Malaysian Tobacco Control Advocates Push for Smoke-Free Culture

Local anti-tobacco advocates in Kuala Lumpur state that even without the visible enforcement seen in developed countries, tobacco control legislation will ultimately lead to a smoking ban culture in public spaces.

A "no smoking" sign is displayed at a Montreal subway station that prohibits smoking, using electronic cigarettes, and consuming cannabis. The photo was taken by Boo Su-Lyn on July 25, 2022.

They emphasized that the main objective of the 2022 Tobacco and Smoking Control Act is not to prosecute smokers or e-cigarette users, but to create a "normative" smoke-free culture.

In the UK, no one dares to litter or smoke in public places...the society has developed to this norm," said Dr. Murallitharan Munisamy, CEO of the National Cancer Society of Malaysia (NCSM), in an interview with CodeBlue last Friday.

Following widespread opposition from lawmakers, lawyers, and human rights activists who claimed that the law was overly restrictive, the vote on the controversial Tobacco Products Control and Smoking Bill has been postponed to the parliamentary session in October.

Legislators including Muar MP and Muda chairman Syed Saddiq Syed Abdul Rahman and DAP Seputeh MP Teresa Kok have expressed dissatisfaction and concern over young people born on January 1, 2007 being convicted and affected under the Generational Game (GEG) that prohibits smoking, vaping, and personal use of tobacco or electronic cigarette products.

However, Dr. Murallitharan and other tobacco control advocates do not view the proposed legislation as an attack on young people, but rather agree with Health Minister Khairy Jamaluddin's explanation to the Dewan Rakyat during the August 2 debate on the bill.

Khairy stated that the enforcement powers contained in the Tobacco Act, such as entering premises, taking samples, intercepting, searching and seizing transportation vehicles, are targeted towards manufacturers, importers and distributors, even though these provisions do not explicitly exempt GEG Group from applicable crimes committed by individual users.

The NCSM alleges that the proposed penalties in the bill are harsher for the sellers than for the consumers, and that the portion of the law that affects GEG is milder than penalties in other developed countries.

Muhammad Sha’ani Abdullah, the tobacco control coordinator of the Federation of Malaysian Consumer Associations (Fomca), highlighted last Friday during a press conference to advocates of tobacco control that current Malaysian laws carry heavier penalties than those imposed on GEG Group under the Tobacco Act.

He referred to a relevant law, namely Article 25(1) of the National Registration Act 1990 (amended in 2001), which states that individuals who are caught without a MyKad may be fined between RM3,000 and RM20,000, or face a three-year imprisonment sentence.

The Parliament has passed a Tobacco Products and Smoking Control Act, which imposes fines up to RM 5,000 on individuals born in 2007 who are found guilty of purchasing, possessing, and using tobacco and electronic cigarette products, as well as smoking or vaping.

During the parliamentary debate, Khairy agreed to plead guilty and will face a maximum fine of RM500 or community service for the conviction of the GEG offender.

Despite this, Muhammad Sha'ani and other members of the anti-tobacco advocacy group, unanimously believe during a press conference that although the newly formed Dewan Rakyat special committee (PSC) chaired by Khairy is reviewing the tobacco control bill, the situation could still change.

Dr. Murallitharan reiterated the stance of the summary group, stating that anti-tobacco advocates welcome efforts to avoid criminalizing individuals. The public health physician stated that convicting people is not their objective, and in fact, the Ministry of Health (MOH) has accepted the "soft landing" proposal put forth by non-governmental organizations.

The concept of a soft landing is to allow non-governmental organizations one to two years to soften, refine, and educate the public, bringing about changes in societal norms. To illustrate his point, Dr. Murallitharan presented Singapore's chewing gum law, which imposes a fine of up to 100,000 Singapore dollars, imprisonment for up to two years, or both for individuals.

He used this example to propose a cultural change: "In the first few years, we need to focus on the legal aspect." The legal aspect was the first hurdle to overcome for anti-smoking advocates to achieve a smoke-free Malaysia.

Roslizawati Md Ali, President of the Malaysian Women's Tobacco Control and Health Action (MyWatch), told CodeBlue that "this must start from home and the household institution.

The leader of MyWatch strongly expressed the need for youth reform. She and Dr. Murallitharan enthusiastically discussed their anti-tobacco work in schools (the Smoke-free Generation program and the Kotak oral health program) and homes, as well as the MyHouse initiative.

