The 20-week sales ban on tobacco products introduced by the South African government in response to the Covid-19 pandemic did not have the intended objective of encouraging large-scale smoking cessation, a study has found.
The paper, published in Tobacco Induced Diseases journal, found that 7,8% of cigarette smokers quit during the sales ban, but 55% of the quitters relapsed after it was lifted. Of the pre-ban smokers, 3,5% indicated that they did not smoke during and after the sales ban, and 3.7% quit after the ban was lifted.
The study by Professor Corné Van Walbeek, Robert Hill and Samantha Filby, based at the University of Cape Town’s School of Economics, used data from wave three of the National Income Dynamics Study-Coronavirus Rapid Mobile Survey (NIDS-CRAM) conducted in November–December 2020.
They first investigated the proportion of people who quit and who continued smoking during and after the sales ban. They also linked the NIDS-CRAM survey to the fifth wave of NIDS (2017) to identify a subset of established smokers and considered whether their quitting behaviour differed from that of all smokers who smoked at the start of the sales ban.
Titled “Quitting behaviour during the tobacco sales ban in South Africa: Results from a broadly nationally representative survey”, the analysis showed that 7% of people who were smoking in 2017 quit cigarettes during the tobacco sales ban, but 70% of quitters relapsed after it was lifted. Only 2% of pre-ban established smokers indicated they did not smoke during or after the ban.
Van Walbeek, director of the Research Unit on the Economics of Excisable Products and lead author, comments: “Before the sales ban was implemented in South Africa, the country already struggled with high levels of illicit trade. Illicit market channels were well-established in the informal market. The sales ban was very effective in shutting down formal retailers as a channel through which smokers could purchase cigarettes. However, the ban proved a boon to informal tobacco outlets, which were able to sell increased quantities of cigarettes at highly inflated prices to desperate smokers.
“With the benefit of hindsight, one can argue that the sales ban was misguided. Yet, in the early days of the pandemic, there were huge uncertainties. The South African government’s precautionary approach thus makes sense. However, the extension of the sales ban beyond the first five weeks of the lockdown seems unjustified.”
Commenting on the unexpected finding that 3,7% of pre-ban smokers quit smoking after the sales ban was lifted, Van Walbeek says this may have been because the tobacco sales ban was implemented in a very stressful period, which would have made it more difficult for the average smoker to quit.
“As time progressed and people became more accustomed to living in the pandemic, the need for stress releasers like cigarettes may have dwindled, leading some people to quit, even though cigarettes, at that stage, were legally available. It might well be that the coercion of the sales ban was counterproductive; most smokers did not respond in the way that the government expected them to do,” he says.
The outcome of the sales ban in South Africa, in terms of the proportion of people who quit cigarette smoking, is disappointing, said Van Walbeek. “The process of quitting smoking is complex and there is no one-size-fits-all quitting mechanism. While a sales ban conceptually may create the right conditions to encourage people to quit, the South African experience showed that if there is a demand for cigarettes, the supply will be forthcoming. This is especially the case when the sales ban is implemented in the context of high levels of illicit trade.
“The fact that cessation support in South Africa is limited and that the government did not provide smokers with any information on how to quit smoking during the ban are policy failures that may explain the low quitting rates of South African smokers in response to the sales ban,” he concludes.