KUALA LUMPUR, Dec 6 — The first year of Prime Minister Anwar Ibrahim’s administration ended with the Dewan Rakyat passage of the Control of Smoking Products for Public Health Bill 2023.
Instead of being celebrated as a momentous piece of legislation that is set to be Malaysia’s first standalone tobacco and vape control Act, pending passage in the Senate, public health experts and health care professionals denounced the bill as a “black mark in the history of public health policy development” in Malaysia.
They attributed the decoupling of the generational smoking ban, or GEG, from the anti-smoking bill to the government’s acquiescence to lobbying from the tobacco and vape industry.
Dr Zaliha Mustafa – appointed to Anwar’s Cabinet a year ago on December 2, 2022 – was also the first health minister in the history of Malaysian anti-tobacco litigation to be sued by health groups, after she removed liquid nicotine from the list of scheduled poisons under the Poisons Act 1952 last March 31.
This was to enable excise duties on e-cigarette and vape liquids with nicotine at 40 sen per ml from last April 1, even though the declassification of liquid nicotine effectively legalised the sale of nicotine vapes to children and teenagers aged below 18.
Hence, on the last day of the Dewan Rakyat meeting last Thursday, parliamentarians were forced to approve the Control of Smoking Products for Public Health Bill, despite heavy reservations, to close the lacuna in the law.
Many MPs, on both sides of the divide, had condemned the exclusion of the GEG proposal from the bill to prohibit the sale of tobacco and vape products for anyone born from 2007.
Dzulkifli: Government Performance On Tobacco And Vape Control ‘Dismal At Best’
The Anwar government’s performance over the past year on tobacco and vape control – including its handling of the Control of Smoking Products for Public Health Bill and the GEG policy – was “DISMAL at best”, said Prof Dzulkifli Abdul Razak, professor emeritus and rector of International Islamic University Malaysia (IIUM).
“Many promises were made with full certainty, only to be let down at the very last minute in the most disappointing way,” Dzulkifli, a neuropharmacologist and recipient of Malaysia’s Tobacco Control Icon Award 2023, wrote to CodeBlue.
“Communication is poorly handled, if at all. Key decisions arrived at were mostly opaque, undemocratic, and morally insensitive. This was apparent most recently when fellow minister(s) in the government exhibited utter ignorance about cancer and smoking, without the Minister of Health clarifying the issue.
“Respect to evidence-based sciences are wanting in preference to political convenience and survival at the expense of the rakyat including those below the age of 18 years and below,” Dzulkifli wrote to CodeBlue.
Dr Zaliha told the Dewan Rakyat during debate last Thursday that the decision to decouple the GEG from the Control of Smoking Products for Public Health Bill was a “collective” decision by the government.
The health minister cited the Attorney-General’s Chambers’ (AGC) view that the generational smoking ban could be challenged in court because it violated Article 8 of the Federal Constitution that guarantees equality before the law.
Ikram Health Malaysia, a non-profit comprising health care professionals, said in a statement that it and other health groups were never informed about the government’s decision to drop the GEG.
When Tourism Minister Tiong King Sing accused former Health Minister Khairy Jamaluddin, who had brought the GEG bill to Parliament last year, of failing to prove that smoking cigarettes causes cancer, Dr Zaliha did not publicly correct her Cabinet colleague or show Tiong decades’ long research proving the link between smoking and cancer.
Dzulkifli said all forms of tobacco and vape control must come into place “first thing” next year. The former member of the World Health Organization’s (WHO) Scientific Committee of Tobacco Product Regulation (2004-2006) stated that tobacco and vape control is not new, nor is it “as difficult as rocket science”.
“Many countries have achieved success; there’s no reason we cannot do the same. At the very least, it cannot be worse off from the pre-April 1, 2023 situation.
“On record, the Minister of Health is the first to be sued in this issue! It speaks volumes.”
Haniki: Malaysia Left With ‘Lose-Lose Situation’
Prof Mohamad Haniki Nik Mohamed, a pharmacist and professor at International Islamic University Malaysia (IIUM), alleged that the GEG was traded for Big Tobacco and Big Vape profits.
“It was the carrot dangled by the previous health minister to NGOs (non-government organisations) when the previous government also wouldn’t ban vaping, citing economic benefits as the main reason.
