CAP Urges Government to Reject Misinformation from ENDS and HTP Industry, Citing Public Health Risks

The Consumers’ Association of Penang (CAP) urges the government to reject the arguments presented by the electronic nicotine delivery systems (ENDS) (inclusive of e-cigarettes and vapes) and heated tobacco products (HTPs) industry.

The arguments proffered by the ENDS and HTP industry and their lobbyists echo those previously employed by the tobacco industry, which is now heavily regulated under the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC), adopted by over 90 percent of countries worldwide.

The industry promotes ENDS and HTPs as safer alternatives and smoking cessation tools, but these claims are simply disinformation perpetuated by the industry to support nicotine addiction. A 1960s memorandum by Addison Yeaman, General Counsel for Brown & Williamson, plainly stated, “We are in the business of selling nicotine, an addictive drug”.[1]

Below are CAP’s rebuttals to claims* made by the Malaysian Vape Chamber of Commerce (MVCC) and its lobby groups (*https://www.freemalaysiatoday.com/category/nation/2024/07/23/drastic-vape-regulations-could-kill-industry-say-groups/):

Claim: The government’s plans to “introduce overly prohibitive vaping measures should be implemented in stages.”

Rebuttal: The so-called ‘prohibitive’ measures implemented in stages represent an industry strategy to prevent or delay government efforts to curb smoking-related diseases and issues. Gradual implementation allows the industry time to lobby, circumvent, and exploit legal loopholes before each new stage takes effect, rendering the approach less effective than comprehensive, immediate measures.

In 2007, the tobacco industry launched a year-long advertising blitz before the introduction of graphic health warnings (GHWs) and the ban on descriptors like “light,” “mild,” “cool,” and “mentholated.” This strategic timing was no coincidence.  Tobacco companies introduced numerous new packaging designs, free gifts, cigarette flavours, variants, and display stands. Ideas to bypass legal restrictions were gathered from ASEAN’s largest tobacco expositions in 2003 and 2005, where industry professionals discussed and showcased developments in the tobacco sector.

Given these tactics, tobacco control measures should not be implemented in stages, as often suggested by the industry. Implementing the Act in its entirety aligns with the WHO’s Framework Convention on Tobacco Control (FCTC), to which Malaysia is a signatory.

Claim: The Products for Public Health Act 2024 (Act 852) could lead to major economic and public health repercussions.

Rebuttal: The government faces a significant fiscal burden in treating e-cigarette- or vaping-use-associated lung injury (EVALI), with costs estimated to reach RM369 million annually by 2030 if no legal measures are implemented. This contrasts with the RM500 million that could be generated annually from vape taxes. Former Health Minister Dr Zaliha Mustafa highlighted that the cost of EVALI treatment is about RM150,000 per patient, with medical expenses expected to escalate over time.[2]

Given the high cost of treatment, most patients are likely to seek care at public hospitals, placing additional strain on already burdened medical facilities. If EVALI patients are hospitalised or unable to work, this could lead to workforce disruptions, reduced earnings, and increased stress and financial hardship for their families—hidden costs that the industry often ignores.

Nicotine and marijuana are both classified as recreational drugs. If nicotine use is permitted, does that mean marijuana should be as well? Moreover, nicotine is as addictive as cocaine or heroin.

Claim: Implementing plain packaging and prohibiting the display of vape products could kill the industry and destabilize the market.

Rebuttal: Plain packaging is addressed by Articles 11 (Packaging and Labelling of Tobacco Products) and 13 (Tobacco Advertising, Promotion, and Sponsorship) of the WHO FCTC. Given that these products are hazardous to health and highly addictive, the argument that the industry will be destroyed or its market destabilized by this measure is invalid.

As of 2024, over 20 countries have adopted plain packaging for tobacco products, removing all branding, logos, colours, and promotional information from packaging, leaving only standardized fonts, sizes, and health warnings. The first country to implement plain packaging was Australia in 2012, followed by several others, including the United Kingdom, France, and Canada.

The number of countries adopting plain packaging continues to grow as more nations recognise its public health benefits in reducing smoking rates and smoking-related harm.

