What Is Known And Unknown About Vaping

Dr Milton Lum highlights the evidence on the impact of vaping. He says Malaysia is highly unlikely to achieve its tobacco control targets (15% smoking prevalence by 2025, <5% by 2045), with the delisting of liquid nicotine and unregulated e-cigarette use.

Smoking cigarettes kills. 

The National Health and Morbidity Survey 2019 estimated that 27,200 deaths annually are due to tobacco smoking. The proportion of current smokers attempting to quit smoking was 52.3% in 2015 and 48.9% in 2019. The exposure to second-hand cigarette smoke at non-air-conditioned eateries was high at 48.1%.

Smoking related diseases contribute significantly to years of life lost by the Malaysian population.

The Health Minister stated in 2022 that estimated cost of treating smoking-related diseases will increase from MYR2.9 billion in 2007 to MYR8.77 billion by 2030.

There has been much public discussion about vaping and its management. This article seeks to address what is known and what is unknown.


Electronic cigarettes, also known as e-cigarettes or vapes, have been around for about a decade. A liquid is heated in an e-cigarette to produce a vapour which can be inhaled. 

They usually contain nicotine, the addictive drug in cigarettes, cigars and other tobacco products. Users inhale the vapour into their lungs. Anyone near a user can also inhale the vapour when the user exhales into the air.  

Some e-cigarettes appear like cigarettes, cigars, or pipes. Others appear like pens, USB drives, and other common items. 

E-cigarettes do not contain tobacco, which is the cause of cancer, chronic respiratory conditions, heart disease, stroke, blood circulation problems, diabetes, infections, infertility, osteoporosis, menopause, hearing and/or vision loss, and dental problems.

Health Effects Of E-Cigarettes

It is difficult for consumers to know what the contents of e-cigarettes are.

The long-term effects of e-cigarettes are still incomplete. However, the current knowledge includes:

  • Most e-cigarettes contain nicotine which is addictive; harmful to the pregnant mother, toxic to the foetus, can harm development of the adolescent brain till the mid-20s.
  • E-cigarettes can and do contain harmful and potentially harmful substances. Apart from nicotine, the substances include volatile organic compounds, heavy metals like nickel and lead, cancer-causing substances, and flavourings like diacetyl, a substance associated with serious lung disease.
  • E-cigarettes have caused unintended injuries. Defective batteries have caused fires and explosions that have caused serious consequences in some instances. Acute nicotine poisoning is toxic with reports of adults and children poisoned by swallowing, breathing or swallowing e-cigarette liquid.

Are E-Cigarettes A Viable Smoking Cessation Tool?

There are many studies which have been inconclusive. 

However, in a September 2022 evidence update on vaping in England, commissioned by the United Kingdom Office for Health Improvement and Disparities, McNeill A et al concluded that “…vaping poses only a small fraction of the risk of smoking and is at least 95 per cent less harmful than smoking (that is, smoking is at least 20 times more harmful to users than vaping)…

“Summarising the relative risks of vaping versus smoking across a range of different products and behaviours and assessed across multiple biomarkers can be simplistic and misinterpreted…this does not mean vaping is risk-free, particularly for people who have never smoked.”

The UK government announced on April 11, 2023 a world-first national scheme to encourage one million smokers to swap cigarettes in a “swap to stop” scheme designed to improve UK health and cut smoking rates. 

About one in five smokers in England will be provided a vape starter kit together with behavioural support to help them quit the smoking habit to achieve the government’s ambition to reduce smoking rates to 5 per cent or less by 2030.

Risk Of Tobacco Smoking Initiation From E-Cigarettes

There is consistent evidence from various reviews and cohort studies that vaping products are implicated in smoking initiation. 

A meta-analysis by the Health Research Board of Ireland in 2020 reported that the association between e-cigarette use and tobacco smoking initiation was four-fold. The European Commission on Health concluded in 2020 that there was strong evidence of e-cigarette use leading to tobacco smoking initiation.

Owotomo et al reported that regardless of United States youths’ intentions, those that used e-cigarettes were 4.6 times more likely to use cigarettes and become tobacco smokers one year later. Osibogun et al reported that current e-cigarette US youths were five times more likely that non-current users to become tobacco cigarette users.

Tobacco Smoking Vs E-Cigarettes

Tobacco smoking is very probably more harmful than e-cigarettes with more negative health consequences, simply because of the difference in the number of chemicals inhaled from each product with 41 chemicals in e-cigarettes and 7,000 chemicals in tobacco cigarettes.

However, vaping has not been harmless. There have been reports of hospitalisation due to e-cigarette and vaping Lung Related Injury (EVALI), an increase in heart attacks in middle-aged males, and associations with pneumonia, pneumonitis, and alveolar damage.

Gross Error

The media reported on April 1, 2023, that through the gazettement of the Federal Government Gazette Excise Duties (Amendment) Order 2023, an excise tax of RM0.40 per millilitre will be imposed on e-cigarettes liquids or gels containing nicotine. 

Liquid nicotine was removed from the Poisons List of the Poisons Act on March 31, 2023, ostensibly to allow for implementation of the excise tax. 

The reason given for this gross error was pathetic, and raises many questions including the failure to distinguish Excise Duties from the Poisons Act, which is to “regulate the import, possession, manufacture, compounding, storage, transportation, sale and use of poisons”.

From April 1, 2023, e-cigarettes containing nicotine can be sold legally to anyone, including children. 

Malaysia’s tobacco control policy targets a smoking prevalence of 15 per cent of the population by 2025, and less than 5 per cent by 2045. Malaysia’s smoking prevalence was 21.3 per cent in 2019 compared to 22.8 per cent in 2015, a paltry decline of 1.5 per cent.

With the removal of nicotine from the Poisons List and the current situation in which e-cigarettes use is unregulated, it would be very probable that Malaysia will not achieve the targets in its tobacco control policy. The Health Ministry has shot itself in the foot.


E-cigarettes have the potential to benefit non-pregnant adult smokers if used as a complete substitute for cigarettes and other tobacco products.

E-cigarettes are not safe for youth, young adults, and pregnant women, and adults who do not currently use tobacco products.

While e-cigarettes have the potential to benefit some people and harm others, there are still significant knowledge gaps about e-cigarettes. Additional research can help us understand the long-term health effects of e-cigarettes.

Readers who have never smoked or used other tobacco products or e-cigarettes are advised not to start.

The Control of Smoking Product for Public Health Bill 2023 is months, maybe a year or so, from coming into effect. Until then, the use of e-cigarettes is totally unregulated. It is a bonanza to those involved in its sales, etc, especially when 14.9 per cent of the young in Malaysia aged 13 to 17 years vape.

It is still not too late for liquid nicotine to be restored to the Poisons List. Better to be safe than sorry.

Dr Milton Lum is a Past President of the Federation of Private Medical Associations, Malaysia and the Malaysian Medical Association. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

You may also like