KUALA LUMPUR, August 1 – A new World Health Organization (WHO) global report has erroneously claimed that Malaysia does not have or barely has any smoking bans in public places.
The WHO Report on the global tobacco epidemic 2023 launched yesterday – which covered data until 2022 – categorised Malaysia as having a “complete absence of a smoking ban, or up to two public places completely smoke-free”.
Other smoking ban categories in the WHO report were three to five public places completely smoke-free, six to seven public places completely smoke-free, and all public places completely smoke-free (or at least 90 per cent of the population covered by complete subnational smoke-free legislation).
Malaysia’s level of compliance with smoking bans was categorised as “data not required or not applicable”.
Going into further detail on public places with complete smoking bans, Malaysia was marked as having “zero” indoor places with a complete smoking ban, as well as having seven outdoor places where smoking is banned either fully or partially.
The 2023 tobacco epidemic report by the United Nations health agency claimed that Malaysia does not have smoking bans in government facilities, indoor offices and workplaces, and pubs and bars.
On health care facilities, educational facilities except universities, universities, restaurants, and public transport, the WHO report categorised Malaysia with “no” ban, but with an additional tag: “Smoking is banned and the law does not allow designated smoking rooms, except if the health authority allows them by administrative act. Until now, no such administrative act has been taken”.
Malaysia did not receive a single “yes” in the WHO report across all eight categories of public places on whether there is a complete smoking ban. Compliance levels with smoking bans in Malaysia for all these categories were marked as “data not required or not applicable”.
Other countries in the Western Pacific region, in which Malaysia was categorised, received “yes” in various different categories of public places on whether there are smoking bans.
The WHO report also stated that for Malaysia, smoking is not comprehensively banned in one or more jurisdictions.
In another table comparing countries on additional public places with complete smoking bans, again, the WHO report marked “no” for Malaysia in all categories except one — outdoor children playgrounds or parks — that got a “yes”.
The “no” for Malaysia with a tag — “Smoking is banned and the law does not allow designated smoking rooms, except if the health authority allows them by administrative act. Until now, no such administrative act has been taken” — was marked for these categories: land transport (train, taxi, bus, metro, tram); air transport (plane); water transport (boat, vessel, ferry); indoor waiting areas of public transport (train station, metro station etc.); airports; hotels; prisons; shops (supermarket, shop, shopping mall); and cultural facilities (museum, cinema, theatre, arena). Other countries, on the other hand, obtained a “yes” for various different categories.
On additional characteristics of smoking bans, the WHO report marked “yes” for Malaysia on the requirement to display non-smoking signs in smoke-free places; fines on the establishment for not asking a patron to stop smoking and for not posting no-smoking signs; fines on the patron for smoking; and a citizen complaints and investigations system.
Malaysia was marked “no” for required signs identify a telephone number or other mechanisms for the public to report violations; fines on the establishment for not removing ashtrays; and dedicated funds for enforcement. “No explicit ban on use” was marked for Malaysia for the categories of ban on the use of heated tobacco products (HTPs) and electronic nicotine delivery systems (ENDS) or electronic non-nicotine delivery systems (ENNDS) in public places.
This table on additional characteristics of smoking bans appears to be mostly accurate for Malaysia, except for the ashtray component. Eateries in Malaysia are prohibited from providing ashtrays.
On “no explicit ban on use” of e-cigarettes in public places, although Malaysian health authorities do sometimes take action against people for vaping in no-smoking areas, this is not explicitly prohibited in the law, as the Control of Tobacco Product Regulations only covers cigarettes and conventional tobacco products.
Malaysia has had smoke-free places for nearly two decades since the enactment of the Control of Tobacco Product Regulations 2004 under the Food Act 1983. Section 11 of the 2004 regulation itself prohibits smoking in government premises, air-conditioned eateries, shopping complexes, hospitals or clinics, educational institutions or higher educational institutions, airports, and public vehicles or public transport terminals, among others. Designated smoke-free zones have been increased in Malaysia over the years in amendments to the 2004 regulation.
According to an update as of 2020 by Tobacco Control Laws – a website by US-based International Legal Consortium, a team of lawyers who specialise in tobacco control – Malaysia is 100 per cent smoke free in multiple indoor places, including public transport, government facilities, health care facilities, schools and universities, and restaurants, among others.
In 2019, then-Health Minister Dzulkefly Ahmad expanded the smoking ban from indoor restaurants to open-air eateries.
Malaysia Achieves Highest Level Of Achievement Only For “Monitor” And “Warn”
The WHO Report on the Global Tobacco Epidemic 2023 measured countries’ performance on MPOWER tobacco control measures that were introduced 15 years ago in 2008 to help countries implement demand-reduction measures of the WHO Framework Convention on Tobacco Control (WHO FCTC).
WHO’s MPOWER package comprises:
- Monitor tobacco use and prevention policies;
- Protect people from tobacco smoke (smoke-free environments);
- Offer help to quit tobacco use (cessation programmes);
- Warn about the dangers of tobacco (pack warnings and mass media);
- Enforce bans on tobacco advertising, promotion and sponsorship (advertising bans);
- Raise taxes on tobacco
Malaysia was listed, among other countries, as adopting the following MPOWER measures at the highest level of achievement last year: Monitoring the prevalence of tobacco use, national tobacco control programmes, health warning labels, and anti-tobacco mass media campaigns.
