Nicotine Vape Delisting: A Health Minister’s Legacy — Azrul Mohd Khalib

One year after then-Health Minister Dr Zaliha Mustafa removed liquid nicotine from the Poisons List, with the regulations expected only in June, Azrul Mohd Khalib says the harm from that policy decision is vast. “Unfortunately, this is Dr Zaliha’s legacy”.

Last week, Universiti Sains Malaysia’s National Poison Centre was reported to have recorded an increase of 30.6 percent in nicotine poisoning last year. This represented a five-fold increase compared to 2019 figures.

More young people, namely teenagers between the ages of 15 and 19 years old, were found to have experienced poisoning due to their use of vape and e-cigarettes (e-ciggies) containing nicotine with symptoms ranging from drowsiness, diarrhoea, severe vomiting, abdominal pain, loss of consciousness, seizures or worse, psychosis and hallucinations.

Alarmingly, there were also reports of illicit drug use utilising e-cigarette liquids which were previously observed occurring in neighbouring Indonesia.

This was not unexpected. In fact, it had been forewarned.

Despite the government not having appropriate legislation or even any regulations in place to manage the distribution, sale and availability of vape and e-cigarettes containing nicotine, one year ago then Health Minister Dr Zaliha Mustafa signed an Order to remove liquid or gel nicotine from the list of controlled substances under the Poisons Act 1952.

This decision was undertaken in the face of a rare unanimous decision by the Poisons Board to reject the proposed action by the Minister. Consultation with the Poisons Board is required under the law before a Minister can make an Order under that particular Act.

The proposal to remove nicotine used in vape and e-cigarettes had also been opposed by numerous public health advocates and health care professionals, especially those working on tobacco control and nicotine addiction. They argued that such drastic actions would cause significant harm and permanent repercussions similar to, if not worse than smoking cigarettes.

These concerns and warnings were noted, but not heeded.

The real-world consequences of this decision have been numerous. Nicotine vape and e-cigarettes of every possible variety and concentration were now legally available and permitted to be sold, not only to adults but also to young people and children. Where regulatory ambiguity existed, a massive and defined gap emerged.

Due to the Minister’s Order, vape and nicotine containing nicotine became totally unregulated. Cheap vape disposables containing high concentrations of liquid nicotine quickly flooded the market, as international players from China, the United States, United Kingdom, together with the existing domestic e-cigarette industry saw Malaysia as a ripe consumer market with massive potential for new nicotine delivery devices, and no regulatory oversight.

The nicotine content for vape products available in Malaysian retail shops and even roadside stalls continues to be among the highest in the world. Liquid nicotine in a single disposable vape device is available in concentrations of 3% to 5%. Vape disposables with 5% nicotine are easily available in this country for as low as RM10 to RM20.

You cannot get these in most countries which regulate and tax vape. In the United Kingdom, Europe, United States and Indonesia, where e-cigarettes are regulated and taxed, the maximum strength permitted in retail is between 20 mg (2%) or 30 mg (3%). Any higher would require a prescription. A person will usually inhale between 1 and 3 mg of nicotine from a single conventional cigarette. Today, many retail outlets don’t even bother stocking up vape devices or liquids with less than 5%.

Encouraged by the policy decision, over the past year, vape and e-cigarette manufacturers and retailers have aggressively targeted, marketed, advertised, distributed and indiscriminately sold their wares openly to all, including young consumers. They have sponsored sporting, fitness, health and lifestyle events, which is prohibited by law to tobacco and cigarette companies.

As a direct result, data has now shown that there are more teenagers and young people who have never been smokers, vaping and smoking e-cigarettes.

Women, specifically young women, whose numbers are a fraction of cigarette smokers, according to industry data now make up to 30 per cent of vape consumers. Vapers find that their addiction has transferred to e-cigarettes and vape. Some become dual users, where they smoke both tobacco and e-cigarettes.

Children as young as 10 are becoming newly addicted to nicotine. Tragically, people have become disabled and some teenagers have also lost their lives.

Pro-government cybertroopers and supporters of political parties mocked public health advocates and health care professionals on social media, diminishing their concerns and saying that the Control of Smoking Products for Public Health Bill would soon be passed in June 2023 and that those who objected to the delisting of nicotine were being unreasonable and impatient.

They asked what could possibly happen between the signing of the Order and when the legislation becomes law?

But in June, the Bill was delayed and referred to a parliamentary special select committee. It would be November and December before the Bill was passed by Dewan Rakyat and Dewan Negara respectively. Gazetted this past February, this law still requires regulations to operationalise. These are expected to be available in June.

Until then and throughout this whole past year, nicotine vape and e-cigarettes remain totally unregulated. The cost of delisting nicotine without regulations in place beforehand has been incredibly high and the harm is vast. The expected tax collected from vape and e-cigarettes sales seems puny in comparison. Unfortunately, this is Dr Zaliha’s legacy.

Any person appointed to be Health Minister has a heavy burden of professional responsibility and duty of care to safeguard the health of the population. The Minister, in fact any cabinet member, should not be treated as a rubber stamp or placed in a position where they have to reject or ignore evidence-based recommendations from health care professionals in favour of politics. Leadership matters and the courage to do the right thing does make a difference.

Today, there is an opportunity to finally close Pandora’s box.

The Control of Smoking Products for Public Health Act now makes it possible to introduce regulations such as plain packaging, point-of-sale display bans, restrictions on e-cigarette flavours and other measures to help prevent and control nicotine addiction and reduce underage smoking and vaping. It will finally regulate nicotine vape and e-cigarettes.

Unfortunately, the generational endgame (GEG) policy was placed on the KIV shelf. The government must now consider increasing the existing excise duties on cigarettes and other tobacco products which have remained unchanged since 2015.

Malaysia spends an estimated RM16 billion annually treating smoking-related illnesses such as cardiovascular disease and lung cancer. Increasing the excise tax rate to RM0.77 per stick, equivalent to 61 per cent excise tax of the retail price, would generate additional tax revenue of RM771.8 million.

The new law is a chance to do things differently and help shape a better and healthier future for all Malaysians.

Azrul Mohd Khalib is the chief executive 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.

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