SMOKING kills.
That’s what we’ve heard for most of our lives. We are reminded when we see horrendous images of smoking-related diseases plastered on every cigarette pack sold legally in Malaysia, which was the whole point of mandating such packaging.
But it seems for many Malaysians, that message has yet to stick, as the Global Adult Tobacco Survey (GATS) 2023 revealed that 14.6% of adults in Malaysia currently smoke tobacco daily.
This is probably why the government has, in the past few years, made efforts to enact a comprehensive tobacco control law.
It eventually culminated in the Control of Smoking Products for Public Health Act 2024 (Act 852), which was gazetted in February this year, though the Act is still not in force yet.
Act 852 involves heavy regulation of smoking products, including conventional cigarettes as well as electronic cigarettes such as vape, though the intensely scrutinised Generation End Game (GEG) provisions were taken out before the Act was passed in Parliament.
While the government’s efforts to reduce smoking are commendable, there are some real-world examples of effectively combating smoking that Malaysia can learn from.
Can Malaysia quit like Sweden?
Take Sweden, for example.
The country has the lowest smoking rate in the European Union, and is on track to becoming the first smoke-free country in the world. A smoke-free country is defined as those having less than 5% of daily smokers among its population.
Within 18 years, Sweden has successfully reduced its daily tobacco smoking rate from 16.5% in 2004 to 5.8% in 2022, according to the Public Health Agency of Sweden.
However, the World Health Organisation (WHO) has noted that general tobacco use in the country remains at more than 20%, similar to global rates, due to the inclusion of smokeless products such as nicotine pouches and “snus”.
Snus is a smokeless, moist powder tobacco pouch that one places under the upper lip. It is marketed as an alternative to smoking in Sweden, though it is banned everywhere else in the EU.
Such smokeless products are seen to be part of the tobacco harm reduction (THR) method that the Swedish population is embracing.
While tobacco smoking has been on a downward trend in Sweden, snus use is on the rise, with 13.8% of the country’s population using snus daily in 2022.
Some are now touting these THR methods in Sweden as something to be emulated by other countries to reduce smoking rates.
Quit Like Sweden (QLS), an organisation which aims to encourage other countries to emulate the “Swedish Experience” in using cessation and prevention measures to reduce smoking rates, recently asked the question, “Can Malaysia quit like Sweden?”
During a QLS forum held in Kuala Lumpur recently, former World Medical Association chair Dr Anders Milton, who is also the current chair of the Snus Commission, argued that nicotine is not the problem despite staunch tobacco control activists saying these reduced-risk products are still dangerous, citing studies that indicate nicotine has harmful effects on cognitive abilities.
“Despite widespread misperceptions, nicotine does not cause cancer and has minimal, if any, contribution to smoking-related diseases.
“Total nicotine use in Sweden is equivalent to other EU countries but because smoke-free nicotine products are allowed, Sweden has significantly less smoking-related disease and premature deaths,” he says.
The Malaysian experience
But how can this translate to Malaysia?
Malaysia actually employs many of the tobacco control tactics Sweden uses, such as restricting smoking in public places like restaurants and imposing a hefty tobacco tax.
However, the situation in Malaysia is slightly different from that in Sweden.
Unlike in Sweden, smokeless products such as snus are not popular in Malaysia at all, with the GATS 2023 survey showing only 0.9% of Malaysian adults using smokeless tobacco products.
ALSO READ: The snus way of stopping smoking
On the contrary, Prof Dr Sharifa Ezat Wan Puteh, from the Faculty of Medicine at Universiti Kebangsaan Malaysia, says Malaysia has a bigger issue with illegal cigarettes and a surge in vape use.
A Nielsen Consumer study on illegal cigarettes showed that Malaysia has an illegal cigarette incidence of 55.3% as of May 2023, meaning more than one in two cigarettes sold in Malaysia are illegal – products with fake tax stamps, smuggled whites, and smuggled kreteks. (According to the WHO, whites are cigarettes manufactured by legitimate businesses but sold without all applicable duties paid.)
This is why, Dr Sharifa Ezat argues, the previous three rounds of tobacco tax hikes – the last round was a whopping 36% increase in 2015 – has not reduced the smoking rate here.
Speaking of the illicit cigarette industry, Tasek Gelugor MP Datuk Wan Saiful Wan Jan, who attended the forum, believes that to tackle the greater issue of smoking in general, the widespread sale of illegal cigarettes in the country must be curbed first.
“This is why I also opposed the GEG when it was being debated. As soon as you introduce the GEG, 100% of cigarettes in the country will be illicit. We have clear evidence that the government is not competent enough to watch our borders properly and they cannot control the amount of illicit cigarettes coming in.
“So unless you tackle that problem, there is no point in introducing the GEG,” he says.
Meanwhile, when it comes to vape use, Dr Sharifa Ezat says studies suggest ecigarettes can be a strategic harm reduction tool for smokers but stresses that it is not a safe option for non-smokers.
Wan Saiful suggests that since vaping is highly popular in Malaysia, perhaps the government should look into products similar to vape such as heated tobacco products as a THR tool.
Among those who have been working to promote appropriate regulations on the vape industry is Samsul Kamal Arifin, president of the Malaysian Organisation of Vape Entity.
He sees vaping as a healthier alternative to smoking conventional cigarettes, and as such has been advocating for industry regulation rather than an outright ban.
Over his almost 10-year advocacy work, Samsul says he has repeatedly tried to bring up scientific research supporting the efficacy of vape use as an alternative to conventional cigarettes to relevant authorities but was shot down every time in favour of blanket ban policies.
“There is a need for the government and the public to understand the distinction between abstinence and harm reduction,” says Dr Sharifa Ezat.
While abstinence involves completely stopping the use of a substance, harm reduction recognises that drug use is complex and thus abstinence may not work for everyone.
“The main priorities of harm reduction are keeping people alive and reducing suffering,” she says.
More innovation needed
Dr Sharifa Ezat suggests the Malaysian government adopt a more pragmatic three-pronged approach as follows:
“If you smoke, stop. If you don’t smoke, don’t start. If you can’t stop, make the switch to a less harmful alternative.”
Putrajaya is not innovative enough when it comes to combating smoking in the population, says Wan Saiful.
“In Malaysia today, the only thing that the government can think of is about banning. Tobacco control? Ban cigarettes. Vape? Ban vaping.
“That, I think, is the main problem, that we are not innovative at all as a government in this country, regardless of whoever becomes the Health minister.
“As a result of that, we hear ideas like GEG. We were trying to introduce that in Malaysia and we already banned smoking in public places and I have no problems with that.
“But the mentality of the policymakers and advisers is about banning, not about finding ways to solve the actual problem, but by sweeping the problem under the carpet without realising they have been failing to do this for years and years and years,” he says.
This is why Malaysia has yet to seriously consider THR as a way of reducing smoking rates, he says.
“We are not open enough to have a proper conversation about this.
“As soon as you say let’s talk about something else other than banning cigarettes, you will be labelled as receiving funds from tobacco companies, and this is not true.
“As a result, we are not tackling the real issue, we are just doing what is popular,” he says.
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