“What are we now left with? A lose-lose situation,” Haniki, who is chief coordinator of the Certified Smoking Cessation Service Provider at IIUM, wrote to CodeBlue.
“We lost earlier on to ban vape like our neighbours Singapore and Thailand. Now, we lost again when GEG was dropped from the newly approved Tobacco Control Act. With no aggressive approach, [it is] unlikely Malaysia will reach the target smoking prevalence of 15 per cent by 2025 and less than five per cent in 2040.”
Haniki noted that Malaysia has not made any significant improvements in reducing smoking and vaping prevalence. Malaysia’s current smoking prevalence was 21.3 per cent in 2019, the most recent data available; four in 10 male adults aged 15 and above currently smoke.
As for vaping prevalence, the prevalence of current e-cigarette or vape use increased from 9.8 per cent in 2017 to 14.9 per cent in 2022 among Malaysian teenagers aged 13 to 17. Nearly a quarter of male adolescents in that age group vape.
The annual Global Tobacco Industry Interference Index by the Global Centre for Good Governance in Tobacco Control saw tobacco industry interference in Malaysia consistently rising over the past four years, from a score of 62 in the 2019 index to 76 this year, the third-worst category.
The report highlighted the lack of an increase in excise taxes on tobacco for the last eight years; the abandonment of plans for standardised tobacco packaging; as well as delays in a ban on cigarette pack display at points of sale and licensing of retailers to sell tobacco.
“If the trend continues, I believe we will not achieve a Smoke-Free Nation by the year 2040, since any good policy to control tobacco and smoking products will be interfered [with] by the industry.
“Without [the] GEG provision, the other part of the bill which controls all the smoking products will still be in place. However, it will take longer for Malaysia to reduce the smoking prevalence and become a smoke-free nation by 2040.
“On the positive side, the number of compound notices shows that there are enforcement activities in place. To ensure the effectiveness of the [Control of Smoking Products for Public Health] Bill, all stakeholders, including other ministries, agencies, NGOs and the community should play their part in supporting the implementation of the Act. Again, corruption needs to be tackled more effectively and those involved shall be punished swiftly.”
MPS: Anti-Smoking Bill Not Fit For Purpose
The Control of Smoking Products for Public Health Bill does not fulfil the needs of the Malaysian landscape, said Amrahi Buang, president of the Malaysian Pharmacists Society (MPS).
He held that the Dewan Rakyat had approved a poorer version of the bill and that the more detailed regulations needed to control the tobacco and vape market – after the bill is passed into law – would take time, estimating six months to a year.
Should the Dewan Negara pass the Control of Smoking Products for Public Health Bill, as it is expected to, by the end of its meeting on December 14, the bill will need to be assented to by the Yang di-Pertuan Agong and gazetted into law.
Only then can regulations be prescribed under the new Act by the health minister.
“They have to come out with a detailed regulation, which will take time. Especially one that involves nicotine. So, how are they going to adjust the nicotine? That is the question we cannot find the answer because it is not in the main Act.
“We have to see the details in the regulation, especially when you involve different parties. For example, the vape device. There will be another ministry and so on and so forth. We have to look into the final point. This all will take time, so that’s why I say it is a lower version,” Amrahi told CodeBlue.
Besides omitting the GEG, the Control of Smoking Products for Public Health Bill also dropped control of “smoking devices”. Dr Zaliha told Parliament that these devices would be regulated by the Domestic Trade and Cost of Living Ministry in terms of safety standards, as well as by the Ministry of Investment, Trade and Industry in terms of manufacturing.
Amrahi held that the bill in its current form was still “flimsy”, expressing uncertainty as to how the Ministry of Health (MOH) intends to govern liquid and gel nicotine, pending drafting of regulations.
When it came to the reduction of fines from RM10,000 to RM5,000 and the removal of the incarceration penalty under the bill for smoking in smoke-free places, Amrahi said the main objective of punishment was to function as a deterrent.
The pharmacist said it was time to place an emphasis on how cigarette or nicotine addiction is a disease that needs treatment.
“They need to go for treatment. I think that message should be very clear. Addiction is an addiction. They need to go for treatment. It’s not recreational.”