MP SPEAKS | Let's do what's right to protect people from nicotine

MP SPEAKS | The parliamentary sitting next week may be extra significant.

This is not just because of the importance of the upcoming Budget 2024, which will set the economic trajectory of our country, but also an opportunity for us MPs to make a monumental public health decision that could lead to greater economic growth and be a fiscal multiplier for our country, especially in the long term.

In this parliamentary session, the Health Ministry will be tabling the Control of Smoking Products for Public Health Bill 2023, where MPs can make the decision to protect our future generations from the harms of smoking and vaping.

The growing tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than eight million people a year, including around 1.2 million deaths from exposure to second-hand smoke.

Despite compelling evidence on the health hazards of tobacco products accumulated over the past 70 years, smoking remains and is likely to remain the leading cause of preventable death throughout this century, unless smoking cessation efforts are ramped up or “game-changer policies” are implemented that can significantly and rapidly reduce the number of smokers, particularly in Asia.

In Malaysia itself, we are not spared and the numbers are worrying. The prevalence of smokers in Malaysia, aged 15 and above in 2019, was 21.3 percent of users, or 4.9 million people. The trend of nicotine products usage showed a sharp increase, following the emergence of new millennium cigarettes, such as electronic cigarettes or vapes.

This is proven through the recent National Health and Morbidity Survey (NHMS) 2022 which revealed a significant increase in the prevalence of e-cigarette and vape use among Malaysian teenagers.

Based on that data, e-cigarette and vape use among Malaysian teens aged 13 to 17 rose from 9.8 percent or 211,084 people in 2017, to 14.9 percent or 307,109 people in 2022. This is alarmingly higher even than the United States, whose own experts acknowledge that the US is struggling with a youth vaping epidemic.

The World Health Organization has also acknowledged the harm of e-cigarettes, with its chief Tedros Adhanom Ghebreyesus describing vaping as a “trap” for children to hook young people into lifetime addiction to nicotine.

Smoking-related complications

What is more, nicotine products are not just harmful to the health of our nation, but also the health of our economy. An estimated RM8.77 billion needs to be spent in 2030 to treat non-communicable diseases (NCDs) caused by smoking complications, such as chronic lung disease, lung cancer, and heart disease.

It is important to note that this expenditure projection only involves three diseases, compared to the treatment costs of other smoking complications and diseases.

It is estimated that for every RM1 collected from the tax currently imposed on tobacco products, RM4 is spent on treating people suffering from smoking-related complications and disease.

Unfortunately, an estimated 27,000 people annually will prematurely lose their lives due to these conditions.

In 2030, the government is expected to spend as much as RM369 million to treat complications due to E-cigarette or vaping product use-associated lung injury (Evali).

On top of that, the non-direct costs are even higher – a study by Tan et al, published in 2020, showed that smoking costs RM275 billion in loss of productivity to Malaysia.

Those are among the many reasons why the tabling of the Control of Smoking Products for Public Health Bill in Parliament, which includes the generational end-game (GEG), is of utmost importance.

It is a sensible policy strategy to protect future generations from lifelong addiction, as well as chronic diseases, and will result in significant public health, social, and economic benefits in the long term.

The spirit and principles of this bill have been 13 years in the making. We know that in order to properly regulate the changing dynamics of tobacco products in our world today, we need a more robust and comprehensive law that governs the sale, use, and promotion of not just tobacco products such as cigarettes, but also vape and other future nicotine delivery systems.

The current 2023 bill has gone through layers of robust scrutiny and amendments in order to address different concerns raised both in the previous Parliament and also multiple engagements with different stakeholders, with the most recent by the Health Parliamentary Special Select Committee (PSSC) led by former health minister Dr Dzulkefly Ahmad.

I acknowledge the validity of many of the concerns raised with the previous version of the bill and had even personally objected to the 2022 bill tabled in Parliament last year due to concerns of over-reaching enforcement powers and the general “punitive” nature of the legislation, which may lead to possible unintended consequences.

My fellow MPs, most of those concerns have been addressed in the 2023 bill that we will debate this coming Tuesday. This 2023 bill under Prime Minister Anwar Ibrahim’s administration is different from the 2022 version we saw last year.

Community service

The very name of this new bill – the Control of Smoking Products for Public Health Bill – shows that this piece of legislation is intended to protect public health, not to punish smokers.

The GEG is no longer a tool of punishment to be wielded by the state against young people, but a measure to protect future generations from lifetime addiction to nicotine and serious smoking-related diseases, including cancer.

Community service is provided for in the bill as an alternative punishment for GEG offenders. The maximum fine for smokers or vapers in the GEG group may even be lowered to below RM500. GEG offenders will not have a criminal record, but will simply get a summons and be provided the necessary support and help to quit the habit.

