Expert Urges Harm Reduction Approach in South Africa’s Tobacco Legislation
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Cape Town – South Africa’s proposed Tobacco Products and Electronic Delivery Systems Control Bill (B33-2022) should adopt a harm reduction framework to effectively address tobacco cessation and public health outcomes, argued Prof. Monique Marks of Stellenbosch University during a briefing to the Parliamentary Portfolio Committee on Health on June 19, 2025.
Prof. Marks, a research fellow, social worker, and health coach, emphasized that an “abstinence-only” approach to tobacco control has proven limited and often fails to acknowledge the complex realities of nicotine addiction. She advocated for a pragmatic strategy that prioritizes reducing disease and death, not merely focusing on usage metrics.
Key principles of harm reduction highlighted by Prof. Marks include:
- Health & Dignity First: Prioritizing well-being over strict abstinence and respecting individual choices.
- Pragmatic Interventions: Implementing practical, evidence-based solutions that reduce negative health impacts.
- Lived Realities: Designing services around real needs and meeting users where they are in their cessation journey.
- Autonomy & Choice: Empowering individuals to make informed decisions about their health.
Prof. Marks underscored that tobacco use is often a complex interplay of biological addiction and coping mechanisms, particularly for vulnerable populations facing stress, stigma, or trauma. She asserted that harm reduction bridges equity gaps by creating accessible pathways to care for marginalized groups, including the homeless, low-income individuals, and those with mental health conditions, who often face significant barriers to traditional cessation services.
The presentation also addressed the “public health quandary” in harm reduction, which involves balancing reduced harm for current users against potential new uptake, managing access to alternatives, and protecting youth while helping adults.
Prof. Marks presented “Imperatives for the new tobacco legislation,” urging policymakers to:
- Embrace Scientific Evidence: Base policies on robust research rather than fear or misconceptions.
- Adopt Risk-Proportionate/Harm Reduction Regulation Framework: Regulate products based on their actual risk profile.
- Monitor Outcomes: Continuously track public health impacts and adjust policies as needed.
- Protect Youth While Helping Adults: Design policies that prevent youth initiation while providing effective support for adult smokers.
She cited examples like the UK, where a harm reduction approach to vaping has shown significant potential in reducing smoking-related diseases and mortality. Prof. Marks concluded by advocating for the inclusion of harm reduction principles as a “public health imperative” within the bill, aiming to improve the health and well-being of all South Africans.
