Use pragmatic approach in tobacco control

EVERY 20 minutes, one Malaysian dies from a disease related to smoking, such as cancer, stroke or heart disease. This results in over 27,200 smoking-related deaths annually, according to the National Health and Morbidity Survey (NHMS) 2019.

Prevalence of tobacco use remains high in Malaysia with over one in five of the population aged 15 and above smoking the substance. Nonetheless, it is on a slight downward trend with a compound annual growth rate (CAGR) of -1.0%.

The government has set a target of reducing tobacco usage to 15% by 2025, and less than 5% by 2045. At the current rate of reduction, however, Malaysia will only achieve its 2025 target of 15% in 2042.

This raises questions on the strategies and effectiveness of the measures taken to reduce tobacco usage. Are the current targets overly idealistic? Have the tobacco control and regulation efforts in addition to multiple preventive measures been effective enough? Should we employ a more pragmatic approach to reduce tobacco usage?

Idealism versus pragmatism has been a long ongoing debate when it comes to policy-making. Idealist policymakers focus on the end goal of visionary ideas, for example the 2025 target of 15% tobacco prevalence. This goal is certainly commendable even though it seems impossible to achieve.

On the other hand, pragmatic policymakers focus on the practical aspects, including the obstacles and challenges involved in getting to the end result. It is a realistic acceptance that while the preferred goal is complete cessation of the harmful habit, it is not always achievable.

Take, for instance, those who understand that quitting smoking is incredibly difficult due to biological, psychological and social factors, in addition to the highly addictive nature of nicotine. What about those who choose to continue smoking to cope with the monotony of working long hours or are in high stress jobs? How can policymakers offer practical and realistic solutions for them?

One pragmatic solution that has been proven effective on the global stage is employing a tobacco harm reduction strategy. This seeks to reduce smoking-related diseases and death by encouraging smokers to switch to less harmful alternatives.

Reputable institutions and independent researchers have highlighted the less harmful effects of electronic nicotine delivery systems (ENDS) such as e-cigarettes and vaping devices, and also heated tobacco products (HTP).

For instance, New Zealand amended its Smokefree Environments and Regulated Products Act in 2020 to include ENDS and HTP to allow smokers to switch to less harmful alternatives.

New Zealand also recently introduced a “QuitStrong” campaign to encourage vaping as a way to quit smoking in line with their Smokefree 2025 goal launched in 2011.

This long-term goal, which incorporates numerous harm reduction strategies, has been successful in bringing down smoking prevalence from 18.2% in 2011 to 13.4% in 2019 with a CAGR of -3.8%.

Another example is Japan, which allows the substitution of combustible cigarettes with lower risk HTPs in the market in line with the harm reduction concept. HTPs are taxed differently than cigarettes and exempted from indoor or outdoor smoking bans in certain cities. These policies have been associated with the success of reducing smoking prevalence with a CAGR of -5.2% in Japan.

It is time for Malaysia to emulate these leading nations who have successfully demonstrated the effectiveness of pragmatism in tobacco control policies. We need science-backed and well thought-through regulation grounded in tobacco harm reduction strategies.


Economist, Bait Al-Amanah

Kuala Lumpur

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