The second Asia Harm Reduction Forum convened in Manila on November 14. Organized by the Harm Reduction Alliance of the Philippines (HARAP) and the Indonesian Public Health Observer Foundation (YPKP), its purpose was to strategize on reducing the harms of smoking combustible tobacco in the world’s largest continent.
More than half of the world’s 1.1 billion smokers live in Asia. According to the World Health Organization, China’s smoking rate among men is 42 percent. In Indonesia, the world’s fourth most populous nation, the male smoking rate is a whopping 65 percent.
The list goes on. The 2015 Global Adult Tobacco Survey conducted in the Philippines, for example, showed that 23.8 percent of Filipino adults were smokers and that the smoking rate among Filipino women (at 5.8 percent) was among the highest in Southeast Asia. Filter has previously covered high smoking rates and obstacles to harm reduction in India.
Asia’s combustible tobacco habit can rightly be called an epidemic—and despite tobacco control measures such as price increases, advertising bans and graphic warnings on packages, smoking rates haven’t decreased significantly in recent years. Like everywhere else in the world, smoking-related death and disease in Asia disproportionately affect people living in poverty.
Existing forms of tobacco control are simply not doing enough to help Asians quit. Yet many cultural, political and financial barriers to reducing the harms of tobacco remain.
“Many Asian countries remain very skeptical about tobacco harm reduction, and some have even banned alternative nicotine products,” noted HARAP Lead Convenor Prof. Ron Christian Sison at the conference. “Regulators need to see that tobacco harm reduction is potentially the most effective solution to solving the smoking epidemic, and can complement existing tobacco control measures.”
“The ‘quit or die’ approach in Indonesia does not work for some smokers. Therefore, it is time to consider ‘quit or try.’”
Other leading speakers at last week’s conference included Congressman Anthony M. Bravo, PhD, of the Philippines, Dr. Kgosi Letlape from South Africa, and Filter contributor Dr. Marewa Glover, director of Nw Centre of Research Excellence for Indigenous Sovereignty & Smoking. (I also spoke there.)
“The ‘quit or die’ approach in Indonesia does not work for some smokers,” said Dr. Drg Amaliya, a co-organizer of the conference. “Therefore, it is time to consider the ‘quit or try’ approach—that is, try alternative nicotine products.”
While most of the world’s smokers live in Asia, the continent also produced the inventor of the electronic cigarette—an innovation with the potential to save millions of lives. It was Hon Lik, a Chinese pharmacist and former smoker, who invented the first such product in 2003.
China is the global leader in manufacturing of e-cigarettes. The flexibility of its small factories was key to the improvement of early models, and the vast majority of e-cigarettes today are still made in factories in Shenzhen.
But many Asian people are unable to benefit. In East Timor, Indonesia, Malaysia, Japan, Singapore and Thailand, e-cigarettes are entirely banned. Hong Kong is currently considering a total ban. Banning safer nicotine products is a disaster for smokers who want to quit: It leaves them with no alternative nicotine delivery devices except cigarettes.
Japan, on the other hand, is a leading example of how to help smokers switch. Although e-cigarettes are banned, heat-not-burn products have transformed the public health landscape there. Heat-not-burn devices use a small ceramic blade to heat small sticks of tobacco, releasing vapor that contains nicotine. There is no combustion, which makes these products safer than cigarettes by orders of magnitude.
At one panel in Manila—“How to Regulate Alternative Products in Support of Tobacco Harm Reduction”—Andrew da Roza, a substance use therapist who lives in Singapore, spoke of the situation in Japan and South Korea (where heat-not-burn products were introduced more recently, in 2017).
“In Japan and South Korea, where alternative tobacco products are widely available, smoking prevalence rates have dropped sharply,” he noted. “In Singapore and Australia, which have banned e-cigarettes, smoking prevalence rates have remained unchanged.”
Heat-not-burn products were introduced in Japan in 2014. Their popularity has seen cigarette sales there fall by an incredible 27 percent in the past two years—an unprecedented national decrease. Japan’s smoking rate has now declined to 18 percent.
Asia is home to great innovations and opportunities, as well as obstacles to reducing the harms of tobacco. In order to save smokers’ lives, vaping bans must end. Safer nicotine products need to be made available and affordable, and all smokers should be encouraged and supported to make the switch.