By Dr. Arifin Fii, President, Advanced Centre for Addiction Treatment Advocacy (ACATA)
Malaysia has long aspired to become a smoke-free nation. Yet despite years of health laws and taxation regimes, one in five Malaysian adults still smoke today – that’s around 4 million adults.[i]
Smoking is increasingly viewed as a public health issue. The shift to vaping is seen as both a challenge and an opportunity for harm reduction, though regulation remains fragmented across states. However, Western public policy and proven results are often ignored.
Europe’s Alternative Nicotine to Cut Smoking Rates
Smoke-Free Sweden 2024: Missing the Target[ii] reports the European Union (EU) nations face a similar challenge. 24% of EU adults still smoke, a decline of just 1% since 2020, despite decades of strict laws and high taxes.
Ireland’s smoking rate is 18% against their 5% by 2025 goal, despite ban on disposable vapes and newly introduced highest in EU vape tax. The Netherlands smoking rate stands at 19%, only a 1% drop since 2020, despite restricting e-cigarette sales to specialist shops. Denmark’s regulation on alternative nicotine has stalled momentum altogether.
Sweden adopted a tobacco harm reduction (THR) strategy by utilizing non-combusted nicotine products nearly achieved smoke-free status (smoking rate between 5.6%–8%) and is expected to reach its 2025 target ahead of schedule. By recognizing proven results in alternative nicotine products, Sweden proved THR can bring real results.
Together, these examples underline one truth: Prohibition Does Not Work. When governments restrict less harmful alternatives, smokers are more likely to stick with cigarettes, delaying progress toward a smoke-free future.
The science behind THR is compelling. The Royal College of Physicians in the United Kingdom has found that vaping is at least 95% less harmful than smoking[iii]. The real danger from tobacco is not the nicotine itself, but the thousands of toxic chemicals released when it is burned. While long-term data on vaping continues to evolve, the current evidence consistently shows it to be far less harmful, and many smokers use it as a transition tools.
Nicotine addiction, as any clinician knows, is not a moral failing but a medical condition that requires compassion and treatment. Many smokers genuinely want to quit but struggle with withdrawal and limited cessation tools. THR provides a pragmatic middle ground, helping smokers move away from the most harmful form of nicotine consumption without punishment or stigma.
Malaysia’s Enigma
Malaysia’s Ministry of Health recognizes that smoking leads to more than 27,000 preventable deaths every year.[iv] Smoking-related illnesses cost the nation billions of ringgits in healthcare spending annually. Despite these staggering numbers, our policy landscape remains uncertain. More alarmingly, it does not distinct the notable difference between carcinogen-induced diseases from cigarette smoking versus vape or e-cigarettes.
Malaysia missed an opportunity to really nip the problem in the bud when the Control of Smoking Products for Public Health Act 2024 took effect about 1-year ago. Harm reduction is not recognised as part of our national tobacco control strategy. Current measures treat all nicotine products as equally harmful, overlooking the opportunity to reduce smoking through less harmful, regulated, nicotine alternatives.
As discussions on whether to impose stricter measures or even a total vape ban continues, we must shift the conversation from viewing vape as a problem to seeing it as a potential public health tool with stricter enforcement for underage access. To do this responsibly will require commitment from all stakeholders: through education, enforcement and regulations that ensures safety while supporting smokers who want to quit.
Learning from Proven Strategies
Sweden’s success offers valuable lessons. Instead of treating all nicotine products as equally harmful, the government adopted a risk-proportionate regulatory approach, giving smokers less harmful, affordable and accessible options. This principle could guide Malaysia’s next step. By creating a clear framework for less harmful alternatives, we can reduce smoking prevalence.
The United Kingdom’s National Health Service (NHS) has incorporated e-cigarettes into its smoking cessation framework, and New Zealand’s regulatory action plan balances access to vaping products with youth protection measures.
Harm reduction is not a new concept in healthcare. It saves lives by meeting people where they are, not where we wish them to be. The same principle should guide tobacco control: helping smokers transition, not punishing them for struggling.
Sweden’s journey proves that a smoke-free future does not require eliminating nicotine altogether, only eliminating the harm that comes from burning it. By giving smokers choices rooted in science and compassion, the country reached its goal years ahead of schedule and improved public health outcomes nationwide. Malaysia can do the same, but it will take courage from policymakers, support from health advocates and trust in the evidence.
[i] National Health and Morbidity Survey (NHMS) 2023
[ii] Smoke-Free Sweden 2024: Missing the Target
[iii] https://www.gov.uk/government/news/e-cigarettes-around-95-less-harmful-than-tobacco-estimates-landmark-review
[iv] Institute for Public Health (IPH) Malaysia, Tobacco and E-Cigarette Survey 2023