For smoking cessation programmes, advertising bans, and tobacco taxation, Malaysia did not achieve the highest level of achievement, but was placed in these categories instead: nicotine replacement therapy and/ or some cessation services (at least one of which is cost-covered); ban on national television, radio and print media as well as on some but not all other forms of direct and/or indirect advertising; and taxes comprising between 50 per cent and less than 75 per cent of cigarettes’ retail price.
No trend change in the affordability of cigarettes in Malaysia was recorded between 2012 and 2022.
Malaysia, however, scored eight of 10 in compliance with bans on tobacco advertising, promotion and sponsorship, defined in the WHO report as “complete compliance”.
Malaysia’s adult daily smoking prevalence in 2021 was 17 per cent, according to the WHO report; best-practice is categorised as less than 15 per cent. Other ASEAN countries in the WHO’s Western Pacific region achieved best practice, such as Brunei (12 per cent), Singapore (13 per cent), Cambodia (14 per cent). The Philippines and Vietnam respectively reported 16 per cent and 19 per cent adult daily smoking prevalence.
On the year of highest level of achievement in five selected tobacco control measures, the WHO report marked just two measures for Malaysia: 2010 for monitor tobacco use and 2008 for warn about the dangers of tobacco. The measures of protect people from tobacco smoke (smoking bans), offer help to quit tobacco use (cessation programmes), and enforce bans on tobacco advertising, promotion and sponsorship were left empty for Malaysia, denoting that the population was “not covered by the measure at the highest level of achievement”.
Mistake In Claiming Malaysia Bans The Sale Of E-Cigarettes
Besides the obvious errors on Malaysia supposedly not having smoking bans or smoke-free public places, the WHO report also wrongly stated that Malaysia is among countries that bans the sale of ENDS.
Malaysia has never banned the sale of e-cigarettes or vape, as the country does not yet have a law prohibiting or regulating such nicotine products.
Before March 31 this year, the sale of e-cigarette or vape liquids with nicotine was illegal – vis a vis the Poisons Act 1952 – only if these were sold by people who are not medical practitioners or pharmacists.
This was because nicotine was a scheduled Group C poison under the Poisons Act that limited sale or supply to doctors or pharmacists for treatment purposes.
What this means is that the sale and supply of nicotine itself (not e-cigarettes per se) was prohibited outside medical settings; but nicotine (in whatever form, including vape or e-cigarettes, but not tobacco that is regulated separately) could be legally provided by doctors and pharmacists in Malaysia for treatment purposes until March 30 this year.
Last March 31, Health Minister Dr Zaliha Mustafa gazetted an order to remove liquid or gel nicotine used in e-cigarettes and vape from the Poisons List to enable the taxation of e-liquids with nicotine from last April 1, effectively legalising the sale of nicotine vape for all, including minors aged below 18. The WHO report only covers data until 2022.
Methodology: Data Collected From Government Reports, Validated Data Sent To Government For Review And Sign-Off
It is unclear how the mistakes in Malaysia data in the WHO report, particularly on smoking bans, occurred. WHO’s report stated that for all MPOWER measures, data was collected from official reports by WHO FCTC Parties to the Conference of the Parties (COP) and their accompanying documentation. Malaysia is a member of the COP after ratifying the FCTC in 2005.
For the P measure (protect people from tobacco smoke), data was collected from original tobacco control legislation (including regulations) adopted in member states that relate to smoke-free environments.
“For each country, every data point for which legislation was the source was assessed by two expert staff from two different WHO offices, generally one from WHO headquarters and the other from the respective WHO Regional Office,” said the WHO report.
“Final, validated data for each country were sent to the respective governments for review and sign-off. To facilitate review by governments, a summary sheet was generated for each country and was sent for review prior to the close of the report database.
“In cases where national authorities requested data changes, the requests were assessed by WHO expert staff according to both the legislation/ materials and the clarification shared by the national authorities, and data were updated or left unchanged. In cases where national authorities explicitly did not agree with the data, this is specifically noted in the annex tables.”
The erroneous data on smoking bans in Malaysia did not contain any notes that national authorities explicitly disagreed with the data.
In a press release on its 2023 report on the global tobacco epidemic, the WHO said 5.6 billion people, or 71 per cent of the world’s population, are now protected with at least one best practice tobacco control policy.
Almost 40 per cent of countries now have completely smoke-free indoor public places. Two more countries — Mauritius and the Netherlands — have achieved best-practice level in all MPOWER measures, a feat that only Brazil and Türkiye had accomplished until now.
“These data show that slowly but surely, more and more people are being protected from the harms of tobacco by WHO’s evidence-based best-practice policies,” WHO director-general Tedros Adhanom Ghebreyesus said in a statement.
According to the WHO’s press release, 44 countries remain unprotected by any of WHO’s MPOWER measures and 53 countries still do not have complete smoking bans in health care facilities. Meanwhile, only about half of countries have smoke-free private workplaces and restaurants.
