Amid intensifying debate over the regulation of novel nicotine products, the Philippines—despite being known for the murderous drug war waged by former President Rodrigo Duterte—has charted a regulatory course that could be a template for other low- and middle-income countries (LMICs) in Asia and beyond.
“For the first time in the legislative history of our country, we have achieved a national differentiated regulatory framework governing vaping products and HTP [heated tobacco products],” said Dr. Lorenzo Mata, a central figure in the Philippine movement for balanced regulation and head of the nonprofit Quit for Good. Among other features, the law requires separate designated public vaping areas where smoking is prohibited, creating clear distinction between the two.
While some Asian nations have banned the sale of safer nicotine alternatives, the Philippines model could serve as a key counterpoint.
Dr. Mata was speaking at the fifth Asia Harm Reduction Forum (AHRF) held in Manila on October 28, an annual conference that brings together doctors, policy experts and consumer advocates from across the continent where the majority of the world’s tobacco users live. While some Asian nations such as India and Thailand have banned the sale of safer nicotine alternatives, the Philippines model—enacted in July after intense opposition from anti-vape groups—could serve as a key counterpoint. (Previously, Duterte had banned vaping products through an executive order.)
“About half of the provisions of the Philippine vape law are intended to safeguard the welfare of minors,” Dr. Mata continued, adding that it prohibits minors from purchasing or using vapes and HTP, imposes strict restrictions on their display at points of sale and near schools, bars the use of flavor descriptors that may allegedly attract kids, and levies severe financial penalties for businesses that break these rules.
“This law was made as a harm reduction strategy to reduce the number of smokers and sway them to switch to less harmful products,” said its co-author, Congressman Ace Barbers, in his address to the conference. “It is not our goal to have nonsmokers, most especially underage Filipinos, be convinced to take up vaping. This is why this law, while allowing the switch to vaping for harm reduction goals, is very strict in its execution to prevent use by nonsmokers.”
This emphasis on preventing youth use would be criticized by many tobacco harm reduction (THR) advocates, when encouraging people of any age to switch—typically with the help of flavors—should be the overwhelming imperative. Yet the law represents an encouraging pragmatic compromise in the context of a country with draconian wider drug laws. It is progressive in that it allows products to carry proven risk-reduction claims, and is open to incorporation of scientific evidence and research data in governance strategies.
A critical roadblock, however, is that tobacco research and harm reduction studies in LMICs remain abysmally scarce. To address this gap, public health researcher Dr. Rosana Ulep, chief of the dental services department at the Polytechnic University of the Philippines, presented a meta-analysis that contextualizes harms from smoking in the country in comparison to vaping and other factors.
The data-rich analysis validates the harm reduction approach; the country has among the highest adult smoking rates in the world, with 10 Filipinos dying every hour from smoking-related diseases. While a sharp hike in tobacco taxes since 2013 led to an overall decline in the prevalence of smoking and related mortality, the total numbers of people who smoke and deaths remain the same or are rising, and the illicit market has swelled. Allowing and encouraging people who smoke to mitigate risk through differentially taxed and safety-checked nicotine alternatives will accelerate smoking decline.
The AHRF also saw presentations on THR policy and advocacy by experts and consumer groups who spoke about the necessity to adopt similar laws in other countries.
David Sweanor, an adjunct professor at the University of Ottawa who has studied tobacco policies for more than two decades, provided historical context for the opposition to THR products whose comparative safety and substitution potential for smoking is well established. “With innovation, there tends to be strong focus on unintended risk, without due consideration to the risk of inaction,” he said. “But innovation is impossible to halt, especially in the case of tobacco alternatives. The incentive is high for anyone to become a billionaire from selling safer nicotine products—they only need to capture one ten-thousandth of the $800 billion tobacco market. Consumers, too, are aware of tobacco risks and are willing to make the switch if given the choice. In Japan, for instance, cigarette sales have declined 50 percent in seven years as smokers switched to heated tobacco products.”
“The increasing smoking-prevalence and mortality gap between these two nations will ultimately prove who got it right.”
The largest nation opposing this innovation is India, which banned vaping and HTPs in 2019 despite more than 100 million of its citizens smoking tobacco, a million of whom die from related illnesses every year. Jagannath Sarangapani—a member of the consumer nonprofit Association of Vapers India (AVI), and a board member of International Network of Nicotine Consumer Organizations (INNCO), which comprises more than 30 national bodies—said the Philippine model will be useful for other LMICs that are considering how to regulate these products. “The increasing smoking-prevalence and mortality gap between these two nations will ultimately prove who got it right,” he said.
Asa Saligupta, who leads the consumer group ECST in Thailand, another country that has banned sales of safer nicotine alternatives, said, “Even our prime minister is in favor of lifting the ban, so vapers may be looking at a bright future.” However, he highlighted that at present there’s still rampant harassment of people who vape. Police continue to fine, arrest and even bribe vapers, despite the fact that personal use and possession are not prohibited.
Joey Dulay, the president of Philippines E-cigarettes Industry Association, which represents over 200 store owners, suppliers and manufacturers, said, “The vape law has struck an appropriate balance between product safety, prevention of unintended use and maximization of the potential for adult smokers to switch to better alternatives.” By ensuring only registered vendors, both offline and online, can sell these products, the government can also hope to raise more revenue while hampering unscrupulous illicit operators, he added.
But there is still some way to go before the Philippines’ 16 million people who smoke can reap the benefit, as the implementation of the law is still being worked out, said Pater Dator, president of the Vapers Ph, the country’s leading consumer nonprofit and the co-host of the event. He hinted at meddling attempts by some agencies in the ongoing deliberations, which raises concerns over the intent of the law being subverted.
“The WHO FCTC has failed the 8 million people who die from unsafe tobacco products annually.”
Consumers are too often excluded from tobacco control conferences, but their voices were a key part of discussions at AHRF. Giving voice to the concerns of tobacco and safer nicotine users, Nancy Loucas, the executive director of the Coalition of Asia Pacific Harm Reduction Advocates (CAPHRA), said that despite vapers having exercised their right to health by switching away from deadly combustibles, a right enshrined in UN and World Health Organization charters, they are treated as pariahs and looked down on by global health organizations.
Presenting a paper on the anti-THR stance taken by World Health Organization’s Framework Convention for Tobacco Control, she said, “The WHO FCTC has failed the 8 million people who die from unsafe tobacco products annually. Until there is a change, billions will continue to be harmed and die from a preventable cause.”
Photograph courtesy of AHRF
Both INNCO, of which the author was previously president, and The Influence Foundation, which operates Filter, have received grants from the Foundation for a Smoke-Free World. Filter’s Editorial Independence Policy applies.