A total ban on tobacco and vape products to curb smoking is nothing but "wishful thinking" by the government.
While the move will not deter smokers, experts warned that it would hurt poor households, spur illegal trade and result in revenue loss for the country.
The concerns came after Health Minister Khairy Jamaluddin recently mooted the Tobacco and Smoking Control Bill to prohibit the sale and possession of tobacco and vape products to those born in 2005 or later.
However, experts said that Malaysia should focus on promoting less harmful alternatives for smokers if it intends to become a tobacco-free nation one day.
Poorer ones to lose more
Former law minister Datuk Zaid Ibrahim described the ban as "cruel and populist" as it cuts poor households deeper than the richer ones. This, he said, was because smokers generally come from the lower strata of the society.
"Smoking is a small pleasure for the poor masses. Many fishermen in Bachok, Kelantan, smoke to dull the pain of not having a good catch after a long day at sea.
"Padi farmers have to endure the heat and reap the minimal harvest when the season is not in favour of a good crop. Only smoking could relax them a little.
"While this initiative may be a clever way of permanently banning smokers from enjoying their puff for good, it will not prove successful in eliminating smoking. It is just another punishment on those who smoke.
"Today the price of cigarettes is sky-high. It is unaffordable to most smokers, yet it does not stop them from smoking.
"Smokers know cheap tobacco will kill them faster, but they have no choice because they like to smoke," he said, in a Facebook post earlier this year.
Zaid said underprivileged people can only rely on "small pleasures" like smoking, as they cannot own luxury items or afford overseas holidays, like the rich elite.
"The government should trust people to do what is good for them. There is no need to manage every bit of people's lives. There is no need to go overboard and punish smokers at every turn," he said.
Likewise, economist Dr Carmelo Ferlito pointed out that tobacco taxes were regressive since they pose greater financial burden on poor households.
The Centre for Market Education chief executive officer said this was because nicotine addiction would keep smokers hooked to smoking despite higher taxes.
"A tax hike on cigarettes will only make many poor households even poorer.
"This is because smoking is income-inelastic, meaning that as incomes grow, smoking products consume a much smaller portion of a household's expenditure.
"Greater tax burdens on the poorest households make the purchases of necessities like healthy food, clean water and adequate shelter more difficult.
"Some studies have found that working-class consumers in high-income countries opt for cheaper tobacco products to reduce expenditure," he said.
Unlikely to end consumption
Banning tobacco products is unlikely to curb consumption, simply because prohibitions cannot break nicotine addiction.
Dr Arifin Fii, a medical practitioner focusing on addiction therapy, said former smokers often relapse and quit intervention programmes within a few months.
"It is also important to remember that it is not only nicotine dependence that makes quitting traditional cigarettes difficult.
"For some, smoking offers relief and other psycho-social pleasure. This often makes the physical act of smoking just as difficult to quit as the nicotine smoking provides.
"Although nicotine addiction keeps people smoking, it is the smoke from combustion which releases thousands of harmful constituents into the body at dangerous levels, leading to deaths," he said.
In 2019, former Deputy Health Minister Dr Lee Boon Chye revealed that 73,836 people had participated in smoking cessation programmes over a seven-year period.
Yet, only 16,980 people were able to successfully quit in six months.
By contrast, the National Health and Morbidity Survey 2019 estimated that over 27,200 deaths occur due to smoking every year.
Hence, Dr Arifin urged the government to reevaluate existing strategies to decrease tobacco-related morbidity and mortality, that has fallen short from delivering on its goals.
Boon for black market
A tobacco ban, Carmelo argued, would do "a great favour" for organised crimes to go mainstream and boost the market share of illegal cigarette trade in Malaysia.
He illustrated this by comparing the proposed tobacco ban with the Prohibition period in the United States (US), during which, the sale and production of alcohol were banned.
"When the Prohibition took effect in the 1920s, mafia groups took over the liquor industry. This led to almost 75 per cent of the country's population resort to start drinking during the ban.
"Alcohol prices skyrocketed and illegal bars started mushrooming. An average of 1,000 people died every year after drinking tainted liquor. The US government also lost US$11 billion due to the liquor ban," he said.
R. Paneir Selvam, a senior lecturer at the Institute of Crime and Criminology in HELP University, said Malaysia that also faced a similar predicament.
Many alcohol consumers, he said, turned to bootleg booze after alcohol excise tripled in 2016. The issue drew public attention after 45 people died after drinking contaminated liquor in September 2018.
