MARCH 11 — Health Minister Khairy Jamaluddin’s announcement in January that a Tobacco and Smoking Control Bill would be tabled in Parliament during this year has been met with a lot of debate, consternation, and hope from many parties.
The bill has been 12 years in the making. Many of the government officers and non-government individuals involved in the original document have since retired, without seeing the fruits of their hard work. Health ministers have come and gone with changes in government, yet despite past promises, the bill remains untabled.
Today, the provisions in the Tobacco Bill are being updated to address a new public health problem: the vaping epidemic which is going out of control.
A vape crisis
The landscape of smoking and tobacco in Malaysia has diversified and evolved over the past decade, and now includes electronic cigarettes (e-cigarettes), heat-not-burn tobacco products, and vape devices using refill containers and e-liquids. Vaping offers a sensation similar to smoking, but supposedly without the thousands of chemicals found in cigarette smoke.
Unlike cigarettes, cigars and other tobacco products, these devices which use heating elements to vaporize both nicotine and non-nicotine liquids, have enjoyed the benefits of being unregulated and untaxed in Malaysia since their inception in 2010.
As a result, this country has grown to be the largest vaping market in the Southeast Asian region, which is currently estimated to be worth RM 3 billion ringgit. Despite Malaysia being one of the biggest exporters of vape e-liquids in the world, the annual volume of nicotine liquids smuggled in is estimated to be equivalent to 12.5 billion sticks of cigarettes. According to the National Health and Morbidity Survey 2019, 1.12 million people in Malaysia now currently vape. The tobacco industry is also slowly taking over the vape industry.
Proponents of vape such as the Malaysian Vape Industry Advocacy and Malaysian Vape Chamber of Commerce like to compare this country to the United Kingdom. But the reality is that the situation in Malaysia is similar to that of the United States, where decades of an unregulated industry have resulted in serious consequences, including teenagers vaping and lung injury.
In the absence of a law, even children and teenagers can currently buy disposable and non-disposable e-cigarettes and vape pens and smoke them. A Ministry of Health study from five years ago showed that at least 600,000 children between the ages of 11 and 18 were already vaping. The numbers of new users today are estimated to be higher and younger. It is not uncommon to now see kids vaping in restaurants, at malls, and even outside school premises. Selling vaping products to anyone aged under 18 and buying vaping products for anyone under 18 must be prohibited.
While e-liquids in the UK cannot contain more than 2% of nicotine, and certain ingredients such as colourings and stimulants like caffeine and taurine are banned, e-cigarettes and vape in Malaysia regularly contain 3% and even 5% of nicotine, similar to those in the US.
In the UK, a manufacturer or importer of e-cigarettes is subject to strict product-safety regulations, including toxicological testing of the ingredients and emissions, and rules ensuring tamper-proof and leak proof packaging. In Malaysia, refilling and concoction of different e-liquids of different colours, flavourings and even nicotine concentration are done in retail shop lots, stalls and even on makeshift drop leaf tables.
Strengthening smoking cessation
Proponents of vape will argue that smokers of combustible tobacco such as cigarettes and cigars will make the decision to switch to e-cigarettes and vape, therefore making progress towards a smoke-free world. They claim that vaping is a form of harm reduction. A pathway towards quitting smoking and curing nicotine addiction.
What we have instead seen are large numbers of people newly taking up vaping, drawn to the colourful, attractive, and youth-centric marketing campaigns, an approach banned for the tobacco industry but not the vape companies.
New vapers, some of whom are not even aware that e-cigarettes and vape devices contain nicotine, are becoming addicted and hooked on to this habit. Far from being a solution to an old problem, it is instead creating a new community of people addicted to nicotine, and in need of treatment.
How about those who transitioned to vape to stop smoking? Despite years of vaping, many continue to struggle as a result of a different addiction, find themselves wanting to quit vaping, and unfortunately unable to do so. Some have even become dual users, smoking both cigarettes and vape. A 2018 study among Malaysian tertiary students found that there were far more dual users, than those who exclusively smoked e-cigarettes. This is rarely acknowledged by vape companies and their supporters. What can now be seen are both smokers and vapers desperately trying to quit.
It is not an exaggeration to say that it is now a major crisis in Malaysian public health, where vape threatens to undermine, not support smoking cessation.
Both smokers and vapers are now looking to nicotine replacement therapies (NRTs) such as nicotine patches and gum for help with their addiction. These smoking cessation aids have decades and hundreds of proven clinical data demonstrating efficacy, thousands of success stories, and medicine grade manufacturing. Research shows that using NRT products increases quit-smoking rates by up to 60%.
At the moment, they remain as dispensed medication at pharmacies and quit smoking clinics. Reclassifying NRTs so that people can easily buy them OTC in the same way cough medicine, paracetamol and chocolate are purchased at convenience shops and supermarkets would help bolster accessibility and support smokers and vapers trying to quit and be treated for their nicotine addiction. Making them available OTC boosts usage, smoking abstinence, and quit attempts.
Generational ban
Malaysia’s smoking prevalence is currently at 21.3%. Implementing the generational smoking ban on those born after 2005 will enable this country to finally make progress in reducing the number of new smokers. Compared to the failed scare tactics of the past using images of shrivelled, charcoaled and cancerous lung tissue, this move combined with a renewed commitment to making smoking cessation aids more easily available, will also make those reductions permanent. This policy will help reduce the number of people stricken with lung cancer. It will lock the gate against new smokers.
Analysts, particularly those who are supporting the tobacco and vape industries, say that the generational ban against smoking cigarettes and vape would be too challenging for Malaysia to implement and enforce.
Will the generational ban work? Honestly, we don’t know. What we know is what will happen if Malaysia does not implement the generational ban. The same situation seen for the past two decades captured in Malaysia’s FCTC (Framework Convention on Tobacco Control) 2020 report to the World Health Organisation will continue to be this country’s future. 45% of men across all age groups will continue to smoke. 17.4% of children aged 13 to 15 will be smokers, and 1 in 10 of those aged younger than 12 will light up a cigarette. Many will be vulnerable to future infectious respiratory diseases such as COVID-19.
Are we comfortable and accepting of this situation?
Implementing this policy is going to be tough but making this first commitment is a critical step forward to address the problem of smoking in Malaysia which has not seen much progress over the past decade.
Countries that are working on the generational ban such as New Zealand and Singapore have their adult smoking prevalence at 13.4% and 10%, respectively. It is not going to be easy for Malaysia. But is that good enough a reason to not try?
We are at a critical inflection point. What kind of Malaysia do we want to see? The Tobacco and Smoking Control Bill is not about the Government or the Minister who will be tabling it. It is not about the Members of Parliament who will be casting their vote. It is not just about smokers, vapers, and non-smokers. This is about a new future for this country. We owe it to our children and their children to make this effort and support the bill so that a different future for Malaysia is possible.
* Azrul Mohd Khalib, is the head of Galen Centre for Health & Social Policy
** This is the personal opinion of the writer and does not necessarily represent the views of Malay Mail.
