Things to do now, to protect our lungs from smoke pollution

 Publish the PM2.5 reading alongside the air pollutant index, which only says the air is unhealthy without saying what people are inhaling. Warn vulnerable groups ahead of time. Set a lower trigger for high-risk pupils.

From Dr Helmy Haja Mydin

Imagine watching a child get punched. The face swells and hurts, causing a mental toll. Now imagine the punch landing every day for a few weeks, every year for 24 years.

Would you expect that child to turn out fine? Would you be tempted to intervene? Replace the fist with haze and the face with lungs, and you have a fair picture of what happens when a child breathes unhealthy air.

This is not imagination.

PM2.5 (atmospheric particulate matter with a diameter of 2.5 micrometres or less) is small enough to slip past the upper airway and reach the alveoli, where oxygen crosses into blood. Three recent findings describe what the smoke over Sarawak does to Malaysians.

A 2025 study of older Americans in Environment International found that each extra microgramme per cubic metre of long-term smoke PM2.5 was associated with a 9.2% rise in deaths from chronic obstructive pulmonary disease (COPD). A Taiwanese cohort in ERJ Open Research showed prolonged exposure slows lung growth in schoolchildren.

A decade of data from Palembang, beside Sumatra’s peat fires, published this year in Annals of Global Health, found strong associations between haze and childhood pneumonia. None of these papers are Malaysian, but they describe what my patients breathe.

Patients cannot wait for the Dewan Rakyat to enact a law on air pollution. This is what Parliament is for: to provide a bill, an enforcement budget, health thresholds, a monitoring network. Any of these would be a more honourable use of a sitting than the racial and religious rhetoric that consumes a number of our politicians.

So here is what could be done this year without a new treaty on transboundary haze pollution:

1. Warn people before the smoke arrives. The Air Pollutant Index takes the highest of six sub-indices, and its PM2.5 component is a 24-hour average, so this morning’s number partly describes yesterday. Hotspot counts, regional forecasts and wind models already exist. We issue flood and storm warnings days ahead. We could do the same for smoke.

2. Publish PM2.5 alongside the index, which says the air is unhealthy without saying what people are inhaling. Fill the gaps in the network: 68 stations is thin, and a reading in Sri Aman tells little to a family in the next district.

3. Let the school rule meet the medical one. Outdoor activities stop at API 101 and schools close at 200.

But 101 is where the environment department’s own categories say children, the elderly, pregnant women and people with asthma or heart disease are already at risk. A lower trigger for high-risk pupils, with leave to stay home without penalty, would cost almost nothing.

4. Get the timing right. MetMalaysia declared the south-west monsoon on May 14. That cue arrives roughly two weeks before a preventer inhaler reaches full effect. Asthma and COPD reviews belong in May and June: check inhaler technique, replace expired devices, issue written action plans, vaccinate against influenza and pneumococcus.

5. Keep a register of vulnerable people. A patient on home oxygen should receive a text when a plume is forecast for her district, not discover it when she cannot finish a sentence. And give people somewhere to go: halls, libraries and clinics with filtration, for those in unsealed housing who cannot afford a purifier or a day off.

6. For people with asthma the advice is unglamorous. Take the preventer daily; feeling well means it is working, and is the wrong moment to stop. Shut windows in the worst hours, run a HEPA filter in a vulnerable person’s bedroom, wear a fitted N95 outdoors, and take a child’s rising breathlessness to a doctor early.

None of this is a cure. It is triage, and should be called that. But triage keeps people breathing while the definitive treatment is arranged.

Treaty with no teeth

In 2002 Malaysia became the first country to ratify the Asean Agreement on Transboundary Haze Pollution. But in August this year our natural resources and environmental sustainability minister urged fellow member states to watch for hotspots and enforce their bans on open burning. That sentence could have been written in 2002. The main difference is the state of the air outside.

The health minister reported that asthma cases logged by his ministry’s surveillance rose from 61 to 219 in one week, and upper respiratory tract infections from 1,637 to 3,674.

On Aug 25, 30 of the country’s 68 monitoring stations recorded unhealthy air. Serian, in Sarawak, crossed 200 on August 12th; a week later schools across nine districts of southern Sarawak were shut. Cheras, Putrajaya and Shah Alam all sat above 150.

24 years later, still no law

Singapore passed its Transboundary Haze Pollution Act in 2014.

In Malaysia, a domestic haze act was put to Cabinet in 2019, shelved in 2020 and formally abandoned in a written parliamentary reply in November 2023. In September 2024, Suhakam published “Silent Enemy”, a report with six recommendations.

Twenty-four years after the Asean treaty and 12 after Singapore’s law, Malaysia has a shelf of communiqués and no statute.

Suhakam’s prescription is broader than a haze act: a Clean Air Act with enforceable ambient standards; constitutional recognition of the right to a clean environment; rules of court for environmental proceedings; and Malaysian leadership on a binding Asean protocol under which each state prosecutes its own companies for fires they cause abroad.

The British example

Britain’s regime, as a House of Commons Library briefing sets out, begins with a binding international protocol on transboundary pollution, written into domestic law as emission ceilings. On top sit legal limit values for ambient air, statutory PM2.5 targets to 2040 and an independent Office for Environmental Protection to hold ministers to their own rules.

Between 1990 and 2024 British emissions of four of the five main pollutants fell by more than two-thirds. In 2020 a London coroner recorded air pollution as a significant contributory factor in the death of a nine-year-old girl with asthma.

I hope Malaysia does not need a high-profile death before it acts.

Malaysia’s patients have managed the consequences of political delay in their own chests for decades, and have become good at it.

That is the unfortunate reality on the ground, and in the air. - FMT

Dr Helmy Haja Mydin is a consultant respiratory physician and Chairman of Social & Economic Research Initiative.

The views expressed are those of the writer and do not necessarily reflect those of MMKtT