When I took on the chair of parliament’s portfolio committee on health, I held a view on nicotine regulation that I no longer hold.
The story of how that view changed is more useful to share than any policy argument I might make today, particularly now that the committee has voted to advance the bill and the detailed work of resolving it properly belongs to others.
A few months before I was elected the chair, I had served as deputy minister of health when the tobacco bill was first introduced. From then onwards the committee began its detailed work on it; the scale of what we were trying to address was hard to ignore.
Smoking-related diseases account for an estimated 50,000 South African deaths every year, roughly 7% of all deaths. The case for legislative attention was not the question. The question was what form that attention should take.
I came into the work with what could broadly be called a “harm is harm” view of nicotine products. A cigarette, a vape, a pouch — all delivered nicotine, all carried risk, and all warranted similar treatment under the law. At the time that view seemed logical and consistent. It was also, as I came to understand, incomplete.
The committee’s consultation was deliberately broad. By the time its deliberations on the bill concluded, it had held hearings in 27 municipalities across all nine provinces, drawing close to 7,900 attendees, more than 1,100 oral submissions and some 40,000 written ones — by any measure, one of the most thoroughly consulted pieces of health legislation parliament has handled.
The submissions that stayed with me most came from medical and scientific specialists. As a medical doctor by training, I am accustomed to revising my views when experts in a given area present credible evidence, and the evidence presented during the process was difficult to set aside.
The argument, in essence, was that the harms most strongly associated with traditional cigarettes flow from combustion. Burning tobacco produces the carcinogens that drive smoking-related cancers; nicotine on its own does not. From a regulatory standpoint, that distinction matters.
It means that products which deliver nicotine without combustion, and products which combust tobacco directly, do not sit at the same point on the risk spectrum and that treating them as if they did is a regulatory shortcut rather than a regulatory strategy.
I want to be careful about how far to take that observation here. The detailed architecture of the bill is properly a matter for the current committee and the legislature, and that clause-by-clause work now lies ahead.
What I can say, and what I find quietly encouraging, is that the committee has now voted in favour of the bill’s desirability and, in doing so, endorsed the need to differentiate between combustible and non-combustible products as a guiding principle.
What I hope South Africa is left with is a framework grounded in evidence rather than habit, one that addresses the disease burden honestly, protects the next generation and remains open to revision as the evidence continues to develop
The department of health, in its responses to public comment earlier this year, accepted the same. The motion drew support across the ANC, DA, MK Party, EFF and ActionSA, with a single dissenting vote.
Several jurisdictions are organising their regulation around exactly this kind of distinction: strictest controls where the harm is greatest, regulated pathways for adult smokers who cannot quit, and meaningful protections against youth uptake across the board.
I should be clear that none of this is a personal vindication, and I would not frame it as one. The endorsement of differentiation is the product of the committee’s own deliberations and the weight of the submissions before it. If anything held steady for me even as the specifics of my thinking shifted, it was a few principles rather than any single conclusion.
The first is the order of priorities. Supporting smokers to quit is and should remain the most direct public health objective. Any pathway to lower-risk alternatives is most defensible as a complement to cessation, not a substitute for it.
That ordering shapes what kind of regulation is being built — one that primarily helps people stop, with provisions for those who genuinely cannot.
The second is youth protection. Advertising restrictions, plain packaging, visible warnings and access controls remain essential across every product category.
One practical observation worth flagging is that single-use vaping devices are cheap and easily acquired, while multi-use systems are more expensive and harder to acquire casually. The shape of a market influences who ends up in it, and product design has implications for youth access that go well beyond age verification at the point of sale.
What I take from the process, looking back, is less about any particular policy conclusion than about how the conclusion was reached. The committee’s work was strengthened by submissions that challenged our starting assumptions, and the vote to advance the bill while committing to differentiate between products reflects exactly that.
The willingness to revise an approach in light of better evidence is not a weakness in public service. It is, I would argue, the discipline the work requires.
The bill now moves to clause-by-clause consideration, where the real test lies — review of penalties, enforcement, illicit trade and the practical impact on businesses and consumers will be made. That work is in other hands, and rightfully so.
What I hope South Africa is left with is a framework grounded in evidence rather than habit, one that addresses the disease burden honestly, protects the next generation and remains open to revision as the evidence continues to develop.
• Dr Dhlomo is a former chairperson of parliament’s portfolio committee on health.
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