Unpacking complexities surrounding tobacco control policy formulation and tobacco industry interference in South Africa: a qualitative study

During the early post-Apartheid transition of the 1990s, South Africa (SA) rapidly implemented effective tobacco control (TC) measures, but progress has stalled since the 2000s. Smoking rates in SA remain stubbornly high, and there are concerns over increases in young people’s uptake of newer nicotine and tobacco products. In an effort to align itself with international best practices, SA has been in the process of formulating the 2018 draft Control of Tobacco Products and Electronic Delivery Systems Bill over the past few years. However, recent research indicates that the tobacco industry (TI) has been actively attempting to influence TC in SA [1]. Industry actors argue, for example, that the proposed control measures would contribute to illicit tobacco trade, reduce access to “safer” smoking alternatives, and prove ineffective in reducing smoking rates. Despite these challenges, no study has yet examined how the TI deploys its well-established playbook of strategies to influence the formulation of the draft Bill. To gain a deeper understanding of TI influence on policy, our research aimed to investigate how TI actors interfere at various stages of the draft Bill policy formulation process.
We employed a case study approach, involving 20 in- depth interviews, complemented by both academic and ‘grey’ literature. In addition, we applied three established policy analysis frameworks: the Policy Analysis Triangle, Bit in the Middle Framework, and Policy Dystopia Model. These frameworks allowed for a more comprehensive examination of the intersection between TI strategies, the context of the case study, and the various stages comprising policy formulation.
The TI employs a multifaceted approach, which includes efforts to shape policy alternatives, influence impact assessments, lobby policymakers, sway public opinion through campaigns, and cultivate alliances, particularly within the commercial sector. These strategies bear a striking resemblance to tactics observed in other low- and middle-income countries, with unique adaptations to the SA context. This context is marked by political corruption and the legacy of Apartheid, especially with regards to sensitivity around race relations. Industry actors sought to link the draft Bill to other TC policies, such as taxation and illicit trade prevention, for which different government entities are responsible. This linkage creates confusion about the objectives of each TC policy. Furthermore, participants report on the rivalry between multinational corporations and local producers, which further shapes their approaches to interference.
This study emphasises the critical role of TI influence as an impediment to TC progress in SA. Advocates, researchers, and policymakers need to pay attention to the complexity inherent in TC policy, notably between policy content, context and the TI strategies. Rather than viewing a policy in isolation, they must remain vigilant against TI efforts to exploit this complexity during policy formulation. To elucidate this complexity, countering TI influence should entail clarifying the aims of different TC measures and targeting public health narratives at those responsible for them and the wider public to help them understand the benefits of effective TC policies.

DISCLOSURE

The authors report no conflict of interest.

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