South Africa is no stranger to complex social and public health challenges. From road safety and substance abuse to food regulation and environmental conservation, policymakers have long recognised a simple reality: human behaviour is not easily eliminated, but its risks can be managed.
This principle is known as harm reduction, and it is neither new nor controversial.
Harm reduction has been embedded into everyday policies. Yet, in certain key areas, such as tobacco regulation, it remains underutilised.
As a pragmatic, evidence-based approach, harm reduction seeks to minimise the negative consequences of human behaviour.
According to Harm Reduction International, the principle focuses on improving health, social and economic impacts of certain behaviours without necessarily eliminating them.
This approach is widely used in public health systems across the world and is supported by a growing body of scientific evidence.
South Africa, among other countries, employs harm reduction across different industries to reduce health, social and economic risks.
In road safety, driving is not banned because accidents occur. Instead, seatbelts, speed limits, airbags and drunk driving laws reduce harm.
In public health, contraception does not eliminate sexual activity; it reduces the risks of unintended pregnancy and disease.
Similarly, alcohol regulations, including age restrictions and blood alcohol limits, acknowledge consumption without mitigating its associated harms, such as addiction, accidents and public health risks, while the use of sugar substitutes and salt reduction strategies reflects a recognition that dietary behaviours are difficult to control or change entirely, but their health impacts can be improved.
Beyond healthcare, harm reduction has also been used in environmental and industrial practices. In climate policy, for example, governments have recognised that moving away from fossil fuels overnight will have immense social and economic consequences.
As a result, they prioritise a gradual, inclusive transition, known as a “just transition”, to protect workers and communities while reducing environmental harm.
SA’s Presidential Climate Commission, guided by the International Labour Organization’s guidelines for a Just Transition (2015), uses stakeholder engagement across government, business, labour and civil society to shape a just transition. It focuses on protecting jobs, supporting skills development and strengthening social protection in coal-dependent regions.
This reflects global climate principles that prioritise fairness and inclusion, as outlined in the Paris Agreement.
These interventions are considered responsible governance and illustrate a consistent policy logic: when behaviours or systems cannot be immediately eliminated, the responsible course of action is to reduce their negative impacts as much as possible.
Despite these glaring examples of intentional harm reduction approaches, SA’s proposed Tobacco Products and Electronic Delivery Systems Control Bill appears to favour a rigid, prohibitionist, abstinence-based framework.
The intention to protect public health is certainly commendable; however, it risks overlooking the behavioural realities of humans and the socio-economic context.
Evidence shows abstinence-only strategies often fail to achieve the desired outcomes, particularly in environments with entrenched structural inequalities and behavioural drivers.
By contrast, harm reduction approaches have been shown to improve public health outcomes as they do not require complete cessation.
In South Africa policy frameworks such as the National Drug Master Plan (NDMP), which treats substance abuse as a public health issue rather than a criminal activity, reflect this understanding.
The NDMP promotes integrated, evidence-based interventions, such as needle and syringe programmes, to reduce harm while addressing the underlying socio-economic drivers, recognising a prohibitionist stance can exacerbate harm instead of reducing it.
In the current tobacco debate, the perception that harm reduction is a recent invention or marketing strategy and that vaping is the same, if not worse, than combustible cigarette smoking, are key challenges.
Neither of these is supported by evidence. As has been shown, harm reduction is a long-established approach grounded in science and human rights. While vaping and cigarette smoking involve nicotine delivery, their risk profiles are vastly different.
Current policymaking does not distinguish between these two approaches, risking access to potentially lower-risk alternatives. Where science indicates differential risk, regulation must reflect this.
In the end, harm reduction must be viewed from a broader lens: it is not about endorsing bad or harmful behaviours, but about reducing their consequences.
Applying the same principles to tobacco regulations as are used in road and food safety, environmental management, and drug policy provides a more balanced and effective approach.
This means moving beyond prohibition and adopting nuanced, risk-based policies that prioritise public health and individual agency.
For SA, including harm reduction within its policy frameworks can be the key to unlocking significant public health and socio-economic benefits.
- Gcoyi is CEO of the Vapour Products Association of SA
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