Health Minister Khairy Jamaluddin’s announcement in January that a Tobacco and Smoking Control Bill will be tabled in Parliament during this year has been met with 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 RM3 billion.
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 currently vape. The tobacco industry is also slowly taking over the vape industry.
Vape proponents 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 vaping among teenagers 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 number of new users today are estimated to be higher, and vapers are getting younger.
It is not uncommon now to see kids vaping in restaurants, at malls, and even outside schools. Selling vape 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 per cent nicotine, and certain ingredients such as colourings and stimulants like caffeine and taurine are banned, e-cigarettes and vape in Malaysia regularly contain 3 per cent, or even 5 per cent 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 at retail shop lots, stalls, and even on makeshift drop-leaf tables.
Strengthening Smoking Cessation
Vape proponents 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, and a pathway towards quitting smoking and curing nicotine addiction.
What we have seen instead are large numbers of users taking up vaping, drawn to the colourful, attractive, and youth-centric marketing campaigns, an approach banned for the tobacco industry, but not vape companies.
New vapers, some of whom are not even aware that e-cigarettes and vape devices contain nicotine, are becoming addicted. Far from being a solution to an old problem, it is instead creating a new community addicted to nicotine, and in need of treatment.
What about those who transitioned to vaping 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 cigarettes and vaping. 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 be seen now is that both smokers and vapers are desperately trying to quit.
It is not an exaggeration to say that it is now a major crisis for Malaysian public health, where vaping 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 of proven clinical data demonstrating efficacy, with thousands of success stories, and medicine-grade manufacturing. Research shows that using NRT products increases quit-smoking rates by up to 60 per cent.
At the moment, they remain as dispensed medication available at pharmacies and quit smoking clinics.
Reclassifying NRTs so that people can easily buy them OTC in the same way that cough medicine, paracetamol and chocolate are purchased at convenience shops and supermarkets would help bolster accessibility.
It would also support smokers and vapers trying to quit, and help them with 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 per cent. Implementing the generational smoking ban for 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 support 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 Organization (WHO) will continue to be this country’s future.
45 per cent of men across all age groups will continue to smoke. 17.4 per cent of children aged between 13 and 15 will become smokers, and one in 10 children below 12 will light up.
Many will be vulnerable to future infectious respiratory diseases such as Covid-19.
Can we accept this situation?
Implementing such a policy will be tough, but making a first commitment is a critical step towards addressing 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 per cent and 10 per cent respectively. It will not be easy for Malaysia. But is that a good enough reason not to 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 votes.
It is not just about smokers, vapers, and non-smokers.
It is about building 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 head of the Galen Centre for Health and Social Policy.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
