Intended for healthcare professionals

Feature E-Cigarettes

South Africa’s vaping tax—a bold move for public health?

BMJ 2024; 385 doi: (Published 10 June 2024) Cite this as: BMJ 2024;385:q829
  1. Yemisi Bokinni, doctor and freelance journalist
  1. London
  1. yemisi.bokinni{at}

The introduction of e-cigarette levies will encourage debate on navigating South Africa’s complex terrain of health among its youth, while facilitating smoking cessation more broadly. Yemisi Bokinni reports

Electronic cigarettes, known as e-cigarettes or vapes, pose challenges and opportunities for governments, clinicians, and individuals worldwide. Debate around regulation of the vaping industry is particularly vivid in Africa.

Countries such as Ethiopia, the Gambia, and Uganda have implemented comprehensive bans.1 Legislation is perhaps less contentious in these countries because of their low rates of adult tobacco smokers (around 4%, 10%, and 6%, respectively2). Mauritius, with a 21% rate of tobacco use, has also opted for a total ban.1

South Africa is a major tobacco market within the continent. In 1993 smoking was prevalent among 32% of the adult population3; by 2014 it had dropped to 17.6%,4 a notable public health achievement. However, that number is now creeping up again, owing to instability in the South African Revenue Service. The period of improvement saw the disbanding of a key unit tasked with investigating the illicit tobacco trade. Consequently, the ability of the revenue service to combat illicit trade and collect tobacco excise taxes was severely compromised.5 The market share of illicit tobacco skyrocketed from 5% in 2009 to 58% by 2022.6

This surge in illicit trade, which circumvents tobacco control measures such as taxes, has kept cigarette prices low, undermining efforts to improve public health through more expensive tobacco products. In an environment dominated by such a significant illicit market, the effectiveness of raising excise tax as a deterrent against smoking is markedly diminished.

Recent estimates show that, similar to Mauritius, around 21% of South Africa’s adults are smokers.2 A meta-analysis published in February estimated the pooled prevalence of tobacco use among South …

View Full Text

Log in

Log in through your institution


* For online subscription