Claim: The industry currently employs 31,500 workers, including a significant portion of Bumiputeras. Severe job losses and a decline in its economic footprint could occur.

Rebuttal: While the industry claims to employ 31,500 workers, it fails to acknowledge that it is endangering the health of 1.4 million adult Malaysian vapers as of 2022.[3] Additionally, the impact on school-going youths who have access to vapes is ignored.

The National Health and Morbidity Survey (NHMS) 2022 revealed a significant rise in e-cigarette and vape use among Malaysian teenagers. The prevalence of ENDS use among teenagers aged 13 to 17 years increased from 9.8 percent in 2017 to 14.9 percent in 2022, marking a notable surge over the five-year period, even as smoking rates declined.[4]

Claim: Industry players have been left in the dark due to a lack of clarity from the government.

Rebuttal: FCTC Article 5.3 states: “In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.” Public health takes precedence over commercial interests.

Tobacco industry representatives violated the sanctity of Parliament when they lobbied in July 2022, on the same day the Health Minister tabled the Generational End Game (GEG).[5]

Claim: The vape industry in Malaysia is a growing sector that offers job opportunities and has the potential to attract foreign direct investment.

Rebuttal: Malaysia does not need foreign direct investment that turns its population into nicotine addicts, much like the East India Company did to China with opium in the 18th century. Nicotine is considered a recreational drug just like marijuana. Instead, Malaysia should focus on developing its skilled and knowledge-based workforce to attract foreign direct investment.

Claim: Prohibitive measures could drive consumers towards the black market, increasing the presence of unregulated and unsafe products, which would put consumers at risk and undermine legitimate businesses.

Rebuttal: The tobacco industry has often used the threat of a ‘black market’ to oppose higher taxes on cigarettes. In response, the government has implemented measures such as security ink, tax stamps, and barcodes on cigarette packs to combat smuggling. However, the most effective way to eliminate smuggled cigarettes, as well as ENDS and HTPs, is through a total ban. This would eradicate unregulated and unsafe products, as even so-called ‘safe’ ENDS and HTPs promoted by the industry are not truly safe.

Claim: Vaping is not intended for non-smokers or youths. Education rather than prohibition is key to addressing this issue. Educating young people and non-smokers that vaping is a harm reduction tool meant for adult smokers is essential.

Rebuttal: If vaping is not intended for non-smokers or youths, it does not make sense to invest so heavily in packaging design, advertisements, and marketing. A packaging design company stated: “Effective packaging design plays a pivotal role in the overall marketing strategy of a product. It serves as a powerful marketing tool that influences consumer behaviour and perceptions.”[6]

Tobacco companies launched Youth Smoking Prevention (YSP) Programs between 1997 and 2001, fully aware that their research indicated such programmes were unlikely to succeed. These programmes allowed the companies to appear socially responsible to the government and public.

MVCC is employing a similar strategy to convince the government.

Claim: Accurate information is crucial for consumers to understand the benefits and risks of vaping. Plain packaging obscures crucial details about the product, such as its contents and safety information.

Rebuttal: Smokers looking to quit cannot rely on ENDS (Electronic Nicotine Delivery Systems) or HTPs (Heated Tobacco Products) because their nicotine cravings may lead them to inhale more deeply, take larger, more frequent puffs, or puff more times each day to satisfy their needs. This mirrors the strategy used by the tobacco industry when lowering “tar” levels and using descriptors like “Light,” “Mild,” or “Smooth” to deceptively suggest a healthier option to governments and smokers.

Moreover, smokers typically know their preferred brand and do not need packaging design to make a purchase decision. The industry’s offer of ‘accurate information’ on ‘crucial product details’ is a tactic to obscure the dangers of vaping and limit the space for graphic health warnings.

While the harms of smoking are well-established, the ENDS industry often cites a 2015 Public Health England review estimating that ENDS are 95 percent less harmful than smoking.[7] However, a 2020 editorial review in the American Journal of Public Health by six leading experts on ENDS and public health debunked this claim, labelling it as “outdated, misleading, and invalid.” The review emphasized that this claim “should no longer be made in discussions on the dangers of vaping.”[8]

Importantly, no long-term studies exist to substantiate claims that ENDS are less harmful. Additionally, the limitations of existing research make it nearly impossible to determine if a product increases cancer risk until it has been in use for at least 15 years. In the meantime, it is known that vapers are vulnerable to EVALI.

