Tobacco Harm Reduction in Asia: An update on regulation

September 27, 2023

The Association of South-East Asian Nations (ASEAN), a political and economic union of 10 states in South-East Asia, represents a population of over 600 million. Smoking prevalence remains very high in this area and harm reduction is received with skepticism. In her keynote speech, Professor Sharifa Ezat Wan Puteh presented some very interesting data about smoking and policies in the ASEAN region.

The projected prevalence of consuming any tobacco product among males 15 years-old and above was high in 2020, especially in low-medium income countries (40.2% in Malaysia, 39.7% in Thailand, 28.3% in Singapore, 46.9% in South Korea, 14.3% in Australia, and 10.0% in Hong Kong); although reduced harm products (HTP, e-cigarettes) are available, they are sometimes poorly regulated. Smoking initiation occurs at an astonishingly young age in many countries and the percentage of ever smokers who first smoked at the age of 7-14 years ranges from 12% in Philippines, and 14,5% in Thailand, to 37.9% in Indonesia, and 68.4% in Malaysia. The prevalence of electronic nicotine delivery systems (ENDS) use among youth is also high (ranging between 9.8% – 13.3%), particularly in Brunei, Indonesia, Malaysia and Philippines. Four of the world’s five largest tobacco companies operate in the ASEAN (BAT, PMI, JTI, and IB) and are ventured into ENDS/e-cigarettes and HTPs to expand their market. The ENDS market value in four ASEAN countries (Indonesia, Malaysia, Philippines and Vietnam) is projected to grow by 30% in 2023. It is estimated that 15.7 m. people were vaping in the Asia Pacific in 2018, but this may be as high as 23,3 million now, if patterns persisted since 2018. High e-cigarette use threatens tobacco control measures and legislation and the WHO Framework Convention for Tobacco Control (FCTC).

When vaping grew more popular around the world only about a decade ago, regulators in Southeast Asia’s nations were quite unsure about how to handle this new product. It was seen as another big tobacco lure into addiction. Most ASEAN countries immediately issued outright bans on vaping products or severely restrict ENDS use. Ten years on, Southeast Asia is no longer unanimously “anti-vape”. Several countries have made vaping legal, while others continue out-law it. The region’s two most “vape-friendly” countries today are the Philippines and Indonesia. At the opposite end of the spectrum Singapore and Thailand, both upholding total vaping bans.

Prof. Puteh then gave some more specific data about Malaysia. Smoking prevalence is still high (ranging from 45% to 49% among men aged 20-54 years in 2019), and there have been almost no significant changes during the past decades. Malaysians start smoking young (some as young as 12 yrs.), and 4.9 million Malaysians aged 15 years-old and above currently smoke. Malaysian teens aged 13 to 17 using e-cigarettes and vaping rose from 9.8% in 2017 to 14.9% in 2022. Malaysia remains one of the world’s largest markets for illicit cigarettes, and according to a recent study, 57.7% of cigarette consumption in the country is illicit; illegal vapes are also gaining grounds. Smoking is consumed by low income, low socioeconomic populations, whereas HTPs are used by more economically apt population. Malaysia’s vape market size reached US $558 million in 2021, accounting for 42% of the country’s total domestic tobacco market.

In Malaysia, two forms of legislative control are proposed in order to protect the young generation from getting into the practice of smoking and to reduce the percentage of smokers by 5% by 2040: the Control of Tobacco Product and Smoking Bill and the Generational End Game (GEG). The GEG prohibits use and possession of any form of tobacco and vape product by those born on January 1, 2007 and later. However, concern is expressed that this law will hugely impact the young, people with low income, and people who cannot resort to addiction therapy.

Prof. Puteh also depicted the situation in the other ASEAN countries. Most of them have signed the WHO FCTC, and all have passed anti-smoking bills. Smoking and vaping measures differ by country; impact on smoking rates also differs widely, but smoking prevalence remains high.

In summary, harm reduction is taken up differently by country, based on population smoking rates, government budget, control of tobacco trade (contraband) and FCTC involvement. To ease implementation of the above policies, most countries take a prohibitionist approach. Policing of illegal trades plays a pivotal role in tobacco control, depending on government budget and priority areas of each state. Harm reduction activities face many obstacles in the ASEAN region, and they are not taken up as they should be.