Doctor Murallitharan stated, "We are still undergoing standardization and transformation. We have always been strong advocates for the government, informing them that nicotine is more addictive than heroin.

Dr. Murallitharan and Roslizawati both oppose the use of electronic cigarettes or vaping as a means of reducing the harm caused by smoking.

Dr. Murallitharan opposes electronic cigarettes for three reasons: first, the amount of carcinogenic substances found in e-cigarettes is higher than previously thought; second, as people already know, smoking and e-cigarettes act as gateway drugs and do not reduce harm; third, the use of e-cigarettes is inappropriate for harm reduction.

The American Lung Association has identified various carcinogens in the toxic chemicals and metals found in electronic cigarettes. These chemicals and metals are heated with the e-liquid to produce the vapor that users inhale.

However, the Cancer Research UK institute states that current research indicates "the harms of e-cigarettes are far lower than smoking" because most of the toxic chemicals found in cigarettes are not present in e-cigarettes. However, it also cautions that e-cigarettes are not risk-free.

A recent study conducted by a cancer research team in the UK has found potential harmful chemicals in e-cigarettes. However, the levels of these chemicals are generally low and are usually much lower than those found in traditional tobacco cigarettes. Exposure to these chemicals is similar to that of individuals using nicotine replacement therapy such as patches or gum. The study did not provide conclusive evidence that e-cigarettes lead to cancer.

However, Dr. Murallitharan did mention that he would only support e-cigarettes if they were truly meant to reduce harm. He further noted that Malaysia's tobacco control laws do allow smokers to use e-cigarettes as a means to reduce tobacco harm, and the proposed legislation only seeks to prevent non-smokers from taking up e-cigarette use.

On the other hand, Roslizawati disagrees with promoting e-cigarettes as a means of harm reduction because she believes it encourages children to adopt the habit.

She told CodeBlue: "We have seen children as young as three months old using electronic cigarettes, with parents giving (them) electronic cigarettes.

The growth of e-cigarettes and their usage has increased significantly, particularly among young girls. However, many are unaware of the potential impact it can have on their future, including reproductive health issues and related concerns.

However, there is limited data on the impact of exposure to electronic cigarette vapor on human reproductive health, with most studies being conducted on animal models. A study on mice published in the Journal of Endocrinology in 2019 found that after exposure to electronic cigarette vapor, the embryo implantation rate in female mice decreased and the start of the first pregnancy was significantly delayed. Female offspring who were exposed to electronic cigarettes in the uterus also did not gain as much weight as the control mice at 8.5 months of age.

According to Kathleen Caron, the lead author of the study and a researcher at the University of North Carolina, the team discovered that fertilized embryos experience significant delays before implantation in the uterus, which ultimately affects and reduces the fertility of mice. The American Endocrine Society is a global community of doctors and scientists specializing in hormone science and public health. This statement was released in a press release in September 2019.

We have found that using e-cigarettes throughout pregnancy can have a lasting impact on the long-term health and metabolism of women's offspring, resulting in lifelong second-generation effects on the growing fetus.

A study published in the International Journal of Environmental Research and Public Health in 2020 analyzed the effect of electronic cigarette liquids with and without nicotine on rats. The study found that when male rats were exposed to e-liquids containing and not containing nicotine, their epididymis sperm count decreased. Rats with no nicotine had a lower epididymis count.

Although there are no public results on the effects of electronic cigarettes on sperm, the study references a 2017 speech by Helen O'Neill at the British Fertility Society Conference, which suggests that toxic chemicals in flavored e-cigarettes may harm male fertility. In her experiment, she found that certain flavors decreased the mobility of male sperm and damaged reproductive cells in mouse testes, which is crucial for fertility.

For Roslizawati, change comes with a variety of smoking cessation programs aimed at supporting smokers who are trying to quit. This viewpoint is in line with the position of the Centers for Disease Control and Prevention (CDC) in the United States regarding smoking cessation, which involves telephone counseling and FDA-approved medication.

Finally, it must be pointed out that many initiatives are being implemented to cultivate a culture of compliance. Dr. Roslizawati and Dr. Murallitharan both agree that the government should allocate more resources to reverse the public's addiction to nicotine.

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