Nicotine vape delisting: A health minister’s legacy

 

From Azrul Khalib

Last week, Universiti Sains Malaysia’s national poison centre reported an increase of 30.6% in nicotine poisoning last year. This represented a five-fold increase from 2019 figures.

More young people, namely teenagers between 15 and 19 years old, were found to have experienced poisoning due to their use of vape and e-cigarettes containing nicotine. Symptoms ranged from drowsiness to diarrhoea, severe vomiting, abdominal pain, loss of consciousness, seizures or worse, psychosis and hallucinations. Alarmingly, there were also reports of illicit drug use facilitated by e-cigarette liquids, a trend previously observed in neighbouring Indonesia.

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

Despite the government not having the appropriate legislation or even any regulations in place to manage the distribution, sale and availability of vape and e-cigarettes containing nicotine, then health minister Dr Zaliha Mustafa signed an order one year ago 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 minister’s proposal. Consultation with the Poisons Board is required under the law before a minister can make an order. The proposal to remove nicotine used in vape and e-cigarettes was also opposed by numerous public health advocates and healthcare professionals, especially those working on tobacco control and nicotine addiction. They argued that such drastic action 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 are 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 has emerged.

Due to the minister’s order, vape and nicotine containing nicotine has become totally unregulated. Cheap vape disposables containing high concentrations of liquid nicotine quickly flooded the market as international players from China, the US and the UK, together with the existing domestic e-cigarette industry saw Malaysia as a ripe consumer market with massive potential for new nicotine delivery devices, without regulatory oversight.

The nicotine content for vape products available at 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 ranging from 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 UK, Europe, US and Indonesia, where e-cigarettes are regulated and taxed, the maximum permitted nicotine strength in retail products ranges from 20mg (2%) to 30mg (3%). Anything higher would require a prescription. A person will usually inhale between 1mg and 3mg of nicotine from a single conventional cigarette. Today, many retail outlets don’t even bother stocking up on vape devices or liquids of 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 sponsored sporting, fitness, health and lifestyle events, a practice prohibited by law for tobacco and cigarette companies. As a direct result, data now shows that there are more teenagers and young people who have never been smokers, vaping and smoking e-cigarettes.

Women, specifically young women, who represent a fraction of cigarette smokers, according to industry data now comprise up to 30% of vape consumers. Smokers find that their addiction has transferred to e-cigarettes and vape. Some become dual users, smoking 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 lost their lives.

Pro-government cybertroopers and supporters of political parties mocked public health advocates and healthcare professionals on social media, diminishing their concerns. They said the Control of Smoking Products for Public Health Bill would be passed in June 2023 and criticised those who objected to the delisting of nicotine as 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 was not until November and December that the bill was passed by the Dewan Rakyat and Dewan Negara, respectively. Gazetted this past February, the law still requires regulations to be operationalised, expected to be available in June.

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

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

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

The Control of Smoking Products for Public Health Act 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 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 a 61% excise tax on 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. - FMT

Azrul Khalib is the head of Galen Centre for Health and Social Policy.

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