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31st May marks World No Tobacco Day, which encompasses not just cigarettes but the broader tobacco and nicotine industry, including vapes and e-cigarettes. In Malaysia, smoking rates remain stubbornly high, cigarette taxes have been frozen for more than a decade now, and policymakers are still grappling with how to regulate newer nicotine products. How coherent is Malaysia’s tobacco control strategy? On this episode of #ConsiderThis Melisa Idris speaks with Professor Dr Murallitharan M., Managing Director of the National Cancer Society Malaysia and Chairperson of the Malaysian Council for Tobacco Control.
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00:10Hello and good evening. I'm Melissa Idris. Welcome to Consider This. This is the show where we
00:15consider and then we consider what you know of the news of the day. 31st May marks World
00:20No Tobacco Day, which encompasses not just cigarettes but also the broader tobacco and
00:26nicotine industry, including vapes and e-cigarettes. Now in Malaysia, smoking rates remain stubbornly
00:32high. We have cigarette taxes that haven't been raised for more than a decade now and
00:38policymakers are still grappling with how to regulate newer nicotine products. So tonight on
00:43the show, we'll examine the coherence of Malaysia's tobacco control strategy. Joining me on the show
00:50to help me do this is Professor Dr. Murali Tharan M, who is Managing Director of the National
00:56Cancer Society Malaysia. He's also the chairperson of the Malaysian Council for Tobacco Control.
01:02Dr. Murali, it's good to have you back on the show with me today. So three years ago, the Malaysian
01:08Council for Tobacco Control was part of one of the NGOs that was behind an unprecedented legal
01:17challenge against the government. And this was over the removal of the liquid nicotine
01:22from the poisons list. Maybe you can take us back to why you and other NGOs decided that
01:29legal action was necessary in this case.
01:32Okay, good morning. And of course, always a pleasure to be with you.
01:38What is this? So three years ago, what happened was we had, I think at that time, put out a
01:44proposal,
01:45meaning the government of Malaysia was going to table a new tobacco law, the first ever
01:49tobacco law. And in line with that, there was a proposal that they needed to legalize vapes
01:56at that point in time, because up to that point in time, vapes were illegal in Malaysia, although
02:00they were widely used and all that. So the idea was to regulate the vaping industry alongside
02:06the conventional kind of cigarette industry and bring about a kind of structured kind of management
02:14of the situation. Now, what had happened was there was a little condition in which in order to allow
02:20nicotine in vapes to be sold, they needed to kind of put it into a control framework where it could
02:31be
02:31sold legally. And the big challenge was this was nicotine was a controlled substance, which came
02:36under the Poisons Act. And allowances had been made for conventional cigarettes to be sold with
02:42nicotine. And so the proposal was to get vapes to also vapes containing nicotine to also be, how to say,
02:52allowed to be sold in and for adults. Now, unfortunately, at that point in time, when the government was
02:58about to do this, they had not tabled the Tobacco Act. So we at that time, recommended very strongly
03:04to the government, look, don't go down this road, you will create a loophole in which vapes can actually
03:10be sold legally with nicotine in them, and no one can police them until an act comes out, knowing very
03:19well that it'll take time for an act to come through parliament. And the moment an act has passed as
03:24well,
03:24it takes time for the act to come into implementation. And usually, even during an implementation phase,
03:30the government goes through a kind of, how to say, like a soft phase. So having known all this,
03:38we recommended strongly and it was supported by other stakeholders, including by the Poisons Board,
03:46recommending against this kind of decision to be taken, very, very aggressively and quickly,
03:54until the act, I mean, it could have been done after the act had come into place.
03:57Right. Dr. Morelli, do you think that the, because critics of that, that said, you know, removing
04:05nicotine from the poisons list, talked about taxing vape products, being one of the angles, I'm just
04:13wondering whether Malaysia is, the way we treat vaping primarily, is that, are we looking at it
04:20from a public health issue? Are we looking at it as from a revenue issue? Is this a consumer issue?
