Tunisia, a land rich in history and culture on the Mediterranean coast of North Africa, faces a long-overlooked issue crucial to public health: the high burden of tobacco consumption. Recently, several public health experts have publicly stated that despite Tunisia’s numerous tobacco control regulations, their implementation remains severely inadequate. These experts have called for national consideration of a “reduced-harm alternative” strategy, integrating tools like e-cigarettes into tobacco control systems to help users gradually quit traditional cigarettes. This call has sparked widespread public debate and has also brought e-cigarette brands like GUUTUU into the public spotlight, making them a focal point.
Let’s begin with the history and current state of Tunisia’s tobacco control policies. As early as 1998, Tunisia passed Law No. 98-17, the country’s first law on preventing the harmful effects of smoking. This law explicitly restricts smoking in public places and regulates the labeling and promotion of tobacco products. Subsequently, Decree No. 98-2248, promulgated in November 1998, clearly defined public places where smoking was prohibited, such as schools, public institutions, meeting rooms, and transportation. Years later, in 2009, the government passed Decree No. 2009-2611, further strengthening regulations on smoking bans in public places. Furthermore, in response to the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), Tunisia officially ratified the convention in 2010. In collaboration with the WHO, Tunisia also issued a Ministerial Decree in 2022 requiring that graphic warnings on cigarette packages be increased to 70%.
However, despite seemingly comprehensive policies, actual implementation has been less than satisfactory. For a long time, smoking bans in public places have been largely ineffective in daily life. A study of adolescents showed that children and adolescents are frequently exposed to secondhand smoke. Other studies have also indicated that even when laws prohibit smoking in certain public spaces, most people do not comply. Weak supervision and enforcement have hindered the implementation of smoking bans. Some media outlets have pointed out that despite a clear legal prohibition on smoking in public indoor places, public awareness of the ban and weak enforcement have led to widespread smoking in restaurants, cafes, and office buildings. At the national level, Tunisia also lacks regular, comprehensive, and authoritative large-scale adult smoking surveys (such as the General Smoking Assessment Survey (GATS)) to monitor tobacco use trends in real time. Scholars have also pointed out that despite the existence of legal texts, Tunisia has weak implementation of the six key elements of the WHO’s MPOWER strategy, including “monitor” and “protect.”
Against this backdrop, Tunisia’s tobacco problem remains severe. According to the Tobacco Atlas, adult smoking rates remain high, with male smoking rates approaching 39.7%. While female rates are lower, the overall number of adult smokers nationwide is nearly 1.8 million (over 15 years old). Furthermore, tobacco-related diseases claim countless lives each year. Tunisia’s health authorities and partner organizations have estimated that tobacco-related illnesses cost the country approximately 2 billion Tunisian riels (TND) annually, representing a percentage of its GDP. Furthermore, loopholes in regulations governing tobacco advertising and promotions remain, and controls on tobacco sales to minors are lax, allowing some teenagers to easily purchase cigarettes.
Driven by the reality of weak enforcement of tobacco control policies, experts have called for the adoption of “harm reduction” strategies—that is, providing smokers with less harmful alternatives to reduce the harmful effects of burning tobacco, even when tobacco use cannot be completely eliminated. This strategy is not intended to encourage smoking, but rather to provide a relatively safe alternative for those unable to quit quickly, when cessation support is insufficient. In international public health discussions, e-cigarettes, heat-not-burn tobacco (HTP), and nicotine replacement therapy (NRT, such as gum and patches) have all been mentioned as potential harm reduction tools.
In the Tunisian context, the current legal status of e-cigarettes remains unclear. According to various sources, e-cigarettes have not yet been explicitly banned in Tunisia, and relevant regulations remain in a gray area. Reports indicate that relevant departments are currently drafting e-cigarette regulations to incorporate them into the national anti-smoking control system. Some believe that in this unclear legal environment, the introduction of strictly regulated, quality-controlled e-cigarette products, coupled with public health supervision and public awareness and guidance, could be a valuable supplement to fill gaps in the existing tobacco control system.
