How Malaysia is falling behind on harm reduction for smokers

A public health expert says Malaysia’s approach prioritises prevention and quitting but provides few alternatives for smokers who struggle to stop completely.

On Dec 16, health minister Dzulkefly Ahmad said the government would proceed to implement a full ban on e-cigarettes and vape products. (Pixabay pic)

PETALING JAYA:

 Little has been done to reduce harm caused by smoking despite the introduction of various policies to get smokers to stub out the habit, according to a public health expert.

Dr Sharifa Ezat Wan Puteh also points out that Malaysia’s tobacco control policies offer few options for smokers who struggle to stop altogether.

Over years of anti-smoking campaigns, Malaysia’s healthcare system has placed little emphasis on reducing the damage caused by combustible cigarettes, the most dangerous form of nicotine consumption, the Universiti Kebangsaan Malaysia professor told FMT.

With a full ban on e-cigarettes and vapes coming in 2026, the need for measures to reduce the harm caused by combustible cigarettes have become even more urgent.

For decades, smoking has remained one of Malaysia’s most persistent public health challenges.

According to a Global Adult Tobacco Survey (GATS) in 2023, a total of 19% of Malaysians aged 15 and above smoke regularly.

In addition, 19.4% of non-smoking adults are affected by secondhand smoke at home while a staggering 77.6% of them face the same risk when dining out at restaurants.

Where Malaysia falls behind 

Sharifa said that while tobacco control policies in Malaysia places emphasis on prevention and quitting, there are few options for smokers who struggle to stop altogether.

“Traditional nicotine replacement therapies (such as patches and gum) are proven alternatives for smoking cessation. But real-world evidence shows that long-term uptake, sustained compliance and successful cessation rates remain relatively low,” she said.

Reports in peer-reviewed medical journal Nicotine and Tobacco Research suggest that e-cigarettes are generally less harmful than combustible cigarettes, exposing users to far fewer toxic chemicals and potentially aiding smokers who switch completely.

“People who don’t smoke should not use any tobacco or nicotine products. But studies consistently show that smokeless products such as legal vapes, nicotine pouches and heated tobacco products are safer than traditional cigarettes,” Sharifa said.

“(On the other hand) traditional cigarettes produce tar through burning at high temperature, and tar is carcinogenic. Nicotine itself is not,” she said.

To help smokers kick the habit, Malaysia relies largely on counselling and traditional nicotine replacement therapies that are provided under programmes like JomQuit managed by the health ministry.

The impact of an e-cigarette and vape ban

Sharifa said banning e-cigarettes and vapes may push some nicotine users back to traditional cigarettes, or even to illicit tobacco or vapes, fuelling the black market trade.

Meanwhile, Jonathan Foulds, a professor of public health sciences at Penn State University, stressed that product standards for e-cigarettes and vapes must be designed to genuinely protect public health, rather than simply shifting risks elsewhere.

“If you introduce a product standard, you always have to ask what effect it will have, and whether people are more likely to use another product, particularly cigarettes, which are more harmful,” he said during this year’s e-cigarette summit held in London.

Foulds warned that it makes little sense to impose stricter standards on less harmful products than on more dangerous ones, saying the obvious result is that people shift to more harmful products.

Lessons from other countries

Countries such as the UK, New Zealand and Sweden have actively incorporated tobacco harm reduction into public health policy and encouraged safer nicotine alternatives.

Through this approach, Smoke Free Sweden noted that Sweden now has one of the lowest smoking rates in Europe, with just 4.5% of Swedish-born adults smoking.

Meanwhile, New Zealand’s smoking rate has nearly halved since 2018, and around three million smokers in the UK have quit using vaping as an alternative.

“These countries still impose age restrictions, quality controls, pre-market checks and content validation,” Sharifa said.

“Malaysia’s tobacco control programme focuses on preventing smoking, reducing initiation and supporting smokers to quit. However, there are limitations, and newer approaches need to play a role,” she added. - FMT