04:25What do you think? So, I mean, we have been very consistent, Melissa. For us, the amount of tax
04:32that's generated from the sales of any of these products is woefully inadequate compared to the
04:38of the medical bills and the medical related bills that we're paying out even on an annual basis.
04:44First, the tax doesn't make sense. It's never made sense. We've always said that it is a joke. So,
04:50we're very consistent on this. Okay. All right. So, what's next? Now that the court has ruled that,
04:59ruled with your judicial review application, what is the next step for the government then?
05:05Okay. So, of course, the first step that the government has to take is, there is already a
05:10debate going back and forth. I think the former ministers already commented that the government
05:14should kind of appeal against this ruling. For us, again, very clear that one, by appealing what the
05:22government is actually mentioning to the people of Malaysia is, they're really putting their cards on
05:27the table and saying that it's all that matters to us is tax. All that matters is revenue. The message
05:33we're sending is, we actually don't really care about the health of our people. So, that in case
05:37there's any kind of gray area in which they think that this messaging is going on, please let me be
05:43very clear. You're putting very clearly on the table saying that you don't care anything about
05:47anything except the money. So, if you are by them appealing against this ruling, that is very strongly
05:53the message that they're providing to the people of Malaysia. And I hope that everybody takes note.
05:57that is the signal that your government is sending to you. That is the first and very clear message.
06:04Second is, by what is this? So, we're saying, look, as a very clear social message, don't appeal.
06:13That's one. Second, and so now what do we now do with this? So, one is the government has to
06:19go back to
06:21look again at this decision that was taken in haste at that point in time to remove nicotine
06:29out of the poison's kind of inclusion list and make it exclusively available. You're now being
06:37allowed like a throwback moment or, you know, a refresh moment to go back and rethink whether this
06:43is the road you want to go down. Because now you have a legal kind of framework kind of backing
06:48your actions if you wanted to do so. The government can now take a choice on whether it wants to
06:54regulate nicotine because I'm also being very fair. It's not that I don't have friends who are vaping.
07:01I don't have family members who are vaping or nicotine users. So, to them, because nicotine is a
07:06clinical condition. It's an addiction. So, they are going to need nicotine therapy. You can't blanket
07:14bad vapes overnight because what you're going to see is mushrooming of every single, what is this,
07:20small guy sitting on the roadside and selling vapes which no one can police. So, the option is then,
07:26do we go for a medically regulated path, for example? That could be one possible mechanism. Nicotine
07:35made available, okay? Because if nicotine substitution products are now available in pharmacies, doctors,
07:43you know, medical related places or clinically related places, is that a pathway the government wants
07:48to take? That could be a possibility. So, you still make available nicotine products and but you're in vapes
07:56and you make sure that they are being given in a regulated manner. So, yeah, they're being sold to people
08:01who are actually users and they need that nicotine in order for them to taper down and they go on
08:06to a
08:07clinical management framework, meaning slowly you kind of push down the road to de-addiction.
08:13So, these are two existing users, but to people who are never users, then this is where our line is
08:19very hard. Our line is very hard because nicotine is addictive within 72 hours. The moment you get a
08:26young child hooked on nicotine, all it needs is three days of playing around with some kind of
08:31vape using products, and sooner or later, within about a week, they become users. I run de-addiction
08:41clinics. My youngest patient is eight years old. So, we need to ring fence in order to protect our
08:50naive population, those who are under 18, those who have never been exposed. Women, for example, have
08:56globally removed themselves from the whole idea of smoking conventional cigarettes. Very few women do
09:03it, but a huge amount of women are now using nicotine products because of vape. So, the industries,
09:12together, tobacco and vaping, again, very linked, they have ensured that they have succession planning
09:21and business continuity planning, if you will, for the next generation or so.
