Tobacco Products Control Amendment Bill: public hearings

HEALTH PORTFOLIO COMMITTEE
30 January 2007
TOBACCO PRODUCTS CONTROL AMENDMENT BILL: PUBLIC HEARINGS

Acting Chairperson: Mr L V Ngculu (ANC)

Documents handed out:
Tobacco Products Control Amendment Bill [B24-2006]
British American Tobacco South Africa
Cancer Association of South Africa Powerpoint presentation
Cancer Association of South Africa submission
Survey detailing the effects of the Bill on restaurant revenues
Fire Protection Association of South Africa submission
Xandra van Biljon (registered nurse) Submission
Dennis Woest: submission on the Role of advertising in smoking
Philip Morris Powerpoint presentation
Swedish Match Powerpoint presentation
Swedish Match submission: Part1, Part2, Part3, Part4, Part5

Audio recording of meeting

SUMMARY
British American Tobacco, which had presented on the previous day, proposed that the legislation should distinguish between smoking and non-smoking tobacco so that information on snus could be made easily available to the public. It now answered questions on the harm sustained by the industry following the control legislation, why health warnings and consumer education were preferred to a total ban, the rights involved in international trade of tobacco, clarity on snus and the suggested wording of the clauses. Further questions related to whether tobacco was a source of biofuel, collaborative attempts to find harmless products, and why snus was presented in similar ways to smoking products. The Committee agreed that snus was a tobacco product. BAT stressed that tobacco was not harmless, but that smokeless tobacco was less harmful than other tobacco. The definition of “brand element” was clarified.

Ms Xandra van Biljon made submissions based on her experience as a nurse. She summarised the activities of the Smoking Cessation Clinics, and commented that the laws thus far introduced had been effective in reducing smoking. She supported non smoking areas in which children were not permitted and non smoking vehicles. She expressed concerns that the “light” branding was misleading. She advocated banning of single cigarette sales. She was concerned at the lack of specialist practitioners in tobacco related illnesses and the lack of specialised training of nurses in this field. She called for funding for smoker counselling and education. Questions related to the addictive nature of nicotine, the relative harm caused by ingestion through the lungs or to the stomach, and her comments on snus.

The Swedish Match company, the leading producer of smokeless products, tabled some of the misconceptions around the South African tobacco market. The properties of Swedish snus were explained, and tabled results of various research into it. Smokeless tobacco was 98% safer than smoking. Snus should be recognised as a smoke free alternative. Sweden, a high user of snus but a low consumer of cigarettes, had significantly reduced health risks. Swedish Match was governed by a voluntary regulatory authority. Nicotine itself was not carcinogenic and substitution of less hazardous tobacco products would separate nicotine addiction from smoking risks. Swedish Tobacco therefore recommended that the Bill should distinguish between smoking and non-smoking tobacco, that the definition of “tobacco product” should either remain as at present or be addressed in the forthcoming Section 76 Bill, and that the Minister’s powers be amended. Questions related to the reasons for the increased use of snus, the effects of nicotine, the crop used for snus, whether it was safe for use by certain individuals, and the reasons why the company no longer produced cigarettes. Swedish Match offered to revert to the Committee with proposed wording for the preamble.

The Cancer Association of South Africa summarised its aims and activities. It was concerned to stop youth taking up the smoking habit. It believed the Bill had positive effects. It made recommendations in regard to public disclosure of the contents of cigarettes, restriction of sales near schools, the recognition of tobacco addiction as a chronic disease, the restriction of smoking in cars, heavy fines for littering and smoke free laws in work and public places. Statistics on health risks, comparative findings in other countries and costs of treatment were tabled. Members supported their input.

Mr Dennis Woest indicated that he had been encouraged to start smoking at age sixteen, due to family and peer acceptance of the habit and because film and media glamorised smoking. This led to addiction by age 19 and cancer of the vocal chords, necessitating a laryngectomy. He welcomed any attempts to prevent the youth from starting the smoking habit and believed the Bill would have positive results. He considered that youth were being exploited by the industry and that non smokers were being harmed by exposure to smoke in public places.

