Circumvention of COVID-19-related restrictions on tobacco sales by the e-cigarette industry in South Africa and comparative analyses of e-cigarette vs cigarette volume sales during 2018-2020.

Abstract

As a public health measure against COVID-19, South Africa restricted the sale of tobacco, e-cigarettes and related products for 5\u202fmonths, ending on August 17, 2020. We examined e-cigarette marketing activities during this restriction. Using web scraping, we accessed data for 2661 e-cigarette liquids marketed online by South African vendors in June 2020. We also analyzed e-cigarette volume sales (complete kits) using retail scanner data. The 2661 e-cigarette liquids assessed comprised cannabidiol liquids, 28.8%[767/2661], nicotine salts, 10.4%[276/2661], e-cigarette juice concentrates, 14.1%[376/2661], nicotine-free e-liquid, 4.0%[107/2661], and nicotine-containing e-liquid, 42.6%[1135/2661]. Cannabidiol liquids had the highest percentage of fruit (78.4%[601/767]) and tobacco flavors (9.4%[72/767]). During the restriction, many online e-cigarette vendors actively promoted cannabidiol liquid in lieu of regular e-liquid. Volume e-cigarette sales in February 2020, preceding the restriction (7.76 million kits), were higher than in February 2019 (4.52 million kits). The restriction saw decreased e-cigarette sales; mean weekly e-cigarette sales in the 6\u202fweeks following the restriction (772,585 kits/week) was dramatically lower versus the 6\u202fweeks preceding the restriction (2.26 million kits/week). Lifting the restriction saw a 131% spike in sales between the latter half of August 2020 (825,638 kits) and mid-September 2020 sales (1.90 million kits), even though total sales in September 2020 were half of what was observed in the preceding year (3.81 million units in September 2020, vs 6.33 million units, September 2019). The marketing of cannabidiol by e-cigarette manufacturers may perpetuate e-cigarette use without net public health gain, especially if it encourages youth use; close monitoring is required.