On the 22nd June, a webinar hosted by thr.net took place. Moderated by Dr. Delon Human and Jessica Perkins from tobaccoharmreduction.net, the panel featured leading medical expert Dr. Konstantinos Farsalinos, Professor Sharifa Ezat Wan Puteth, President of the Malaysian Society for Harm Reduction and Professor Neil McKeganey, director of the Centre for Substance Use Research at the University of Glasgow.

“Many Malaysian smokers are seeing ecigs, and other non-combustible nicotine alternatives as their fire escape. We need to promote evidence-based regulation that gives comfort to consumers to switch from the most harmful to the least harmful alternatives." - said Dr Delon Human.

The 3 eminent academics discussed the need for regulation of tobacco harm reduction (THR) products in Malaysia, and misconceptions about alternative nicotine products and flavours.

Key misconceptions and the role of health practitioners

The Kantar survey showed that many adults in Malaysia are misinformed about the relative risk of THR products such as vaping. More than a third of Malaysians perceive them as more harmful or as harmful as cigarettes. “These figures underline the importance of health practitioners to encourage the efforts of smoking cessation”, argued Professor Neil McKeganey.

However, the survey shows that just 4% of people who vape said that they were encouraged to do so by a health practitioner. This also stems from the fact that many of them do not understand the relative risks of vaping or the fact that nicotine itself does not cause cancer.

All the speakers agreed that there is a huge role to be played by health practitioners in advising smokers to switch to less risky products, such as vaping. But in order to do that, misconceptions about reduced-risk products need to be dispelled.

Professor Sharifa Ezat spoke about THR encountering resistance from regulators and policymakers, since it’s a relatively new concept and the risk perception is skewed by exaggerated and fear-mongering media reports.

The survey also found that 52% of Malaysian smokers perceive vaping to be less harmful than smoking cigarettes. On this basis, 86% said that vaping should be made available to smokers as a less harmful product and 90% believe that vaping should be actively promoted as a less harmful alternative to smoking cigarettes.

The good news from the survey, however, is that those who have actually managed to switch to vaping, did so in order to cut down on smoking or quit completely (49%).

The use of flavours in vaping

The Kantar survey showed that nearly a third of respondents (61%) who vape used fruit flavours, hence the use of flavours is a powerful way for people to cut down on or quit smoking entirely. Dr Farsalinos commented on the issues of flavours, and highlighted that if products do not taste good, smokers will unlikely want to use them to quit smoking. What can prevent e-cigarette users from relapsing back into cigarettes, is to provide a variety of flavours for them to choose between - keeping the e-cigarette experience more interesting.

We need to provide practical solutions through risk - based regulation

In Malaysia today, e-cigarette products are unregulated, which on the one hand means that users can easily access products that can help them to switch or quit smoking; but on the other hand it provides poor quality manufacturers the opportunity to use potentially dangerous ingredients - causing harm to consumers.

The Kantar study saw that consumers are willing to embrace regulation of THR products, and the members of the panel agree that regulation is necessary to avoid having any substandard items on the market that could be dangerous to people’s health. However, as proven by other countries, bad regulation can cause people to switch back to smoking or never switch to vaping in the first place.

Success can only be achieved through proper information, knowledge and favourable legislation. Professor McKeganey said that what will be important for any future legislation of THR products in Malaysia is that it increases the accessibility, availability and safety of these products compared to cigarettes.

This webinar was the start of a much-needed debate in Malaysia on tobacco harm reduction. It highlighted how consumers feel about it and where it can go next.