Philip Morris South Africa (PMSA) indicated its broad support for the Bill, emphasising that smoking was dangerous and addictive, and that regulation had a number of benefits for all. It was concerned with the definition of “organised activity”, and called for an exemption for the retail and wholesale tobacco trade, and for exemption on trade only communications. It recommended that manufacturing standards should be amplified in consultation with the tobacco companies. It called for disclosure of information to be treated confidentially. It indicated that it would not oppose the recommendations of the Department of Health in regard to health warnings. Questions by members related to the disclosure of information.

MINUTES
Continuation of discussions on British American Tobacco (BAT) submission on 29 January
Mr David Crow, Managing Director, BAT summarised that the questions standing over from the previous day related to the harm sustained by the industry following the tobacco products control legislation, the reasons why health warnings and consumer education were the preferred tactic over a total ban on tobacco products, comments on the rights pursuant to the international trade in tobacco, and clarity on the definition of tobacco products, since snus had a different harm profile to smoking, and clarity on its scientific details. He had also been asked to suggest what wording should be used in the clauses for which he had suggested amendments.

In answering these questions, Mr Crow said that some people had alleged that the industry had not been harmed by the legislation. However, legal cigarette sales had declined from 38 billion to 23 billion in the last 15 years. A tobacco farm in Paarl had been forced to close with loss of employment. Fewer people were smoking, according to research that surveyed 9000 people. He believed that the legislation was effective. Although the industry has suffered harm, this was justified in balance with the health risks associated with smoking.

Mr Crow said that the total abolition of smoking had been tried before and had failed. He considered that it was far preferable for South Africa to have a known and identifiable industry and subject to regulation. South Africa did have rights to legislate on various trades, but he suggested that it should negotiate with those countries who did not have legislation controlling tobacco products.

Mr Crow conceded that snus was a tobacco product. The existing legislation did not include snus, and BAT felt that consumers should be able to access harm reduced products. He said that some scientists supported access to and some were opposed to snus. The Committee would have to review the facts and not the emotions. He requested that he be permitted to play a video detailing the production of snus.

The Chairperson requested that the video not be played due to time constraints.

Mr Crow continued that a timeframe of three to six months should be set aside to review the science without the emotions of interested parties.

In regard to the wording, BAT submitted a list of suggested definitions to the Bill. Under “organised activity” BAT were requesting the right to communicate with consumers. A more constitutional wording was proposed for “stakeholder”. BAT suggested that “brand element” be updated.

Further Discussion
Dr R Rabinowitz (IFP) asked whether the industry had looked at tobacco as a source of biofuel.

Mr Crow said that BAT itself had not done so, and he was unaware of other research. He agreed it would be an interesting avenue of inquiry.

Mr A Madella (ANC) said that there had been exploitation of tobacco products. The country should not export detrimental products that it was not prepared to consume itself. Since BAT was an industry leader in tobacco, their research was vital, and he asked whether there were any collaborations with other bodies to find harmless products

Mr Crow agreed with the Member but felt that they had a difference in interpretation as to how such export could be implemented. He would welcome a healthy debate. South Africa needed to set high standards for other countries. There was already collaboration and ongoing research in Brazil, Germany and the United Kingdom (UK). Many institutions reacted strongly against working with the tobacco industry. There was also work done with other governments, including Sweden and Japan.

A scientific advisor from BAT added that it was a valid point that BAT should look for reduced exposure products. There was as yet no good definition for this but substantial work was being done with the universities. Tobacco was not risk free, and BAT sought to understand each additive.

Ms M Matsemela (ANC) said that the tobacco industry was not a sole source of government income. She referred to Section 32.2 of the constitution, and said that that clarity was needed on the issues raised.

