'M'sia needs a tobacco harm reduction strategy not more confusion and bans'

Focus Malaysia

05-07-2025

As the World Health Organisation's Framework Convention on Tobacco Control (FCTC) marks its 20th anniversary, the global conversation about how to reduce smoking-related deaths is reaching a critical turning point. For Malaysia, this isn't just a theoretical debate — it's an urgent policy issue affecting millions of lives and livelihoods.
Last year, Parliament passed the Control of Smoking Products for Public Health Act 2024, which for the first time provides a legal framework for regulating e-cigarettes, vape liquids, and other alternative nicotine products. The Act, long overdue, was a step forward in recognising that people smoke for nicotine but die from the tar and toxins in burning tobacco.
Yet after the law's passage, state governments like Terengganu, Kelantan and Pahang have announced complete bans on the sale of vape products, sparking legal uncertainty, public confusion, and frustration among stakeholders.
These state-level prohibitions not only undermine the national regulatory framework but also highlight a glaring omission in Malaysia's tobacco control strategy: the lack of recognition for tobacco harm reduction (THR) as a legitimate public health approach.
Harm reduction: A proven strategy, not a loophole
Globally, countries like Sweden, New Zealand, and the UK have made dramatic strides in reducing smoking rates by embracing lower-risk alternatives such as vaping, nicotine pouches, and heated tobacco products. Sweden, for example, is on track to become the first smoke-free country in the EU — thanks largely to its harm reduction strategy using snus, a smokeless tobacco product.
In the UK, Public Health England has repeatedly found that vaping is at least 95% less harmful than smoking.
Meanwhile in the US, a recent study published in Addictive Behaviours found that non-tobacco e-cigarette flavours significantly improved smoking reduction and cessation outcomes compared to tobacco-only flavours.
Among participants, 95% chose non-tobacco flavours, and those using them were more likely to continue vaping (74% vs 55%), reduce cigarette consumption by at least half by the end of the trial (34% vs 14%), sustain that reduction after six months (29% vs 5%), and completely quit smoking (14% vs 5%). These findings suggest that flavours play a crucial role in supporting smokers to reduce or quit smoking through vaping.
Yet here in Malaysia, such evidence is often ignored or dismissed. Instead of leveraging these tools to reduce the country's 4.8 million smokers, policy debates remain trapped in outdated 'quit or die' thinking, where abstinence is the only accepted path — and everything else is framed as a threat rather than an opportunity.
What's at stake for Malaysia?
Smoking remains one of the leading preventable causes of death in Malaysia, claiming an estimated 27,000 lives annually. The economic burden is also massive, costing the public healthcare system billions each year in treatment for smoking-related diseases.
We cannot afford to wait for abstinence-only policies to work — especially when they've failed for decades. Nor should we allow state-level bans to fracture the national approach, sow confusion among consumers, and penalise small businesses trying to operate within legal boundaries.
A clear, national-level commitment to tobacco harm reduction is essential. That means:
Recognising THR in national health strategy documents, including the National Strategic Plan for Non-Communicable Diseases. Investing in research and public education about the relative risks of various nicotine products. Respecting regulatory coherence, so that individual states do not undo the progress made at the federal level.
The FCTC must evolve — and so must we
Much of the reluctance to embrace harm reduction stems from the FCTC's rigid stance on nicotine products. While the treaty has been instrumental in reducing smoking globally, it has become increasingly dogmatic — discouraging innovation and painting all nicotine use with the same brush.
This approach may work in theory, but in practice, it ignores the realities faced by developing countries like Malaysia, where smoking prevalence remains high and healthcare access is uneven.
Harm reduction tools — if properly regulated — offer a low-cost, scalable solution to help millions quit smoking and avoid chronic disease.
Malaysia must assert its policy autonomy and lead with evidence, not ideology. We should not fear criticism from international bodies for charting our own course.
After all, health policy should serve the people of Malaysia — not the preferences of distant bureaucrats.
Conclusion: Time to catch up with the science
The tools to reduce smoking are already here. What's missing is the political courage to embrace them. If we truly want to cut smoking rates, lower healthcare costs, and save lives, then harm reduction must be part of the strategy—not pushed to the margins or banned outright.
We owe it to Malaysian smokers — and future generations — to offer better choices, not fewer. — July 5, 2025
Tarmizi Anuwar is the Country Associate for Malaysia at the Consumer Choice Centre.
The views expressed are solely of the author and do not necessarily reflect those of Focus Malaysia.