Smoking has been a long-standing issue worldwide, with its detrimental effects on both public health and the environment.
In an effort to reduce the harm caused by smoking, Malaysia has implemented anti-smoking laws, with the latest, the landmark Control of Smoking Products for Public Health Bill 2023, which was passed in the Dewan Rakyat nearly two weeks ago.
However, the Bill has sparked a controversial debate, with critics arguing that it may not be effective in achieving their intended goals. Among the key issues raised centred on the provision dubbed generational end game (GEG), which prohibits Malaysians born from Jan 1, 2007, onwards from consuming or buying any type of smoking products, has been removed from the Bill.
On Nov 30, the Dewan Rakyat gave its nod of approval to the Control of Smoking Products for Public Health 2023, after two days of debate. Health Minister Dr Zaliha Mustafa tabled the Bill for the third and final reading, which was then unanimously approved by the lawmakers via voice vote.
The minister proposed the Bill to be tabled for the second reading on Nov 29. She also retracted the previous version of the Bill which was tabled for its first reading in June this year before being sent to the Parliamentary Special Select Committee (PSSC) for further review.
The GEG was removed as it was stipulated to have contradicted with the provisions under Article 8 (1) of the Federal Constitution, which states that every person shall be equal under the law and have equal protection of the law.
Despite her explanation later that the GEG was dropped after taking into account the views from the Attorney-General's Chambers (AG), several quarters have expressed their dissatisfaction over the matter. They argued that the clause would go a long way towards creating a smoke-free generation among Malaysians.
While expressing their concerns over the government’s decision, several experts interviewed by Bernama, however beg to differ with views that the omission of the GEG clause would be the “end” to efforts in creating a generation of non-smokers.
The Control of Smoking Products for Public Health Bill 2023 aims to regulate the sale and purchase of tobacco products, smoking materials, tobacco substitute products and smoking devices, for public health and to give rise to a smoke-free generation.
For them, the bill is critical especially in addressing the growing trend among the young in vaping of e-cigarettes, adding that this was is in light of a decision to delist nicotine in gel and liquid form used in products like e-cigarettes and vape from the list of controlled substances under the Poisons Act 1952 on March 31.
Furthermore, they said, Dr Zaliha has expressed her commitment to the GEG, noting that the Bill is pending approval of the Dewan Negara, before it is voted into law. The ongoing sitting of the Senate ends on Dec 14.
“If we feel that there is a need to relook at the possibility of GEG, maybe then we will bring it back. But I am not giving any timelines,” Dr Zaliha said.
The new version prohibits selling of tobacco products, etc to any person who is a minor in Clause 13 – which means that those born on Jan 1, 2007 can still use any tobacco products, smoking materials or tobacco substitute products, after they reach 18 years old and above. The previous version prohibits Malaysians born from Jan 1, 2007 onwards from consuming or buying any type of smoking products.
FIRST STEP TOWARDS GEG
Head of Sustainable Smoke-free Campus Community Flagship, International Islamic University of Malaysia (IIUM) Prof Dr Mohamad Haniki Nik Mohamed views the new Bill as the first step towards the implementation of the GEG.
In this regard, he said, the government should strengthen its enforcement of the law to curb the smoking habit among the younger generation, noting that the prevalence of cigarette smoking among Malaysian adults is still high at over 21 per cent for many decades.
"This shows that past efforts only managed to contain the smoking rate (percentage) from further rising but failed to significantly reduce the number of smokers.
“Studies have shown that the majority of smokers started smoking during adolescence, that is less than 18 years old,” he told Bernama.
“The data also indicates the new smokers are mainly adolescents as studies have shown that the majority of smokers began smoking below 18,” he told Bernama.
What is more worrying, he said is the significant rise in electronic cigarette use or vaping especially among minors and youth.
According to the National Health and Morbidity Survey (NHMS) 2022, the prevalence of youth using e-cigarettes or vape rose to 14.9 per cent in 2022 from 9.8 per cent in 2017, marking a notable increase over the five-year period.
In contrast, the prevalence of cigarette smoking among young conventional smokers has witnessed a decline. The NHMS survey shows that the rate of current cigarette use among adolescents dropped from 13.8 per cent in 2017 to 6.2 per cent in 2022.
In this regard, he said the new Bill has its own strengths in protecting the younger generation from modern smoking devices that are among the new millennial trends and those who need to be protected as they reach adulthood.
