Picture: KEVIN SUTHERLAND
Picture: KEVIN SUTHERLAND

The murky political history of the cigarette offers a vantage point to locate current debates on the cigarette sale ban in SA under lockdown. It offers the opportunity to dispassionately unpack the puritanical, moral, industrial protectionist and scientific arguments that have been made by stakeholders who have sought to control the national Covid-19 narrative.

Cigarette consumer culture has revolutionised the tobacco industry and influenced global political and economic institutions for 10 decades. To date, tobacco sales have caused 100-million deaths globally. It is estimated in a World Health Organisation report that 1-billion more deaths will occur in the 20th century unless stringent tobacco control regulations are implemented.

Worryingly, the global epicentre of this epidemic has shifted to the developing world, where lax tobacco regulations have caused rising cigarette use among youth.

The Covid-19 narrative is a subtext of bigger interactions involving cigarette companies, the state, public health experts, citizens, advertising executives, smokers and non-smokers, with the very history of the cigarette as a consumer product enmeshed in the complex interactions between these roleplayers. It is also strongly linked to political endorsements. Before World War 1 the cigarette was a maligned product and a target of attack by moral reformers and the temperance movement in the US, where its sale was prohibited in most states.

In the postwar years, the state in most tobacco-producing and manufacturing countries conscripted the tobacco industry to expand global markets for cigarettes. The growth of most postwar tobacco economies stemmed from the alliance between farmers, tobacco merchants and the state in a mutual relationship of “tobacco state-making”.

While the 1964 US surgeon-general report (and medical evidence that followed) finally erased doubt and changed the narrative on smoking on a global scale by linking it to cardiac and respiratory diseases as well as cancer, “Big Tobacco” has continued to sponsor parallel research aimed at refuting medical science and subsidising the myth of “safe” tobacco products.

This criminal network has captured political institutions and corrupted state officials so much that despite the ban on cigarette sales there is a thriving black market

Shockingly now, 56 years after the 1964 report, there is still debate about the debilitating effects of cigarette smoke regarding respiratory failure. This absurdity reflects how “Big Tobacco” controls political levers that set the public opinion agenda, subverts regulations and creates a public relations smokescreen to whitewash its complicity in the biggest public health scandal of our century.   

The dangers of being dragged down the path of scientific medical revisionism in the debate are twofold: the history of public health and the smoking controversy show that tobacco regulation has largely been driven by politics rather than science; and the question of scientific proof must be asked in the context of “Whose science?”. The tobacco industry has a notorious reputation of capturing the scientific research community and sponsoring surrogate scientific research. Now, there is a proliferation of spurious medical research that suggests nicotine contained in cigarettes can be used in the treatment of Covid-19 patients.

The political power that the R30bn SA tobacco industry wields is palpable, while the smuggling and illicit sale of cigarettes is estimated to cost the country billions of rand annually. This criminal network has captured political institutions and corrupted state officials so much that despite the ban on cigarette sales there is a thriving black market. Claims by the government that the ban will reduce demand for cigarettes, cripple the illicit trade and force most smokers to quit underestimates the insidiousness of a problem that requires more pragmatism.

Social contract

The industrial protectionist argument on the loss of tax revenue from cigarette sales and the impact on the economy are grossly overstated. A 2004 World Health Organisation (WHO) report on tobacco and poverty has proven that the public health burden from smoking by far outweighs the revenue accumulated from the industry. Tax revenue from most economic sectors is declining due to the lockdown.

The desperate attempt to frame the debate in terms of smokers’ personal choices and the ban as a violation of the social contract between the state and smokers is also misinformed.

While there is euphoria that “Big Tobacco” has lost the fight as cigarettes remain banned, this is just a Pyrrhic public health victory. Throughout history the tobacco industry has always lost battles but eventually won the war. We need to use this crisis as an opportunity to frame a new national conversation on tobacco regulation and eliminate the tobacco epidemic in the post-Covid-19 era.

• Dr Doro is a postdoctoral fellow in the history department at Stellenbosch University.

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