The Chairperson reminded the Committee of a presentation the previous day outlining the dangers of snus. BAT was indicating that the definition included different types of products. He requested Members to focus on the central issue.

Dr Rabinowitz said that a previous presenter had the opinion that snuff was better than snus, as the latter contained addictive additives. She asked if it would not be preferable then to regulate snus.

The Chairperson noted that Dr Rabinowitz may have missed some presentations, and pointed out that the Committee had also heard that snuff carried other problems and the marketing to black women was also problematic.

Ms Matsemela referred to BAT’s statement in its primary submission that snus contained tobacco. Dr Yusuf clearly said that it was consumed. Clarity was needed. If the product was not burned, there would be no TAR (tobacco aerosol residue). If snus was better, she asked why BAT sought to present it in a container that was emotive of smoking?

Mr B Mashile (ANC) said that there was clear agreement that snus is a tobacco product. He could not understand why it should be excluded from the definition and saw no reason for this.

Mr G Morgan (DA) stated that snus contained tobacco, but was interested in its reduced harm profile. He was sympathetic to Mr Crow’s request that it be treated differently in the Bill. Snus must, however, be regulated. He asked what the practical effect would be if snus was not included in the Bill?

Mr Madella reminded Mr Crow of his opening remarks that tobacco in any form was harmful and therefore any tobacco product, including snus, must be included in the Bill. Smokeless tobacco was less harmful but was not risk free. He commended the industry for protecting children. If snus was not included in the Bill it would be available to children.

Mr Crow agreed with Mr Madella on the definition of the product, and confirmed that snus contained tobacco and nicotine. Since snus produces no TAR, there was reason to believe that it was less harmful to the lungs. It needed to be regulated but if it was wrapped in with cigarettes then this fact would prevent consumer access to a less harmful product. He believed it should fall under separate regulation. With regard to the commercial implications, information about the product could not be freely communicated. Snus carried the risk of harm, but it should be dealt with differently to cigarettes.

The Chairperson felt that this took matters no further, and suggested that perhaps the Committee needed to revisit this issue. He asked the Department of Health to elaborate on the question of ‘brand element’.

Mr F van der Merwe, Legal Advisor, Department of Health (DOH) replied that the current definition of “brand element” was the result of the splitting of the Bill into the Section 75 and 76 aspects.

Dr Rabinowitz said that she had understood the split to related to trade. It was possible to ask industry for comment on how the regulation would differ and for comment on its placement in the Section 76 Bill.

The Chairperson commented that in the absence of Dr Rabinowitz the Committee had already dealt with the 75/76 split. “Brand element” and “organised activity” would be deleted from the Section 76 Bill.

Mr Crow welcomed the debate and pleaded that the anti-smoking lobby groups should join in debate at a further forum.

Xandra van Biljon: Submission
Ms Xandra van Biljon, a Registered Nurse presented her submission, which set out her views based on her nursing experience at the ground level. The consumers of tobacco products invariably ended up in the care of nurses. It was an emotional issue for all. It took a long time for smokers to die of their smoking related complications. Smoking was preventable. She summarised the activities of the Smoking Cessation Clinics that had been operating since July 1999. She believed that the laws had been effective and that if people were required to exert more effort, through the fact that stricter restrictions existed, in order to smoke, it was likely that consumption would decrease.

Ms van Biljon indicated that the instigation of separate non-smoking areas had been positive, especially for children, who should not be permitted in any smoking areas. She was in favour of non-smoking vehicles. She was concerned about the misleading “light” description, stating that smokers who switched to these brands ended up smoking more cigarettes a day. She strongly advocated banning the sale of single cigarettes. She tabled statistics showing that smokers worked less hours a day because they took “smoke breaks”. She also tabled statistics on the instances of smoking. She lamented the fact that there was not a training programme for nurses on tobacco related issues and no specialist skills. She detailed the effects of tobacco consumption on health. She noted with concern that whereas cigarettes were readily available, it took a long time to have nicotine studies concluded and approved, and for approval of safe drugs to assist people to overcome their nicotine addiction. She stated that the method of smoking had changed since many were inhaling more deeply as they were permitted only to smoke during breaks. She called for funding to support smoker counselling and for better consumer education as to the nicotine and additives in cigarettes.