According to Dr Zaliha, the government is expected to bear treatment costs of about RM369 million per year in 2030 for e-cigarette or vaping product use-associated lung injury (EVALI) cases if no legal controls are in place.
She said the Ministry of Finance estimated the revenue from vape taxes to be about RM500 million a year, but research showed that the cost of treatment for EVALI was RM150,000 per patient.
“This is expected to increase to RM369 million a year in 2030. If no control is taken through this bill, then more people will be exposed to the risk of disease complications due to the use of e-cigarettes,” she said during the winding up on the Bill.
The Ministry of Health was earlier reported to have received 17 EVALI cases within the first six months of this year.
Based on the situation abroad, EVALI has shown that it is a potentially fatal disease, with the United States, for example, recording more than 2,800 people hospitalised with EVALI this year, and at least 68 deaths were recorded.
In Malaysia, the National Poison Centre recorded 77 poisoning cases due to nicotine exposure from e-cigarettes from 2015 till last year. For this year alone, at the time of writing, seven such cases were reported, five of them involving children.
COMPREHENSIVE
The 54-page Bill among others provides for matters related to registration, advertising, control over sales and purchase of tobacco products, smoking materials and tobacco substitute products.
At the same time, the Bill also prohibits the sale and purchase of tobacco products, smoking materials or substitute tobacco products or providing any services for smoking to minors.
Universiti Putra Malaysia's School of Business and Economics Deputy Dean, Associate Professor Dr Norashidah Mohamed Nor said the Bill should be immediately implemented to curb the smoking and vaping habit among youth.
“Smoking products not only cover tobacco products but also tobacco substitute products, with widespread uptake of vaping in Malaysia. So far, only tobacco products are subject to regulations stipulated under the Food Act 1983, but the new law provides a more comprehensive control over smoking products,” she said.
She further explained that among the strengths of the Bill when it comes into force include protection from all smoking products, namely tobacco products covering processed tobacco or products containing tobacco for human use.
"This also covers substitute tobacco products whereby whatever products or processed products in addition to tobacco products that can be used for smoking, are prohibited from the sale and purchase involving minors.
“No buying or selling of smoking products to those below 18 and no promotion or any sponsorship from companies selling smoking materials. As such, the community should also monitor their children or their neighbourhood to ensure problems of addiction to smoking products can be contained among youth,” she added.
She said it is also crucial that all parties work closely in support of initiatives undertaken by the government given the prevalence of smoking in the country is still high at 22.8 per cent with the total number of conventional smokers estimated at five million.
GEG THE WAY FORWARD
IIUM’s Mohamad Haniki also expressed hope that the government would not forget the GEG provision, which is regarded as imperative in ensuring the effectiveness or success in addressing the smoking scourge among youth.
GEG is critical as a new approach to containing the cigarette smoking and electronic smoking epidemic in the country, he said.
He said e-cigarettes containing nicotine are addictive, much like regular cigarettes. They can deliver nicotine rapidly to the brain and the high level of nicotine delivered by the current generation of e-cigarette devices can cause addiction or dependence on nicotine.
"Studies have shown that non-cigarette smoking youngsters who started smoking electronic cigarettes have high risks of becoming dual users or switching to conventional smoking. They largely contributed to the high percentage of adult smokers in Malaysia.
“As such, Malaysia’s goal of reducing the prevalence of tobacco use of 15 per cent by 2025 and less than five per cent by 2040, may not be realised, hence, GEG is a step in the right direction,” he said.
Meanwhile, a private sector employee, Hasliza Nusi, 40, said that vaping, while having negative effects on the young smoker’s health, can influence their behaviour including having no respect for his parents as well as the risks of being involved in various social ills.
“Our concern is if the law is not immediately enforced, vape smoking that is rearing its ugly head, could be regarded as ‘snacks’ among the young adults.
“They will lose their respect for their parents and the community and they may regard vaping as a trend with perceived self-image enhancement effects on the young smokers.
“The young smokers will continue smoking either vape or cigarettes as long as these products are easily available in the market,” said the mother of three children, aged five to 14.
Sharing similar sentiments, Siti Aziela Wahi, 38, called on the authorities to adopt a holistic approach to enforcing the law, with continuous monitoring in both urban and rural areas.
“Vape is now available in various flavours and colours. My concern is if they have been hooked to vaping from an early age,” she added.
Translated by Salbiah Said
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