DURING his university days about 15 years ago, one pack of cigarettes could only last Khairil Azizi Khairuddin three days.
He would smoke after his meals,after participating in sports activities and also during toilet breaks.
On numerous occasions, he had tried other alternatives, including switching to snacking in an attempt to reduce his cigarette intake but such efforts failed.
"It was during a dinner outing that I was first introduced to vaping.
"It felt good and that it was totally different from smoking cigarettes since vaping is all about the flavour (of the vape juice).
"I immediately realised that vaping was a win for me, especially afterwards when there was no lingering smells," said Khairil.
From that day on, Khairil noticed his dependency on smoking cigarettes gradually reduced before he completely replaced the habit with vaping.
"The change did not happen immediately since vape devices were pretty expensive back then.
"For a start, I would alternate between smoking cigarettes and vaping.
"Nevertheless, I noticed a change in my smoking pattern from one stick in every two hours to a stick in every five hours," he said.
Khairil shared his experience on how vaping helped him kick his smoking habit when he was featured as one one of the three panellists during a New Straits Times (NST) Insight forum titled: "Understanding Harm Reduction — An International Perspective".
Moderated by Nadia Azmi, the other panellists included Advanced Centre for Addiction Treatment Advocacy president and addiction therapy expert Dr Arifin Fii and Dr Marewa Glover, who is a director of the Auckland-based Centre of Excellence: Indigenous Sovereignty and Smoking.
"The process (from quitting smoking and replacing the habit with vaping) was gradual and took me quite a few years.
"Now it is completely gone," said Khairil, who is the president of the Malaysian Vapers Alliance.
When asked if he still had the urge to smoke in a setting where he was surrounded by smokers, Khairil replied: "I have vape. I will vape when the urge to smoke cigarettes persists."
Below are excerpts from the interview.
Q. What is tobacco harm reduction since there is a lot of debate on claims that e-cigarettes are a less harmful alternative to tobacco smoking?
Dr Glover: Based on the numerous studies conducted in the United Kingdom (UK), New Zealand, Japan and South Korea, the evidence is clear and we have seen an unprecedented drop in smoking in these countries.
Since vaping was introduced in New Zealand in 2015, we have seen much faster reduction in smoking prevalence. And that reduction in smoking prevalence sped up the New Zealand government passing the legislation to regulate vaping. It really has been quite spectacular. Therefore, I would like to point out to the people to look at case studies conducted in the UK, New Zealand as well as smoking prevalence in the United States (US), especially among youth, which has plummeted.
Based on the 2021 statistics in New Zealand, the reduction in smoking has accelerated from a gradual pace to rapid. With that, I am pretty sure that the number of smokers will continue to show a decline in the years to come.
Q: What is your view on the studies conducted by Public Health of England, which has maintained that vaping is 95 per cent less harmful than smoking cigarettes?
Dr Glover: It is absolutely correct. What people need to understand is that the combustion process in the smoking of tobacco products resulted in most of the harm towards smokers. The harm is caused by the carbon monoxide and the tar, which is inhaled.
These substances do not exist in the greatly risk-reduced alternative to accessing nicotine.
Among the countries with very low smoking prevalence are Sweden and Norway with the young and women accounting for less than one per cent of the group.
Dr Arifin: I agree with such findings since it is backed by many studies. In 2014, a group of researchers made an evaluation of the risk of the harm minimisation of vape and few other harm-reduction products.
Therefore, the level of harm caused by vape is almost as equal as nicotine replacement therapy. There were also other research conducted which showed it was beneficial for smokers to switch to vaping.
A case in point is a study conducted by the American Heart Association, which was published in May this year.
The study showed the risk of cardiovascular disease for those who switched to vape was equal to those who do not vape.
Q: New Zealand has embarked on a smoke-free journey when the country introduced new laws in July in its attempt to create a smoke-free generation. Can you share with us what this law entails?
Dr Glover: The journey towards this path started in 1945 with education before the ban on advertising about 20 years later. It has really been an incremental process over decades and lives of generation.
In 1990, New Zealand became the first country in the world to pass a comprehensive smoke-free environments act. Since then, there have been numerous amendments to the Act — every time increasing the bans to more areas from inside to outside and increasing the taxes and increasing the stigmatising campaign to make the people who smoke feel bad about themselves and their behaviour.
It has been a slow and gradual reduction in smoking prevalence over that long period of time.
However, I do want people to understand that New Zealand is pretty much smoke-free now and it depends on where you are living as well as what community you are in.
There is the latest law that is being pushed by the government. As you know, the law is introducing a sinking lid on the age of purchase of the cigarettes.
What this means is that every year, the age of purchase will increase from 18 to 19 and on until nobody will be able to buy cigarettes.
The problem is that a younger person will just ask someone who is one year older who is still able to buy cigarettes for them.