Discussion
Mr Morgan welcomed the viewpoints and asked how difficult it actually was for a smoker to stop smoking.

Ms C Dudley (ACDP) asked for Ms van Biljon’s opinion on the proposed legislation on snus.

Ms van Biljon answered that it was extremely difficult to stop smoking. Nicotine was so addictive that it only took one puff of a cigarette to start a person smoking again after he had tried to quit. She felt that snus was the future of tobacco and had heard of positive health effects to snus. She believed that the Bill should include provisions in regard to the training of nurses.

Ms N Mathibela (ANC) asked whether there was a difference in nicotine being ingested via the lungs or the stomach.

Ms van Biljon said that snus went to the stomach and not the lungs and was safer in this way. Whilst it might have positive effects in moderation, the fact remained that nicotine was addictive.

Mr Morgan said that a person’s home and car were not included in the Bill. She asked if, based on her experience, she had found that smokers were more self aware of where they could smoke.

Ms van Biljon answered that young smokers were not very self aware, but smokers, due their addiction, had to smoke to avoid feeling unwell, and were not sensitive to peripheral issues.

Ms R Mashigo (ANC) suggested that training should not be limited to nursing staff, but should rather be multidisciplinary.

Ms van Biljon said that smoking problems were not necessarily complex, but health professionals were required to commit time and energy. She stressed that there were no smoking specialists in South African hospitals.

The Chairperson noted that this was an issue for the Department of Health.

Swedish Match Company submission
Mr Johnny Ghosal, Managing Director, Swedish Match, reported that his company was the leading producer of smokeless products. It employed over 500 South Africans. He summarised the operations of the company and set out some of the misconceptions in relation to the South African market. He indicated that Swedish snus was a smoke free tobacco product with a unique quality standard, which differed from both American snuff and South African nasal snuff. He believed that while the preamble to the Bill contained correct statements regarding smoking products like cigarettes, roll-your-own and pipe tobacco, it was incorrect in its assumptions about smoke free tobacco like snus. Swedish snus has little effect on the health of the users compared to cigarettes, and the preamble should properly distinguish between smoking and non-smoking tobacco. Swedish Match was also concerned about the wide powers granted to the Minister of Health.

Mr Ghosal detailed that only food-approved ingredients were used in snus. He tabled the results of a number of studies, showing that smokeless tobacco was 98% safer than smoking. He believed the Department of Health (DOH) had provided misleading information and urged that snus should be recognised as a smoke free alternative.

Mr Tomas Hammargren, Group Public Affairs, Swedish Match described the ingredients of snus as tobacco, salt, water and food approved flavours. Sweden had the highest snus use in the world, and consumed as much tobacco as other European countries, yet had significantly reduced health risks, with the lowest lung cancer mortality rate, and second lowest oral cancer levels in the EU. The use of snus was rising whilst cigarette smoking declined. Swedish Match had a voluntary regulation authority to control the quality of snus. He noted that the European Union (EU) had a ban on snus because of an American company who was selling snus in the UK. He maintained that switching to snus helped smokers quit. He pointed out that nicotine was not a cancer producing substance, and that it had similar effects to caffeine. He also stressed that Sweden was the only country in the western world that had reached the World Health Organisation´s (WHO) goal of reducing the percentage of smokers in the adult population to below 20%. Substitution of less hazardous tobacco products would separate nicotine addiction from smoking risks. The majority of snus users would not take up smoking but a significant number of smokers were switching to snus.