Claim: The Global Adult Tobacco Survey (GATS) 2023 revealed that vaping has become crucial in helping smokers reduce or quit their habit.  In 2023, the smoking rate in the country decreased to 19 percent from 23 percent in 2011, while the prevalence of vaping rose to 5.8 percent from 0.8 percent during the same period. Vaping is now the second most favoured method among smokers seeking to quit smoking.

Rebuttal: This claim is based on Global Adult Tobacco Survey (GATS) Malaysia 2023 and it is misleading because:

• GATS Malaysia (2023) specifically states: “Although the prevalence of tobacco use and tobacco smoking has decreased from 2011 to 2023, the increase in e-cigarette prevalence is a public health concern. Hence, all healthcare providers should advise adults who smoke tobacco or use e-cigarettes to quit, using an effective intervention offered by the Ministry of Health.”[9]
• GATS did not explicitly express that “vaping has become crucial in helping smokers reduce or quit their habit”. It just showed that smoking conventional cigarettes declined and use of ENDS increased. Vaping is not a recognised means to quit smoking.

There are several critical issues that the industry has not mentioned:

• Environmental pollution: The Malaysian Vape Industry Study 2023 reported that disposable vaping devices have “quickly gained market share in a short time.” [10] However, these devices contribute significantly to plastic and chemical pollution, including nicotine and other hazardous ingredients in e-liquids. Additionally, lithium-ion batteries in these devices pose a fire risk when discarded in landfills.

According to a study by University of Oxford and University College London (UCL), supported by The Faraday Institution, about 1.3 million of ENDS are discarded in UK each week and this would mean that about 10,000 kg of lithium from ENDS ending up in landfills annually. It was found that the discarded batteries can still be charged and discharged more than 450 times, and it is thus a waste of valuable resources.[11]

ENDS related nicotine poisoning: Accidental nicotine poisoning among children in Malaysia is also on the rise. The Universiti Sains Malaysia-based National Poison Centre (Pusat Racun Negara, PRN) reported 66 cases of vaping-related poisoning between January 2015 and August 2022. The number of cases increased from six in 2019 to 21 in 2021, with most incidents involving children aged between one and four years, the youngest being just four months old. In 76 percent of these cases, the poisoning resulted from accidental ingestion of e-liquids at home. [12]^,[13] These e-liquids, often available in flavours that appeal to children, can be lethal if ingested.

By the end of 2023, the Malaysian Council for Tobacco Control (MCTC) observed a shift in the trend of nicotine poisoning, which was previously concentrated among children under five years old before 2021. The rise in Electronic Nicotine Delivery Systems (ENDS) usage among youths has led to increased cases among teenagers and adults.[14]

Industry objection to prohibition of Vape Product Displays: Since 2005, Thailand’s Health Ministry has enforced a ban on the display of cigarette packages at the point-of-sale. This move faced significant resistance from tobacco companies, which mobilised retailer associations to oppose the ban and challenged the clarity of the law’s wording. Anti-smoking groups had to rally health organizations, family networks, and the media to support the Minister of Health in standing firm against the pressure from tobacco companies. The ban is a success as 2009 Global Adult Tobacco Survey (GATS) found that only 6.7 percent of the over 500,000 retail stores in Thailand continued to display cigarette packages or other advertisements.

 In Malaysia, vape products are often displayed in retail outlets at or near the point-of-sale, sometimes alongside sweets and snacks, and less than one meter from the floor—within easy reach and eye level of children. Some vape devices are even designed to resemble cartoon characters or other items that appeal to children.[15]

In conclusion, the Consumers’ Association of Penang (CAP) strongly urges the Malaysian government to reject the disinformation spread by the Electronic Nicotine Delivery Systems (ENDS) and Heated Tobacco Products (HTPs) industry. The industry’s arguments, which echo those previously used by the heavily regulated tobacco sector, aim to perpetuate nicotine addiction and undermine public health. The claims of ENDS and HTPs as safer alternatives and smoking cessation tools lack credible evidence and are part of a broader strategy to delay or weaken tobacco control measures.

