DEAR Prime Minister,

By the time this day ends, 74 people in Malaysia would have died premature death due to smoking and vape-related illness and conditions.

More schoolchildren would have purchased their first vape devices using their pocket money and will be puffing away with their friends.

The overall number of smokers would not have changed. But there will be more people becoming addicted to nicotine, and many others would be desperately trying to quit smoking and vaping, and be treated for their addiction.

Not too long ago, Malaysia was regarded as one of the leading countries in the region in the field of tobacco and smoking control. However, in a short period of time, we have not only retreated but also gone in the opposite direction.

It was a major mistake to exempt liquid and gel nicotine from the controlled substances schedule under the Poisons Act 1952, allowing vape and e-cigarettes containing nicotine to be freely sold without restrictions, safeguards and protections. Doing so without a legal framework or even minimal regulations already in place, resulted in the worsening of a threat to public health: uncontrolled vaping among children and teenagers.

On hearing the news from Malaysia, World Health Organization director-general Dr Tedros Adhanom Ghebreyesus on June 2 delivered one of his sharpest rebukes of the vaping and e-cigarette industry.

“When the tobacco industry introduced electronic cigarettes and vaping, one narrative they really tried to sell is that this is part of harm reduction. It’s not true. It actually is a trap, meaning kids are being recruited at the early age of 10, 11, 12 to do vaping and e-cigarettes,” he said.

Vape and e-cigarettes should be treated similar to that of tobacco products and cigarettes. Yet, they remain unregulated and unrestricted. Why?

The lack of commitment and political will to enforce vape and e-cigarette restrictions in previous years resulted in the Malaysian market being flooded by unsafe, disposable, high nicotine vapes aimed at children.

Due to the nicotine exemption order signed by the health minister on March 31, contrary to the recommendations of the Poisons Board, it is now not even illegal to sell these products to children. This is a fact.

It is not an exaggeration to say that people are also now under the impression that nicotine is no longer a toxic or dangerous substance.

The vape and e-cigarette industry and supporters claim that their devices help people quit smoking. This is a medical claim. Such a claim needs to be supported by scientific studies and evidence, registered and regulated as a medicine like all pharmaceutical products. If it were true, vaping should be regulated as a medicine. Yet, it is treated like a consumer product.

Today, there is a worldwide alarm to the threat of vape and e-cigarettes. Governments around the world such as the United Kingdom, the United States, Australia and New Zealand, which have long regulated the production, availability, advertising and sale of these products, are waking up to vaping epidemics in their countries where children and teenagers are becoming addicted to nicotine.

The seriousness of the situation in Malaysia is staggering. The prevalence of vaping among 13-17-year-olds in Malaysia at 14.9% is already higher than those in the same age category in the United States. Vaping among young people is already higher than cigarette smoking. How is this acceptable?

The government should take this issue seriously. 

Many as young as 10 and 13 are reportedly starting to vape despite never having smoked before. They are drawn by aggressive marketing, the lacing of vapes with sweet flavours and colourful packaging. They are not using it as a tool to quit smoking. The exceptionally high nicotine levels in vape and e-cigarettes sold in Malaysia and used by adolescents, which increase their addictiveness, threaten to cause a youth addiction crisis.

The absence of legislation and regulations on vape and e-cigarettes also mean that these devices are not compelled to have child-resistant and tamper-evident features. The recent case of the two-year-old accidentally inhaling or ingesting liquid nicotine from disposable vape, which was laying around the house, resulting in the toddler developing seizures and needing to be hospitalised and intubated, could have been prevented. Unfortunately, there might be more such cases in the future.

Prioritising the growth of Malaysia’s RM3 billion domestic vape industry and looking to gain from the tax revenue collected would be pointless if it comes at the cost of more people becoming addicted to nicotine, and children and teenagers forming a new generation of smokers and vapers suffering from disease.

For every RM1 collected from the tax currently imposed on cigarettes and tobacco products, RM4 is spent on treating those suffering from chronic smoking and vape-related diseases such as lung cancer, heart disease, stroke, chronic obstructive pulmonary disease and at least several types of cancer. Collecting RM4 billion means little when you have to spend RM16 billion to treat the consequences of smoking. The vape tax is expected to bring in RM600 million annually.

Responding to the public health threat of vape and e-cigarette should be a main priority of the government. It does not look that way at the moment.

Unfortunately, the generational end game proposal has served as a convenient distraction and reason for many in the industry, business and politics to oppose and condemn the Control of Smoking Product for Public Health Bill 2023 (formerly known as the Tobacco and Smoking Control Bill 2022). They prefer an indefinite postponement of any regulation, which addresses these concerns.

This bill is the closest tool available today to prevent the formation of a generation of Malaysians with long-term addictions, lung damage and poorer quality of life.

We urgently need laws that protect children from vaping and e-cigarettes through restricting sales to over-18s only, limiting nicotine content, refill bottle and tank sizes, labelling requirements and through advertising, promotional and marketing restrictions.

The unity government, embodied by the Malaysia Madani principles, and under your leadership, has the opportunity and duty of care to secure a healthier and better future, not only for this generation but also for the ones that come after us. – June 9, 2023.

* Azrul Mohd Khalib is the head of Galen Centre for Health & Social Policy.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.