KUALA LUMPUR: The "generational endgame" mooted by the Health Ministry forms part of the country's strategy to be a tobacco-free nation by 2040, when smoking prevalence is projected to be less than five per cent.
Experts believe that the time is ripe for Malaysia to acknowledge the damage done by the tobacco industry (TI) and work towards ending the sale of tobacco products, denormalising smoking culture and promoting zero exposure of tobacco use to children.
They said while the ministry's bold vision was technically feasible and socially desirable, it required decisive and strategic action, which included a clear roadmap for the generational ban on cigarette sales, political willpower to mitigate TI interference, and passage of the Tobacco and Smoking Control Act.
Malaysian Association of Adolescent Health president Professor Dr Mohamad Haniki Nik Mohamed said the act needed to be passed soon to provide the legal framework to enforce the World Health Organisation Framework Convention on Tobacco Control (WHO FCTC), which Malaysia is a party to.
"It (the legislation) has been with the Attorney-General's Chambers for more than six years. The government is duty-bound to protect us, the majority of whom are non-smokers or vapers, from tobacco advertising, promotion and sponsorships (TAPS), as well the so-called 'CSR' activities by the TI.
"TI is known for using TAPS to target young people in becoming lifelong nicotine addicts," he told the New Straits Times.
Health Minister Khairy Jamaluddin had, on Thursday, said Malaysia hoped to pass legislation this year that would outlaw the sale of tobacco and other smoking products to anyone born after 2005.
Khairy had also talked about a "generational endgame" earlier, stating that there would come a time when the coming generation "will no longer know what a cigarette is".
Haniki, a leader of the Sustainable Smoke-Free Campus Community Flagship at the International Islamic University Malaysia, said there should be a clear roadmap for the generational ban to ensure enforcement and overcome TI interference.
The findings of the 2021 TI Interference Index, he said, showed further deterioration in Malaysia's performance with a total score of 66 compared with 63 in 2020.
"Additionally, over the past six years, Malaysia has not made any progress in implementing the Article 5.3 guidelines of the WHO FCTC, and is faring poorly in protecting public health policies from TI interference.
"Corruption leads to watered-down policies and ineffective implementation of tobacco control strategies."
He said, for instance, the TI had claimed that an increase in cigarette price led to a boom in illicit cigarettes and related crimes.
However, he said, given that there had been no hike in cigarette tax since 2016, the continuous illicit cigarette business could be attributed to other factors, including poorly controlled borders and a lack of enforcement.
Article 5.3 requires that "in setting and implementing their public health policies with respect to tobacco control, parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law".
On the recent United States Federal Trade Commission (FTC) Cigarette Report, Haniki said an increase in sales of cigarettes could be attributed to many factors, including lack of enforcement of other effective tobacco control strategies.
According to the FTC report, manufacturers sold 203.7 billion cigarettes in 2020, a 0.4 per cent increase from 202.9 billion in 2019.
This, it said, represented the first time annual cigarette sales had increased in 20 years.
Haniki said WHO FCTC supported price increases via taxation as one of the most effective strategies to reduce the prevalence of smokers, especially among youth, due to their lack of income and purchasing power.
"We need to be wary of contradictory reports since it is known that such reports are usually sponsored by or affiliated with the tobacco industry."
Federation of Malaysian Consumers Association coordinator of the Tobacco Control and #SmokeFreeMY initiative Muhammad Sha'ani Abdullah said protecting minors from taking up smoking was the easiest way to reduce smoking prevalence.
Sha'ani said the tobacco-free generation plan was stipulated in the National Strategic Plan on Tobacco Control 2015-2020, but was delayed due to the 14th General Election in 2018.
He said the government should adopt a Code of Conduct against TI Interference to enforce Article 5.3 and look into tobacco tax increase, a proven strategy to reduce smoking prevalence.
He said the TI had offered systematic resistance to higher tobacco taxes and other control measures.
