From Azrul Mohd Khalib
The issues of smoking, vape and nicotine addiction in Malaysia have not seen much progress over the past decade.
The prevalence of smoking is currently at 21.3%. About 45% of men across all age groups smoke. Women smokers hover around 1%.
Nearly 17.4% of children, aged 13 to 15, will be smokers, and one in 10 of those aged younger than 12 have lit up a cigarette.
For every RM1 collected from tax imposed on tobacco, RM4 is spent on treating those suffering from smoking-related diseases. Unfortunately, some 27,000 people each year prematurely lose their lives due to these conditions.
According to the National Health and Morbidity Survey 2019, 1.12 million people in the country are now using e-cigarettes. An industry survey indicated that around 68% of male respondents vape, compared with 32% of women. At least 600,000 children between the ages of 11 and 18 have taken up vaping as well.
The number of new vape users becoming addicted to nicotine, many of whom have never smoked cigarettes before, is increasing and they are starting younger each year.
Adolescents can regularly be seen puffing away in restaurants, malls and outside school premises, enough to make the police express their concern.
Somehow, despite the known and growing threat of nicotine addiction, Malaysians and their elected representatives have been lulled into giving up and thinking that nothing more can or should be done when it comes to cigarettes and e-cigarettes.
On April 14, 1994, the heads of the largest American tobacco companies were subpoenaed to appear before the US Congress. The seven CEOs and presidents refused to admit that they knew cigarettes were addictive and emphatically stated that they did not believe nicotine was addictive. Today, we know differently.
A similar scene has been playing out recently in Malaysia. The top executives and representatives of both the tobacco and vape industries and businesses publicly claim that they were in support of a smoke-free world but opposed and disagreed that a generational ban on cigarettes and e-cigarettes would be effective or necessary.
They now say that smoking is addictive, but vaping is not; that breathing in burnt tobacco fumes is harmful but inhaling nicotine in vapour form is safe.
As the tobacco industry begins to increase its presence in the e-cigarette market, it will soon be hard to differentiate between those selling cigarettes and those selling vape.
In a few weeks’ time, health minister Khairy Jamaluddin will table the Tobacco and Smoking Control Bill in the Dewan Rakyat for debate, to be voted on by MPs. It has taken 12 years for such a legislation to get to this point.
What is being proposed in the upcoming Bill is not only bold and far-reaching but also contains world-leading measures, such as a generational ban on cigarettes and vape.
This is a piece of legislation that, if implemented properly and effectively, will help save the lives of thousands of Malaysians each year. It will make a serious dent in smoking prevalence and regulate vape, which has gone out of control.
This Bill has captured the interest and concern of people and governments in this region and made news around the world. For once, Malaysia is making international headlines for the right reasons.
But there is tremendous opposition and pushback to the proposals. Most, naturally, come from industry stakeholders, business owners, smokers and vapers. But some worries have also come from MPs, reflecting their own individual concerns as well as those of their constituents.
Slippery slope and personal choice
A common strategy used by the tobacco and vape industry to oppose and undermine control measures is the “slippery slope” or unintended consequences argument.
It suggests that a policy such as the generational ban would set a troubling precedent that would then be applied to other products such as sugar, fast food, butter and even alcoholic beverages. The argument is intended to create fear and hesitation among policymakers.
But tobacco is a unique product. It cannot be treated similarly or compared to sugar or alcohol. When used properly as intended, it is a fact that smoking will kill half of its consumers.
The impact of vaping is still not fully understood. What is known is that, increasingly, more people, especially younger users, are coming down with e-cigarette or vaping use-associated lung injury (EVALI) due to long-term use and adulteration of liquids being heated and inhaled.
The claim is that smoking, and vaping, are adult choices and do not justify state intervention. However, this ignores the long-known fact that most people start smoking when they are adolescents and teenagers.
As long as vape remains unrestricted and unregulated, the journey to nicotine addiction begins in individuals as young as 10 years old.
Quitting is hard. It takes smokers at least 30 attempts and relapse rates are high. More and more smokers and vapers are desperate to quit.
Loss of revenue
A straw man argument is being promoted by those who oppose the upcoming Bill. The claim is that the generational endgame aims to completely ban cigarettes and vape for everyone beginning from 2023. This is untrue and is deliberately misleading to create fear, distract from the merits of the proposal, and raise unreasonable opposition.
What is being proposed is a prohibition against the sale and use of cigarettes and vape by those born from 2005 onwards, beginning with those turning 18 next year. For everyone else, they will be able to continue buying and selling their products at retail outlets, and smoking and vaping at permitted locations. For them, nothing will change.
In time, businesses such as retail outlets, pubs and restaurants adopting smoke-free and vape-free policies will adapt and thrive as they have in the UK and Europe.
Illicit market
Much of the data surrounding the illicit tobacco market originates from industry-funded research. The tobacco, and now vape, industries routinely use the findings from these commissioned reports to argue and conclude that every control policy, without exception, will lead to an increase in smuggling and growth of illicit products.
Though the black market in illicit tobacco and vape does exist in Malaysia, these reports when compared with independent sources, consistently overestimate the availability and scale of the problem.
This inadvertently results in policymakers and law enforcement becoming worried and hesitant in adopting policies such as this upcoming Bill which the industry players claim could allegedly exacerbate the situation.
The industries argue that they are the victims of the illicit market, emphasising the role of counterfeit cigarettes and vape devices, which escape taxation and regulation.
However, they have never stopped benefiting from the illicit market. Recent studies found that around two-thirds of illicit cigarettes worldwide came from the tobacco companies themselves. Fewer than one in 10 were actual counterfeit products.
Harm reduction
Malaysia has grown to be the largest vaping market in the Southeast Asian region. The vape industry is estimated to be worth RM2.3 billion, with 330 manufacturers and importers and 3,000 retail shops, employing around 15,000 people.
The industry has touted heat-not-burn (HNB) tobacco products and vape as allegedly safer alternatives to cigarettes and as a less harmful approach to smoking. It has also made a claim to vape being a means to quit smoking.
Instead, what is happening is the introduction of new nicotine delivery devices with high nicotine levels, which are unregulated, unrestricted and available to all.
The 16mg per ml of nicotine works out to 1.6% nicotine. Most cigarettes contain 1-3mg of nicotine. However, in Malaysia, vape liquids in disposables can be found to have 1%, 3% and 5% strengths.
In the UK and Europe, the maximum strength permitted is 20mg, or 2%. The lethal dose of nicotine for adults is about 60mg or 6%.
With prices lower and nicotine content higher than a pack of cigarettes, it is not surprising that 4.9% of the Malaysian population are now estimated to be vaping.
Today, because it is unregulated and unrestricted, the vape industry has now replaced cigarettes in public promotions, advertising and sponsorships.
Vape needs to be regulated as strictly as tobacco and appropriate taxes imposed.
During the upcoming debate on the Tobacco and Smoking Control Bill, I ask that our MPs be on the right side of history and vote yes in support of building a better healthier future for everyone in Malaysia. - FMT
Azrul Mohd Khalib, is the chief executive of Galen Centre for Health & Social Policy.
The views expressed are those of the writer and do not necessarily reflect those of MMKtT.
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