2015 and 2016. In this way, 30% of tobacco products were purchased outside of legal channels in South Africa. Finally, for researchers, this ban can only be effective if it simultaneously prohibits and monitors the tobacco production chain, from its manufacture, its transport to its distribution.

Ultimately, according to the elements identified in the study, a number of essential conditions were not met at the time of the tobacco ban in South Africa to achieve full effectiveness of the measure. As such, the South African experience cannot be considered fully relevant for assessing the effectiveness of such a measure.

[1] Filby S, van der Zee K, van Walbeek C

The temporary ban on tobacco sales in South Africa: lessons for endgame strategies

Tobacco Control Published Online First: 20 January 2021. doi: 10.1136/tobaccocontrol-2020-056209