09:25Dr. Murilly, on that note, can I just ask you, when we talk about regulation, sometimes it's slower to
09:32adapt than industry. Industry is far quicker. How have you seen tobacco and nicotine and vape companies
09:38adapt their messaging in a vape area? And when we talk, public health advocates often talk about
09:45quote-unquote, industry interference, and I'm wondering what that looks like, what that means
09:50in actual policy-making terms. Okay. So, industry interference actually is, I wouldn't even go so
09:57upstream in the sense that industry interference means they work together with lobbyists, they work
10:03together with people working in government to, for example, distemper regulations or, you know, make sure
10:10the regulations are weak or make sure that the government doesn't enforce controls. They make
10:15sure that, for example, and a lot of theories on this because even the minister, the ex-minister said
10:22that she had been approached and offered, what is this, incentive, if you will, of a couple of million
10:29ringgit, if I'm reading it correctly in the media. So, industry interference is real. And so now, of course,
10:36the question that a lot of people are asking is, was there industry interference in the first place
10:41when you decided to take out nicotine? So, these are questions I have no, how to say, visibility over.
10:48But it exists, it's real, and it's consistent. Because essentially, industry is doing what it's
10:55meant to do. As industry, they need to sell and they need to market their products. So, they're going to
11:00do
11:00everything that they can to do that. So, in terms of messaging though, and they are trying to, one,
11:08ensure that they have new users. Like any salesman, they want to make sure that I've got a consistent
11:12stream of customers and I've got new customers coming in who've never bought my product before.
11:16So, it's very standard marketing, right? But unfortunately, the products are not safe.
11:21So, and this is where the kind of challenge is. One of the big issues that's been going on
11:26is actually how they've been targeting, as I was telling, naive users. Naive users meaning
11:33people who have never been exposed or who are conventionally would never use tobacco. So,
11:38young women, children, and the loophole essentially, again, looping it back if you will, pardon the pun,
11:48what is this? It has enabled people under 18 to have access to nicotine-related vaping products for
11:54about a year and a half. And nobody could police it. Nobody could police it because we didn't have
11:59any kind of law or regulation or anything in place. So, if this wasn't a freefall bonanza for every
12:06single industry selling these products, because it now allowed them to sell for one and a half years,
12:12trouble-free, I don't know what is. And on that note, I just want to ask you, Dr. Morelli,
12:19for public health advocates like yourself, when you advocate for stronger controls,
12:25is it far more difficult because there are stronger kind of commercial and fiscal interests at play here?
12:33Right. So, no, for sure, Melissa, but also in a real world kind of, how to say, setting, right? Advocates
12:42have traditionally also called for like very stringent controls, bans and all that. For us nowadays,
12:49for the, I suppose, the newer, much more pragmatic advocacy is, we're saying control should come in,
12:56but it's not about stronger controls, it's about effective controls. For example, our neighbour down
13:03south has effectively banned vapes, right? But they're still seeing a huge amount of problems. So, there's
13:09still widespread usage, there's still a huge amount of addiction, you know, and, and what is this,
13:16you know, people are just smuggling across the border. And again, once again, it's a beautiful thing.
13:20Malaysia is to blame for this largely because our, our boys and girls are the ones that are ferrying it
13:25over.
13:26So, in effect, a ban is ideal, but I'm more concerned about the process and the pathways that
13:35we take to lead to a ban. So, it's about making sure that we have systems in place for the
13:415 million
13:42odd people who are using nicotine. They need to have some measure of access to products, regulated products,
13:50if you will, to enable them to step down or lower their usage because you're addicted for many years
13:55to nicotine. It's, it's as addictive as heroin. It's difficult to get off. So, like I ban, I, I, I,
14:04I
14:05informed Melissa today, you know, the PM should ban this tomorrow. The PM does ban it. What do we do
14:09with these people? So, we need processes like frameworks in place to enable that we can soften the
14:16the movement. There's also, I'm also being, how to say, uh, cognizant of the government's very,
14:21uh, needful in these times of the taxes and all that. So, that is a consideration. I, I, I'm not
14:28saying no. It's again, it's a real world issue. Yeah. Dr. Murli, thank you so much for being on the
14:33show with me today. Professor Dr. Murli Tharan M there. Um, and we're going to take a quick break
14:38here and consider this, but we'll be back with more on this topic. So, stay tuned. We'll be right back.
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