Prof Lars Erik Rutquist, Medical doctor, Swedish Match indicated that patients who smoked had higher risks with other medical treatment. Radiation therapy works less well in smokers. A risk study for snus had found no risk from the exposure time. Cigarettes caused particular problems in combination with other substances like alcohol and asbestos. He maintained that not all tobacco was evil.

Swedish Tobacco therefore recommended that the Bill should distinguish between smoking and non-smoking tobacco, that the definition of “tobacco product” should be either kept as it existed at present, or be addressed in the forthcoming section 76 Bill, once further knowledge had been gathered by the DOH. It also recommended the amendment of the Minister’s powers, and deletion of clauses 4(f) and (g).

Discussion
The Chairperson asked whether the increase in snus use arose only because of stricter laws governing smoking.

Mr Hammargren replied that the decrease in smoking was not only due to snus, but that 50% of Swedish males had used snus to quit smoking.

Dr Rabinowitz said that she had understood that the nicotine levels in snus were higher than in cigarettes. She would like to hear precisely what were the harmful effects of nicotine. If Swedish Match were saying that Swedish snus was cleaner than other products, was it implying that snus would be a safer product.

Prof Rutquist replied that nicotine levels must be assessed over a full day, when the nicotine metabolite in the blood would indicate how much nicotine was being absorbed and used by the body. Snus and cigarette nicotine levels in the user were not substantially different, which is why snus, as a replacement product, was preferable to nicotine patches. The effects of nicotine alone were hard to isolate because it was linked to tar. He conceded that the tobacco industry had a bad reputation and that it had manipulated the facts in the past. Swedish Match had high ethical standards and had reduced the production of cigarettes. He urged the Committee to look at the scientific facts. He stressed that snus was not carcinogenic.

Ms Matsemela did not see the distinction between smoking and snus use, and asked if there was any difference in the tobacco crop used.

Ms N Nkabinde (UDM) asked how snus could be said to save lives. She asked whether it would be wise to advise pregnant women or those with heart disease to use it?

Mr Mashile noted that Swedish Match were presenting snus as a replacement for smoking. It appeared to be an old product. He asked whether Swedish Match had ceased cigarette production as an ethical or business decision.

Mr Ghosal stressed that snus was less harmful, not safe.

Prof Rutquist said that pregnant and lactating women should not use snus, just as they should not smoke, but that snus use would be less harmful than smoking.

Mr Hammargren confirmed that snus was a traditional product, especially for Swedish males. Its use as an alternative to smoking was a new concept. He stated that Swedish Match had divested itself of the cigarette manufacturing part of the company purely on ethical grounds, as this had been a profitable part.

Prof Rutquist said there were many ways in which snus saved lives, and said again that nicotine was not carcinogenic.

Mr Ghosal responded that the crops used for snuff and snus were similar. 50% of Swedish Match tobacco came from South Africa. It was believed, although not absolutely proven, that snus was safer than snuff owing to a process of pasteurisation, although Swedish Match produced both. Snus and snuff were completely different products.

The Chairperson noted that both products had nicotine.

Ms Matsemela said that the new Bill required manufacturers of tobacco products to give information to their users. She asked how the smoking and non-smoking references in the preamble should be worded. She also noted that Swedish Match recommended deletion of some clauses, and enquired whether this would permit people to smoke in planes and taxis.

Mr Ghosal said that the smoking/non-smoking wording in the preamble should be clear. He suggested he come back to the Committee later in the day with more appropriate wording.

Mr Hammargren said that snus should not be lumped together with the other tobacco products.

Dr Rabinowitz said that it might be possible to leave this wording and deal with snus differently, perhaps by special exemption.

The Chairperson indicated that he was not in agreement that this was appropriate and might not address the issue.