The government must implement comprehensive and immediate regulations, as gradual measures only allow the industry to exploit legal loopholes and continue harmful practices. The significant public health risks, including the growing prevalence of vaping among youths, environmental pollution from disposable devices, and rising cases of nicotine poisoning, outweigh any economic benefits the industry might claim.

Public health, particularly the protection of young people, must take precedence over the commercial interests of the tobacco industry. The Malaysian government should follow the principles of the WHO Framework Convention on Tobacco Control (FCTC), to which it is a signatory, and prioritize the health and well-being of its citizens by enacting robust and immediate regulations on ENDS and HTPs.

 

 

Mohideen Abdul Kader
President
Consumers Association of Penang (CAP)

Letter to the Editor, 5 September 2024

 

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References

[1] LA Times (23 June 1996). Smoking Gun: The Unlikely Figure Who Rocked the U.S. Tobacco Industry. https://www.latimes.com/archives/la-xpm-1996-06-23-fi-17774-story.html

[2] Bernama (30 November 2023). Govt expected to spend RM369 mln per year to treat Evali cases. https://www.bernama.com/en/news.php?id=2249795

[3] CodeBlue (21 August 2023). Malaysia’s Vape Industry Grew 53%, Adult Users Rose 27% – Before Nicotine Delisting. https://codeblue.galencentre.org/2023/08/21/malaysias-vape-industry-grew-53-adult-users-rose-27-before-nicotine-delisting/

[4] CodeBlue (25 May 2023). NHMS Survey: Among Malaysian Teens, Smoking Rate Falls But Vaping Prevalence Rises To 15%.
https://codeblue.galencentre.org/2023/05/25/nhms-survey-among-malaysian-teens-smoking-rate-falls-but-vaping-prevalence-rises-to-15pc/

[5] Malaysia Now (27 July 2022). Health expert slams big tobacco lobbyists at Parliament ahead of anti-smoking bill. https://www.malaysianow.com/news/2022/07/27/health-expert-slams-big-tobacco-lobbyists-at-parliament-ahead-of-anti-smoking-bill

[6] Appinio (12 January 2024). What is Packaging Design? Process, Examples, Trends.
https://www.appinio.com/en/blog/market-research/packaging-design#

[7] Public Health England (August 2015). E-cigarettes: an evidence update. A report commissioned by Public Health England.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/

[8] American Journal of Public Health, Vol. 110, Issue 2 (February 2020). Invalidity of an Oft-Cited Estimate of the Relative Harms of Electronic Cigarettes.
https://ajph.aphapublications.org/doi/epdf/10.2105/AJPH.2019.305424

[9] MOH and WHO. GATS Malaysia 2023 Executive Summary.
https://drupal.gtssacademy.org/sites/default/files/country_

[10] Malaysian Vape Chamber of Commerce. The Malaysian Vape Industry Study 2023, Consumption and spending habits.
https://dpvmalaysia.com/downloads/the_malaysian_vape_industry_study_2023.pdf

[11] University of Oxford (14 December 2023). Study finds that vast amounts of waste are caused by single-use e-cigarette batteries.
https://www.ox.ac.uk/news/2023-12-14-study-finds-vast-amounts-waste-are-caused-single-use-e-cigarette-batteries

[12] PRN (15 November 2021).
https://www.instagram.com/p/CWSA98JJPMl/?hl=en (viewed on 6 March 2023).

[13] Universiti Sains Malaysia, National Poison Centre. Nicotine Poisoning trend after emerging of e-cigarette products in Malaysia.

[14] CodeBlue (17 November 2023). MCTC Links Rise In Teen, Adult Nicotine Poisoning In Malaysia To Vape.
https://codeblue.galencentre.org/2023/11/17/mctc-links-rise-in-teen-adult-nicotine-poisoning-in-malaysia-to-vape/

[15] Pusat Racun Negara (8 September 2023). Penjualan Vape Tanpa Kawalan.
https://www.facebook.com/prnusm/posts/pfbid02u