"Young adults are often tempted to rebel and seek for ʻforbidden pleasuresʼ. So, a generational tobacco ban intentionally targets them might actually provoke them to start smoking.
"A ban also enables organised crime gangs to flourish their illegal businesses through mass production of cheaper and harmful counterfeit alternatives.
"In the case of tobacco, contraband cigarettes are already gaining traction in Malaysia, and a ban will further exacerbate this," he said.
Paneir urged the government to introduce new legislation to distinguish vape products from traditional tobacco products.
Regulating the vape industry, he said, would prevent underage vaping and ensure that vape products strictly serve as tools to quit smoking.
"Imposing a ban on tobacco consumption is neither practical nor economically viable in the long run.
"Furthermore, the state should guide consumers to make informed decisions, and not dictate their consumption options," Paneir added.
According to Euromonitor International, Malaysia was the world's largest tobacco market in 2019, with illegal cigarettes making up almost two-third of the country's tobacco market.
The local industry body, Confederation of Malaysian Tobacco Manufacturers, through a study has also stated that Malaysia has been losing RM5 billion in tax revenue annually from the sale of illegal cigarettes.
The same study also found that at least six in every 10 cigarettes consumed locally were illicit ones.
Carmelo said further revenue loss is imminent should the Parliament green-light the generational tobacco ban.
In this regard, Bangi member of parliament Ong Kian Ming said the enforcement aspect will play a key role in determining the proposed bill's fate in the Dewan Rakyat.
Ong asked the Health Ministry to detail out its approach to curb illegal trade in Malaysia, strategies to prevent minors from purchasing cigarettes, and the mechanisms to enforce the generational tobacco ban.
The ministry, he said, should also provide an evaluation on current harm reduction strategies and on the possibility for smokers to shift towards contraband cigarettes, if the bill is passed.
Promote and regulate less harmful options
Rather than trying to eradicate consumption, Carmelo said, the government should encourage smokers to opt for less harmful consumption options.
"People are entitled to the pleasure that they choose. Our strategy should not be to destroy the pleasure, but rather promote lesser harmful options that offer similar pleasure.
"This can be done through three ways. Firstly, incentivise consumers when they choose less harmful products.
"Secondly, focus solely on decreasing tobacco smoking and reduce restrictions on heated tobacco, e-cigarettes and vaping products.
"Thirdly, welcome, encourage and incentivise innovation of harm-reduction alternatives," he said.
Meanwhile, Dr Arifin believed vaping could be a viable solution to phase out smoking.
Multiple studies, he said, have asserted that vape products were far less harmful compared with cigarettes and were more efficient in getting smokers to quit.
"For example, a report by Cochrane Review which reviewed 61 studies involving 16,759 adult smokers, found that more people stopped smoking for at least six months using nicotine vape than using nicotine replacement therapies.
"In New Zealand, which promotes vape as a smoking cessation tool, daily smoking rates have dropped from 16.4 per cent (between 2011 and 2012) to 9.4 per cent in 10 years (between 2020 and 2021).
"Similarly, in the United Kingdom (UK), smoking prevalence has declined since the country encouraged the use of vape to quit smoking. In England, the number of smokers dwindled from 7.7 million people in 2011 to 5.7 million in 2019.
"Another report in June 2021 also found that nearly two-third of current vapers in UK are ex-smokers (64.6 per cent), and this proportion is expected to grow," he said.
Likewise, international tobacco harm reduction specialist Clive Bates said allowing less harmful smoke-free products to replace cigarettes in the marketplace will bring the greatest and fastest return to public health.
"Smoke-free products do not require the user to quit nicotine but eliminates the toxic burden ofsmoke.
"They also serve as economic substitutes for cigarettes – which means that measures that increase demand for smoke-free products tend to decrease demand for smoking.
"This will also suppress demand for cigarettes among younger people, as there will be fewer parents and adult role models as smokers," he said.
Bates stressed that the right way to approach the smoking problem is to manage the risks of using nicotine, by adopting risk-proportionate regulations.
"For example, have high taxes on cigarettes but low or no taxes on smoke-free products.
"Ban cigarette advertising, but control advertising for vaping products to restrict themes and placement that appeal to younger people.
"Cigarette packaging and warning should convey significant risk, but the packaging of smoke-free products should encourage switching from smoking," he added.
Bates said Malaysia can still become a smoke-free nation, provided regulators have a clear goal, rather than pursuing naive and simplistic measures that drifts the country further away from its ambition.