Cancer Association of South Africa (CANSA) submission
Mr Joel Perry, Director of Health Programmes, CANSA and Dr Carl Albrecht, Research Coordinator, CANSA stated that CANSA was a non profit organisation, formed in 1933 to address cancer research, education and communication about cancer. The aims and activities were summarised, and it was noted that the programmes were run throughout the country, and also targeted rural communities through the primary healthcare model. CANSA had taken special interest in anti-tobacco legislation as tobacco was the single most preventative cause for a range of cancers in users and those exposed to tobacco smoke. It worked with other organisations to stop tobacco and prevent the youth from taking up the smoking habit. It had been involved with DOH in making input into the first Bill and discussing further amendments. It promoted health through school programmes and other communication. CANSA set out what it believed were the positive effects of the Bill. It further recommended that the Bill should make provision for public disclosure of cigarette constituents, restriction of sale of cigarettes at entrances to schools, that tobacco addition be recognised as a chronic disease, that smoking be restricted in cars carrying minors, that littering with tobacco butts be heavily fined and that there be comprehensive smoke-free laws in all workplaces and public places. It welcomed the Bill as endorsing public policies and balancing freedom of enterprise against promotion of health and the rights of citizens to be protected. It believed that the Bill would avoid “window dressing” of ethics by the industry, and ensure that defined deliverables were met. It welcomed stricter limits on accessibility to the most vulnerable minors. A number of statistics on the results of similar measures in other countries were tabled, indicating that public support for the measures grew once the public became more aware of them, and of the statistics on smoking-related diseases and the costs of treatment, which were also presented.

Discussion
The Chairperson welcomed the input by Cancer Association and stated that the Committee agreed with many of the concerns.

Mr Perry urged that people be aware that smoking caused cancer, but also raised the risk of or exacerbated several other medical conditions endangering health.

Mr Dennis Woest submission
Mr Dennis Woest, Motivational Speaker, National Council against Smoking indicated that he had been a 20 to 30-a-day smoker for some 33 years, having begun smoking at the age of sixteen. He started smoking as his family and peers did so, and as smoking was glamorised in films and media. He had tried to stop smoking after three years but had found he was addicted. He finally had to have a laryngectomy as he had cancer of the vocal chords. He had begun to work with smokers attempting to quit and detailed some of their experiences. He was particularly concerned that children between 13 and 15 were already addicted, and believed strongly that youth were being exploited for financial gain of the tobacco industry, and that non smokers were being injured by exposure to smoke in public places. He stated that nicotine was one of the most addictive drugs and had severely negative effects on human health. He would heartily endorse this exercise to address smoking, particularly by the youth.

Philip Morris South Africa submission
Mr G Givishvili and Neetesh Ramjee, Corporate Affairs, Philip Morris South Africa (PMSA) indicated that PMSA welcomed the Bill in broad terms, as smoking was dangerous and addictive. It was clear that the sale and use of tobacco products raised many concerns, and it felt that the regulation of the industry would provide stability and predictability for business and ensure a level playing field, as well as addressing many public concerns. Having expressed support, it then detailed its suggestions for improvement of the Bill.

Philip Morris was concerned with the definition of “organised activity” and believed that a specific exemption should be included for the retail and wholesale tobacco trade, as well as for trade-only communication. It also supported the manufacturing standards provisions in the Bill, but felt that this was a complex field and that the draft should be amplified in consultation with the tobacco companies.

Philip Morris suggested that Clause 4(f), dealing with disclosure of information, should also be refined, to include provision that the disclosure must be treated in a confidential manner so that companies were protected against their competitors.

Other proposals that had been raised by the Department of the Health, but had not been included in the Bill, were also discussed These included restrictions on signs at selling points and the inclusion of graphic health warnings. These would not be opposed by Philip Morris.

Discussion
Ms Matsemela asked why Philip Morris wanted information to be strictly confidential, since the Promotion of Access to Information Act prescribed that information should be accessible.

Mr Givishvili clarified that the company would not wish to disclose to its competitors the figures of spending on consumers. Although it was happy to make this information available to the appropriate persons, it was merely wanting to ensure that the information, which was essentially confidential company information, should not be made available to competitors.

The meeting was adjourned