KUALA LUMPUR: THE use of alternative products such as vape, snus, and heated tobacco products (HTP) has significantly reduced the number of conventional cigarette smokers in several countries.
This is evidenced by studies conducted in New Zealand, Sweden and other countries in smoking statistics over the past few years following the switch to alternative nicotine products.
Centre of Research Excellence: Indigenous Sovereignty & Smoking, New Zealand director Dr Marewa Glover said New Zealand has enacted numerous policies over the past 50 years aimed at reducing smoking rates.
She said the most significant decline in smoking prevalence occurred after the government regulated vaping products as consumer goods, leading to a halving of smoking rates in just five years.
"This situation occurred after the New Zealand government legalised the use of vape in 2018.
"Importantly, vaping products are exempt from tobacco excise tax. New Zealand's excise tax is the highest in the world relative to income.
"The much lower price of vaping products due to this risk-proportionate taxation was no doubt a motivating factor for low-income adults who smoked to completely switch to vaping," she said at the Harm Reduction Conference 2024, held on Oct 19.
This conference brought together global and local experts to explore the latest innovations and emerging paradigms in harm reduction.
Themed "New Innovations and Paradigms in Reducing Population Harm", the conference focused on tobacco harm reduction, alongside discussions on non-communicable diseases (NCDs) and drug reform.
However, Glover said the pace of smoking reduction could be hindered if regulations undermine the efficacy of these products, such as by imposing excessively low nicotine limits.
She said the measures New Zealand has implemented to reduce the number of smokers of conventional cigarettes include raising tobacco taxes and providing subsidies for alternative products such as nicotine pills, nicotine inhalers and nicotine patches.
To be effective substitutes for cigarettes, Glover said, these alternative products need to be acceptable to consumers.
She said if the nicotine level is insufficient for regular smokers, they may find it challenging to fully transition to the less harmful option.
She said the percentage of New Zealanders who vape has risen from 2.6 per cent between 2017 and 2018 to 9.7 per cent from 2023 to 2024.
To counter the misinformation about nicotine and harm reduction products, Glover said the New Zealand government produced a Vaping Facts website.
"They also require government-funded health services and groups to support adults who smoke to switch to vaping.
"Misinformation to put people off vaping is now mainly being spread by groups who will lose funding once fewer people are developing smoking-related respiratory diseases and lung cancer," she said.
Public health expert Professor Dr Sharifa Ezat Wan Puteh from Universiti Kebangsaan Malaysia (UKM) said the cost of the tobacco control programme in 2019 was RM142,389,193.40.
She said this figure includes expenses for enforcement, the operation of stop-smoking clinics, health education and training for officers.
Sharifa, who is also Malaysia Society for Harm Reduction president, cite a study that surveyed 1,000 individuals aged 18 and above who vape.
"From the survey, 43 per cent of vape users are aged 30 to 39, 39 per cent are between 19 and 29, 15 per cent are aged 40 to 49, and 3 per cent are 50 years old and above.
"According to the survey, 45 per cent of them quit smoking cigarettes, 45 per cent believe vaping is less harmful than cigarettes and 36 per cent switched to vaping because it is more affordable," she said.
Sharifa also expressed concern about the Control of Smoking Products for Public Health Act 2024 (Act 852) which took effect on Oct 1.
"While Act 852 is a positive step aimed at reducing smoking and regulating vaping, especially for those seeking to quit, it currently allows up to 35 milligrams of nicotine per millilitre in vape juice.
"But at some point, it will be reduced to 20 milligrams per millilitre," she said.
Sharifa said the issue arises for those who require a higher dose. If the nicotine content is too low, they may not feel satisfied and could return to smoking.
Former World Health Organisation Switzerland director of research policy and cooperation Professor Tikki Pangestu said every year, more than 8 million people globally die from tobacco use and Southeast Asia records approximately 1.6 million.
"As for the difference between these devices and burnt cigarettes, vaping does not contain tobacco.
"The e-liquid contains nicotine, but the nicotine amount is another issue. As mentioned, if the concentration is lowered to 20mg or less, those who want to switch from cigarettes to vaping may not be satisfied because the nicotine content is too low," he said.
In Indonesia, Tikki said, clove-laced tobacco cigarettes called "kretek" are significant where 80 per cent of smokers smoke these instead.
"Kretek cigarettes typically do not have filters, and their nicotine content may be much higher.
"Therefore, this situation makes it very difficult for the government to implement policies to reduce the number of smokers, despite research showing that alternative nicotine products are significantly less harmful," he said.