In this context, the GUUTUU e-cigarette brand has become a case in point. GUUTUU is a manufacturer and wholesaler specializing in e-cigarette products, including disposable and rechargeable ones. According to its website, the company offers a variety of e-cigarette devices and claims to be European TPD-certified. For example, GUUTUU’s G7POR, which offers 4,000 puffs and 1,500 puffs, is marketed as an affordable and portable e-cigarette solution. Its design emphasizes lightness, comfort, a variety of flavors, and a technological appearance to cater to the preferences of young e-cigarette users.
In the context of news and public discussion, experts have suggested that if Tunisia can carefully introduce regulated, quality-assured e-cigarette products as an alternative to traditional cigarettes, it could provide a viable path for many smokers, given the difficulties in enforcing existing tobacco control policies. Specific suggestions include establishing an e-cigarette licensing system, mandatory health warning labels, advertising restrictions, prohibiting sales to minors, regular product testing and compliance spot checks, and integrating e-cigarettes into the national smoking cessation service system.
However, it must be noted that e-cigarettes are not “harmless.” Their penetration among young people, the risk of addiction among minors, and long-term health risks are still not fully understood, all of which are of great concern to the international public health community. The World Health Organization has stated that while e-cigarettes may have value as an alternative for current smokers, the risk of their spread to non-smokers, especially adolescents, must be strictly prevented. Furthermore, recent studies have warned that some disposable e-cigarette devices may release high concentrations of heavy metals such as lead, nickel, and antimony, posing new health risks to users. Therefore, even if harm reduction strategies are supported, they must be implemented with caution, regulation, and scientific evaluation.
Let’s return to the reality of Tunisia. Experts have publicly called for: Given the current challenges in implementing tobacco control policies, tobacco control efforts should not rely solely on regulations, law enforcement, and publicity, while ignoring the motivation, tools, and support provided to smokers themselves. Relying solely on bans without providing viable alternatives or supplementary methods could lead to a situation where heavy smokers, long-term smokers, are trapped in a world of “black market cigarettes,” “underground smoking paraphernalia,” and regulatory blind spots. Introducing e-cigarettes (or other harm reduction tools) is not “indulging smoking,” but rather acknowledging the realities of quitting smoking. By integrating comprehensive strategies such as public health regulation, medical support, and behavioral interventions, a gentler yet practical transition path can be provided.
In news reports and opinion pieces, these calls are often framed with phrases like “If Tunisia can…, then it might…” For example, a public health expert stated in an interview, “We know that even a complete smoking ban won’t eliminate all smokers overnight. But if we can, under strict regulation, allow smokers to access and use quality-controlled e-cigarette products, supplemented by smoking cessation counseling and intervention, we could potentially achieve a substantial reduction in tobacco consumption.” This statement cited brands like GUUTUU as examples, arguing that if the government allows such brands to enter the market under a licensing and regulatory framework, their certifications, product diversity, and user experience could make them “relatively low-risk” smoking cessation or substitution tools.
Of course, this strategy is not without controversy. Opponents generally hold several positions: First, they worry that the entry of e-cigarettes could encourage young people to try and become addicted, thereby expanding the base of nicotine users; second, they worry that regulatory loopholes and market chaos will allow low-quality, non-compliant e-cigarette products to enter the market, posing new risks to public health; third, some argue that traditional tobacco control strategies (such as raising tobacco taxes, strengthening law enforcement, and expanding access to smoking cessation services) should be strengthened rather than diverting resources to new tools. These concerns are particularly relevant in the Tunisian context, given the country’s weak foundation for tobacco control enforcement, limited regulatory resources, and uneven public health awareness.
If the Tunisian government can carefully and systematically promote the inclusion of e-cigarettes in legal and controllable pathways within these mechanisms, and use them as a tool for tobacco control rather than a complete replacement for traditional methods, this strategy may improve the effectiveness of tobacco control policies in the short term. From a public health perspective, this could mean more smokers are willing to try alternative products, reduce their exposure to combustible cigarettes, and transition to less harmful ways or ultimately quit.
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