While I understand certain concerns raised by our constituents on the bill, I urge us MPs to consider the long-term benefits that this bill will bring to their constituencies in terms of better health and improved quality of life.

As I stated earlier, this can have an economic multiplier effect through better productivity and better quality of life for our people and their children.

We need to “stop the start” since the smoking habit often begins in the teenage years; it is our responsibility as lawmakers to step in and help protect children and youths, especially when parents across the country – whether from the B40, middle class, or T20 – are busy dealing with the rising cost of living and may not have the time to constantly monitor and prevent their children from taking up smoking or vaping.

Some argue that the GEG is a form of discrimination and infringement of fundamental rights, especially for the young, or rather, those born from a certain year.

First and foremost, there is case law for this, where the Court of Appeal ruled that the smoking ban at public premises does not contravene Article 5 (right to life or personal liberty) or Article 8 (all persons are equal before the law and entitled to equal protection of the law) of the Federal Constitution.

The Court of Appeal also stated that smoking is a “choice”, rather than a “right”.

I would also like to put forth that discrimination is depriving one person of a fundamental “positive need”, i.e. food, education, health care etc. However, limiting something “negative” that causes so much harm to self and to those around is not discrimination but rather, protection.

In the end, rights have limits, especially if they cause harm to others (harm principle).

Most importantly, another one of the more significant amendments in the Control of Smoking Products for Public Health Bill is the addition of a clause that mandates a periodic review of the effectiveness of the act, first, by January 2025 (before the law applies to the first generation of the GEG), and then every five years, which will be tabled in Parliament in full transparency.

This is important to determine the effectiveness of the implementation of the law and to allow room to ensure that issues arising from implementation can be addressed by making the necessary amendments to the act, and by taking into account any emerging data or science.

That basically is the “safeguard” that allows us to make needed changes and adaptations to ensure the success of the act and its implementation on a periodic basis.

Although coffeeshop associations and retailers have raised concerns about the economic impact of the GEG on their income, such impact is minimal and may only come into place over a long period of time.

In fact, they have at least two to three decades of “soft-landing” since the pre-2007 generations, which are the current market, can still continue to smoke.

There is no tangible data to show that smoking prohibitions affect businesses. Former New York City mayor Michael Bloomberg pointed out that a smoking ban in bars and restaurants that he implemented in 2002 led to record-high tourism numbers and a growth in the number of bars and restaurants.

There are calls to recognise vapes or non-heated tobacco as “harm reduction”, or a less-harmful alternative to traditional cigarettes and to be excluded from the GEG.

While I am open to the concept of “harm reduction” – and that is one of the things that will be evaluated in the mandatory review – the spirit of GEG is to lock the gate against the possibility of new smokers and vapers, especially among young people.

We are trying to protect them from starting in the first place.

That is why this is not a question of “harm reduction”, which is mainly for existing smokers, not the GEG generation. Even so, there is room where decisions and amendments can be made based on the newest data and science, if it clearly points that way.

However, even if implemented, “harm reduction” must come with proper regulation and control. Even in the UK, its Prime Minister Rishi Sunak recently announced plans to restrict the availability of vapes to children, as one in five children in the UK have used E-cigarettes.

The UK government plans to examine restricting flavours, brightly coloured packaging, visible point-of-sale displays, as well as disposable e-cigarettes. New Zealand also recently announced plans to ban most disposable vapes and to enforce generic flavour descriptions in a crackdown on youth vaping.

In Malaysia, many vape companies have targeted young people with sleek devices, an innumerable array of flavours in a “flavour war”, and even vape vending machines in universities – laying to waste claims that the products are only targeted at adult smokers. On top of that, e-cigarettes and nicotine vape are now increasingly sold in restaurants and convenience stores, beyond speciality vape stores.

That is why we, MPs, have a responsibility to not allow our children and young people to be trapped by harmful and addictive e-cigarettes and vapes, the new tobacco.

With all that said, we as policy-makers are at an important juncture.

Once in a while, we will be presented with a decision, the consequences of which will be felt for many, many years to come. I believe this is one of them.

Last June, a 16-year-old girl with a three-year vaping history died from heart failure in Selayang Hospital in a case classified as probable Evali. We may not know her name, but we must ensure that her friends and other young women and men do not die from the addiction and harm of nicotine.

While I understand the concerns and complexity surrounding the Control of Smoking Products for Public Health Bill, it is our responsibility as MPs to do what is right and responsible to protect the general public and, more importantly, our future generations.

This decision can catalyse not just a better nation, but give birth to a healthier and more productive generation of leaders who will lead our nation to greater heights for years to come.

KELVIN YII LEE WUEN is the MP for Bandar Kuching.

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.