It is really not very practical and it is more about the government saying "look at this wonderful thing we've done" but we are going to see very serious negative consequences of people who break the law. And that is what I am really concerned about.
Q: Closer to home, do people in Malaysia understand what tobacco harm reduction is given the mixed reaction when the generational end game (GEG) bill was tabled in Parliament recently?
Dr Arifin: Harm reduction is not new concept in medicine especially in the treatment of tobacco addition. In fact, it has been used in the treatment of heroin addiction. They are switching heroine to a less harmful product such as methadone.
Tobacco harm reduction is part of the country's strategy in smoking cessation but currently, the programme is limited to only nicotine replacement therapy such as the use of nicotine gum.
However, vape is not encouraged or may be prohibited in Malaysia possibly because of the information available and the existing perception among the people towards the use of such devices.
As such, this shows that the people do not understand the concept of tobacco harm reduction.
The awareness is not there since the information accessible and available to them is not correct. There were "frightening" things presented to the people (in relation to the tobacco harm reduction concept).
Q: What can the Malaysian government learn from the framework which has been implemented in New Zealand with regard to tobacco harm reduction?
Dr Arifin: Reduction in smoking prevalence in Malaysia is very slow. The 1971 statistics showed the prevalence of male smokers was 41 per cent. The prevalence of male smokers increased to 49 per cent about five years later in 1976.
The latest figure showed the prevalence of male smokers has dipped slightly to 44 per cent. The prevalence of male smokers is reducing but at a slow pace.
We have already witnessed evidence in the US and the UK, these nations are a bit relaxed. In fact, both nations are encouraging the use of vape as a tool for harm reduction. They have seen a remarkable reduction in smoking prevalence.
Our tobacco control measures or policies were first introduced in 2004 and they are comparatively new compared with New Zealand.
In my opinion, Malaysia should learn from New Zealand and other countries such as the UK on what they have done to reduce the prevalence of smoking.
With that in mind, it will take quite a long time for Malaysia to see the results.
Q: Do you think the people have been receptive in complying with the previous laws that deter them from smoking before the GEG comes into play?
Dr Arifin: The compliance among the people with the many measures (previously introduced by the government to reduce smoking) is very low.
For example, the "Tak Nak" (Say No to Cigarettes) Anti-Smoking campaign that started in 2004. Despite the millions in allocation spent for the campaign, it did not really prove to be effective.
In 2011, the prevalence of smokers in the country stood at 23.2 per cent. Fast forward to about eight years later (in 2019), the prevalence of smokers was only 1.8 per cent lower.
Many other measures to reduce smoking have been implemented in Malaysia such as the ban on smoking at eateries, if you walk around, there are still people smoking in the toilets despite the enforcement of such a ban.
This showed that the compliance among Malaysians towards such laws is poor.
Therefore, we need to think of a better and more comprehensive policy we could emulate such as the ones enforced in the New Zealand and UK.
Q: Since the proposed GEG is being reviewed by the Special Parliamentary Select Committee, what is the approach that the Malaysian government should look into with regard to the implementation (enforcement) of this Bill?
Dr Arifin: On paper, the proposed law appears easy and feasible to be implemented. After going through it, I feel that the proposed legislation would be a very difficult, complex and delicate policy for the government to implement.
The proposed law demands the cooperation from all sides of society, great enforcement and commitment and a high level of compliance.
With the wide socio-economic disparity, I feel that the country is not prepared for a prohibition-like policy such as the GEG.
This country will be a breeding ground for many illegal activities such as illicit trade. This has happened before in the US when the country prohibited alcohol consumption.
We need to rethink and revise and see what policy best suits Malaysia that can bring a much better result.
Dr Glover: The solution that you (the government) plan to put in place should not cause other harms.
Harm reduction approach is about helping to choose a substitute behaviour, reduce the risk of harm and vaping does that (for cigarette smokers who wish to quit smoking).
This policy (proposed GEG) is prohibition by stealth. Prohibitions come with increased black market activities.
In New Zealand, we have seen a huge rise in cases involving robberies in stores selling tobacco due to the high price of the item.
Because of the regulation concerning vaping, we have also seen a rise in robberies of stores selling vape products as well.
This is because the law made it slightly harder to access vape products and also increased the cost of vaping.
I am concerned that young people will have to resort to the black market for either cigarettes or vape products if the GEG is implemented. This will also expose them to other sort of harm.
Q: From the perspective of those who would be directly affected by the implementation of the GEG if it is passed in Parliament, what are your thoughts on the proposed law?
Khairil: I think this GEG will not be effective. This is because the proposed law equates vape to smoking cigarettes. To me, the two are not the same. In fact, to equate both vaping and smoking cigarettes is very inaccurate.
By grouping these two together, it will send a wrong message to smokers who want to quit the habit.