This article first appeared in The Edge Malaysia Weekly on December 4, 2023 – December 10, 2023
AT the E-Cigarette Summit UK, held at the Royal College of Physicians in London last month, experts lauded government initiatives for a smokeless future, but they also said these measures should be implemented in stages to curb the growth of a black market.
They said tobacco harm reduction strategies can play a significant role in helping the country work towards a “smoke-free” plan rather than the complete prohibition of all tobacco products.
A speaker at the summit, Clive Bates, director of Counterfactual Consulting Ltd, suggested that e-cigarettes such as vapes, heated-tobacco products and oral smokeless tobacco are among the widely used methods to reduce the harm caused by regular cigarettes. He reckoned that prohibitionist approaches may have unintended consequences that could lead to the growth of a black market for tobacco products.
“I don’t think the Generational End Game (GEG) proposal is the way to deal with youth smoking. The best way to deal with it is to warn about the risk and the problems arising from smoking,” he said on the sidelines of the summit.
Citing the age prohibition method as an example, Bates said it has not been effective in preventing youth smoking. “People get around it. You don’t need to deprive them or stop them. But what we can do is to control the access by regulating the market, including for vape and heated tobacco products.”
In its 10th edition in the UK, the summit brings together scientists, regulators, industry, public health and practitioners to explore and debate the latest research on e-cigarettes.
It is worth noting that countries such as New Zealand and Malaysia were among the early ones to introduce GEG. But one year later, New Zealand’s new government said it will repeal smoke-free laws, including the ban on cigarettes for those born from 2009. The coalition government will tax smoked products and reform regulations for vapes, including a ban on disposable vapes, and increase penalties for illegal sales to those aged under 18.
In Malaysia, the government removed the GEG element from the revised Control of Smoking Products for Public Health 2023 Bill, which was tabled and passed by the Dewan Rakyat last Thursday after two days of debate.
The rationale for removing the GEG component, according to Minister of Health Dr Zaliha Mustafa, is to accelerate the revised bill legislation and enact regulatory control over tobacco and vape products and discourage their use by minors.
A speaker at the summit, Universiti Kebangsaan Malaysia professor of hospital management and health economics and deputy dean Dr Sharifa Ezat Wan Puteh, believes regulatory control over vape products is one of the essential steps to prevent unsafe ingredients and unsafe levels of nicotine from being sold to consumers.
She said while she sees GEG as a good move to prevent youth smoking, an outright ban will spur the black market.
According to the Illicit Cigarettes Study (ICS) in Malaysia report by Nielsen Inc, the incidence of illicit cigarettes at the national level was 56.6% in 2022, one of the highest in the world.
“The issue arises when there is no regulation of vape products because then you don’t know the content and whether they are illegal or legal.
“Legal sellers should have proper labelling that reflects the contents and the nicotine concentration. Some of the respondents that we spoke to don’t even know the nicotine content in vape, meaning there is a risk that you may be taking more than what you get from smoking,” she told reporters on the sidelines of the E-Cigarette Summit.
At the same time, Dr Sharifa urged the government to develop regulations that will take into consideration the harm reduction potential of vape products.
“If you don’t smoke you should not vape. The best is not to use anything, clean air. But if you are hooked on smoking, then you should switch to a safer alternative.
“Multiple independent data from local and international research show that vaping has been proven to be less harmful than smoking and is effective in assisting smokers to quit, she said.
This is especially important as, according to data from the World Health Organization (WHO), in 2020, more than 40% or 4.7 million Malaysian men were smokers. Four in 10 adults, or 7.6 million adults, were found to be exposed to second-hand smoke at home, and four in 10 or 2.3 million adults, were found to be exposed to second-hand smoke indoors at their workplace.
Despite the growing use of e-cigarettes, vapes and heated tobacco products, coming up with laws to regulate this segment is an issue that many countries, not only Malaysia, have yet to address.
The Philippines and Indonesia have made vaping legal while Singapore, Brunei and Thailand have issued a complete ban on vape products. In Malaysia, nicotine liquids and gel are exempted from the Poison Act 1952, making vape liquid easily accessible to the general public over the counter, although the passing of the tobacco bill last week would mean that vape products will be regulated soon.
According to another speaker at the summit, Professor Tikki Pang, former director, research policy and cooperation at WHO, about 30% or 127 million of the adult Asean population are smokers, representing 10% of the world’s 1.25 billion adult smokers. He suggested that tobacco harm reduction should be advocated to Asean policymakers for “regulation, not prohibition”.
“The focus should be on risk-proportionate regulations and policies that improve access for adult smokers to healthier alternatives while limiting youth access.”
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