OCTOBER 1 — Addiction is a pervasive issue affecting countless individuals around the globe, and smoking stands out due to its significant health risks and high mortality rates. Despite decades of tobacco control efforts, including education and enforcement, smoking rates remain stubbornly high — especially among men. In Asia alone, more than 4 million people die prematurely each year from smoking-related diseases, representing a staggering and largely avoidable toll.
Addressing smoking addiction requires a multifaceted approach, as traditional abstinence-based models have proven difficult to maintain, and strict prohibition measures often bring about unexpected challenges. With sixty percent of the world’s smokers living in Asia, it is clear that health authorities must rethink current tobacco control policies. Emerging research points toward sustainable recovery options, such as Tobacco Harm Reduction (THR), as more effective alternatives. This discussion will explore these strategies and their potential impact on public health across the region.
The World Health Organization (WHO) warns that by 2030, tobacco will claim 8.3 million lives annually, with the steepest increases in low- and middle-income Asian countries. This is not just a public health crisis — it reflects inadequacy in policy. And it demands a shift in strategy, embracing a commonsense approach that can improve public health and the lives of millions of smokers.
A lifeline ignored: The case for tobacco harm reduction
For smokers who don’t or will not quit, tobacco harm reduction (THR) offers safer alternatives — such as e-cigarettes, heat-not-burn products, nicotine pouches and snus — that are up to 99 per cent less harmful than traditional cigarettes. Countries with significant uptake of safer alternatives have seen dramatic results:
In Japan, smoking rates dropped from 33 per cent in 2000 to 15.7 per cent in 2023.
In Sweden, smoking rates fell to 5.3 per cent by 2025, making it the first country on track to become smoke-free.
These are not anomalies. In Sweden, total cancer deaths are 37 per cent lower than EU average. A 2024 report estimated that 2 million lives can be saved by 2060 in Japan if THR is incorporated in cessation services together with improved lung cancer treatment. They are proof that THR works — and that ignoring it costs lives.
Cultural resistance and policy paralysis
Asia’s tobacco control policies are often constrained by cultural norms, economic dependencies, and regulatory inertia. The WHO’s Framework Convention on Tobacco Control (FCTC) focuses almost exclusively on prevention and cessation, excluding THR entirely. This narrow approach fails to reflect the complex realities of Asian societies, where smoking is deeply embedded in social and economic structures.
Countries like Indonesia and India illustrate how uneven FCTC adoption and resistance to THR have created policy gaps. Millions of smokers are left without viable alternatives — and millions more will die as a result.
No more excuses: What governments must do
Governments must stop treating THR as a threat and start recognizing it as a complementary tool in the fight against tobacco. Here’s what must happen:
- Integrate THR into national tobacco control strategies, alongside cessation and prevention.
- Regulate safer nicotine products to make them more accessible than cigarettes.
- Educate communities on the relative risks and benefits among different tobacco and nicotine products.
- Regulate THR products responsibly to prevent youth uptake.
- Reignite WHO’s FCTC Framework which originally included THR as a pillar of tobacco control.
The debate is not about choosing between THR and cessation. It’s about saving lives with every tool available.
A global mandate for action
Asia cannot do this alone, but it can lead the way. Tobacco harm reduction must be elevated to a global public health priority, with international institutions, donor agencies, and research bodies working together to support evidence-based THR policies. The WHO must evolve its strategies to reflect the realities of today’s epidemic — not yesterday’s ideology.
We need a coalition of courage: governments, health leaders, civil society, and global partners united in the belief that every smoker deserves a safer option, and every country deserves the tools to make that possible.
The time for half-measures is over
Public health isn’t a stage for moral idealism — it’s a mission to protect lives. And right now, millions are at risk.
The question is no longer whether tobacco harm reduction (THR) belongs in the public health agenda. The real question is: How many more lives must be put in jeopardy before it is?
Asia must lead. The world must follow. And the time for global cooperation is now.
*Adjunct Professor Dr Prem Kumar Shanmugam is the founder and CEO of Solace Asia Addiction Retreat
** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