Documented tactics to resist taxes included claiming that higher taxes would increase smuggling and other forms of illicit trade; threatening governments that raised tobacco taxes with lawsuits; labelling tobacco taxes as anti-poor; and asserting that higher tobacco taxes would reduce government revenue and weaken employment.
However, he said, research evidence in the Malaysian context did not support the industry's claim that higher taxes prompted greater tobacco smuggling.
He said figures on illicit tobacco-derived products by the Customs Department contradicted the main arguments advanced by the industry.
"The true incidence of tobacco smuggling in Malaysia is likely to be about half of what the industry claims. Meanwhile, impartial research shows that raising tobacco taxes is likely to reduce the number of smokers in Malaysia and increase tax revenue.
"The Customs Department's analysis emphasises the impact on tobacco smuggling of non-tax factors, such as the presence of a large population of foreign workers who prefer to smoke their brands of cigarettes, along with the geographical particularities discussed above.
"It is worth noting that the large tobacco companies are sometimes engaged in illicit cigarette trade.
"Ultimately, the key strategies to fight smuggling and illicit trade are stringent enforcement and cracking down on corruption.
"Strong resistance by the TI has challenged Malaysia's progress in achieving the smoking cessation targets."
According to the National Health and Morbidity Survey, smoking prevalence stood at 21.5 per cent in 1986, 24.8 per cent in 1998, 22.8 per cent in 2006, 24.8 per cent in 2011, 22.8 per cent in 2015 and 21.3 per cent in 2019.
Former Malaysian Medical Association president Datuk Dr N.K.S. Tharmaseelan said the ban on the sale of tobacco to Malaysia's young was long overdue.
"The government spends millions looking after Malaysians who are afflicted and ravaged by smoking.
"A large number of hospital beds are taken up for treating smokers with various non-communicable diseases. It is morally unfair for non-smokers to pay via taxes to look after smokers who know the devastating effects of smoking."
Dr Tharmaseelan said the current approach of setting a minimum legal age for smokers (18 years) sent a misleading message that there was an acceptable age for smoking.
He said a total ban on smoking should be the ultimate aim to realise a tobacco-free generation.
"Minimum-age laws gives the impression to teenagers that the legislation is about youth control, which drives rebellion and resistance. Instead, efforts should be made to persuade youth that tobacco is too dangerous at any age."
He also said teenagers were exposed to subtle influence in various forms, including television and movies, which depict smoking as fashionable and classy.
Therefore, he said, Malaysia should look into becoming the first to censor smoking scenes in the media.
He said the government should start annual licensing of outlets allowed to sell cigarettes/tobacco products with smoking areas gradually reduced.
Public health expert and epidemiologist Datuk Dr Zainal Ariffin Omar said the generational endgame was timely, but the Finance Ministry and the Customs Department should beef up enforcement at the borders.
"The ban on those born after 2005 serves as a deterrent. This is to ensure they continue to be a smoke-free generation after 18 (2023 and beyond)."
Dr Zainal Ariffin said this, however, might not affect the older generation, thus the tobacco business would not be interrupted for at least 50 years, taking into account that the life expectancy of the current generation (allowed to smoke) was 75 years old.
He said the Tobacco and Smoking Control Act should come into force before the 15th General Election and Malaysia should set up a special task force similar to Australia's Illicit Tobacco Taskforce or the US Bureau of Alcohol, Tobacco, Firearms and Explosives to focus on the illicit trade of tobacco.
He said, the government should also review the National Kenaf and Tobacco Board's role and function in tobacco products and introduce standardised or "plain" packaging for cigarettes to deter smoking.
Malaysian Green Lung Association president Ho Rhu Yann said tobacco control strategies, such as increase in tobacco tax would also encourage smokers to quit.
"According to WHO, on average, a tax increase that increases the tobacco price by 10 per cent will reduce the consumption by five per cent in low and middle-income countries.
"This (generational smoking ban) is an optimal solution.
"This policy can help address the current gap in the existing tobacco control legislation."