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  • Ban Vape Now to Protect Public Health in Malaysia

    Executive Summary

    Vaping has emerged as a growing public health and security crisis in Malaysia. Once promoted as a safer alternative to smoking, vaping is now strongly linked to nicotine addiction, youth uptake, serious health harms, and even drug abuse. The enforcement of the Akta Kawalan Produk Merokok Demi Kesihatan Awam 2024 (Act 852), effective 1 October 2024, is a positive step but its implementation has proven difficult. The Ministry of Health (MOH) is now burdened with too many roles including policymaking, regulation, licensing, monitoring, and enforcement. With limited resources, MOH cannot manage this growing threat effectively. An immediate ban on all vape products is necessary. In the longer term, stronger measures must be taken to restrict cigarette use and move toward a smoke-free future.

    Key Issues

    1. Act 852 is difficult to implement

    Act 852 requires comprehensive regulation of vape products, including licensing of all retailers, monitoring of product contents and marketing, control of online and physical sales, and enforcement of advertisement bans. MOH is expected to take full responsibility for these tasks while also managing other core public health functions. This regulatory and enforcement burden is unrealistic and unsustainable.

    2. Vaping is not harm reduction

    Peer-reviewed research in BMJ Open (2023) involving ASEAN tobacco control experts confirms that nicotine vaping products are not viewed as effective cessation tools and are instead considered a public health threat. Most adult vapers in Malaysia (75%) are dual users who continue smoking cigarettes, thus undermining the notion of risk reduction.

    3. Vaping causes serious health harms

    Published studies report that Malaysian vape users commonly experience dry mouth, cough, headaches, and dizziness. More severe outcomes include EVALI (e-cigarette or vaping product use-associated lung injury), which has been documented in Malaysia. Each case costs an estimated RM150,000 to treat, with a projected national healthcare burden of RM368 million annually by 2030 if left unregulated.

    4. Estimated cost burden for Malaysia

    With over 1 million adult daily users in Malaysia (based on 5.4% prevalence), even a 0.1% complication rate requiring hospitalisation would result in 1,000 EVALI cases annually. At RM150,000 per case, this would translate to RM150 million in direct inpatient costs alone, not accounting for outpatient care, productivity loss, or future chronic disease management. Meanwhile, vape tax revenue of RM500 million per year is unlikely to cover the rising health and enforcement costs.

    5. Vaping as a vehicle for drug abuse

    An increasingly alarming trend in Malaysia involves the misuse of vape devices as covert drug delivery tools. Law enforcement and the National Anti-Drugs Agency (AADK) have reported seizures of vape devices containing methamphetamine, ketamine, THC oil, and synthetic cannabinoids. These substances are often inhaled using modified pods or liquids indistinguishable from regular vape products. Students and youths are particularly vulnerable due to the discreet nature of vape use, making enforcement nearly impossible under current regulations. This trend represents both a public health emergency and a national drug control challenge.

    Policy Recommendations

    1. Ban all vape products immediately

    Enact a full ban on the manufacture, import, sale, promotion, and possession of all vape devices and liquids. Strengthen controls on online and cross-border purchases. Declare a national public health and security emergency linked to youth vaping and drug misuse.

    2. Reduce the burden on MOH

    MOH should focus on public health policy, surveillance, and prevention. Licensing, inspections, and enforcement functions should be delegated to other agencies, including municipal councils and the Ministry of Domestic Trade. MOH resources should be redirected toward cessation programmes and school-based health promotion.

    3. Begin long-term restrictions on cigarette sales

    Malaysia should adopt a structured roadmap toward a cigarette-free society. Immediate steps include increased tobacco taxation, plain packaging, limiting retail outlets, and expanding access to evidence-based cessation support. Stronger action is also needed against illicit tobacco trade.

    References

    Gravely, S., Yong, H. H., Reid, J. L., et al. (2022). The prevalence of e-cigarette use in Malaysia: Findings from the 2020 ITC Malaysia Survey. Tobacco Induced Diseases, 20(42). https://doi.org/10.18332/tid/146917 Wong, L. P., Alias, H., Aghamohammadi, N., et al. (2023). Self-reported side effects, dependence, and behaviour in e-cigarette users in Malaysia. Substance Abuse Treatment, Prevention, and Policy, 18(1). https://doi.org/10.1186/s13011-023-00558-7 Hamilton, W. L., et al. (2022). E-cigarette markets and policy responses in Southeast Asia: A scoping review. International Journal of Health Policy and Management, 11(10), 2236–2246. https://doi.org/10.34172/ijhpm.2021.104 De Guia, M. C., et al. (2023). Implications of nicotine vaping products for tobacco control in ASEAN LMICs: In-depth interviews with experts. BMJ Open, 13(9): e073106. https://doi.org/10.1136/bmjopen-2023-073106 Ibrahim, N., et al. (2023). Emerging trends in drug delivery through vaping devices. Frontiers in Public Health, 11:1198763. https://doi.org/10.3389/fpubh.2023.1198763 United Nations Office on Drugs and Crime (UNODC). (2021). Synthetic Drugs and Novel Psychoactive Substances: A Global Threat. https://www.unodc.org Ministry of Health Malaysia. (2024). Cost estimation for EVALI treatment and projections. MOH official communications reported in multiple government briefings.

  • Why Vaping Is More Dangerous Than Cigarette Smoking And Why We Must Act Now

    Introduction

    Vaping was once promoted as a safer alternative to smoking. However, emerging evidence indicates that electronic cigarettes (e-cigarettes) may pose equal or even greater health risks compared to traditional cigarettes, particularly among youth. Unlike conventional tobacco products, vape liquids often contain a complex mix of chemicals, heavy metals, and flavouring agents that can bypass detection and regulation. Their sleek designs, enticing flavours, and the misconception of being “less harmful” have made vapes a gateway to nicotine addiction for a new generation.

    In Malaysia, the removal of nicotine from the Poisons Act in 2021 created a legal loophole that allowed unregulated vape products to proliferate. Although the Control of Smoking Products for Public Health Act 2024 was gazetted to address this issue, enforcement remains challenging. The health costs of inaction are escalating and may soon surpass the damages caused by traditional cigarettes.

    What Makes Vaping More Dangerous Than Cigarettes

    1. Rapid Uptake Among Youth and Stronger Addiction

    Vapes appeal to adolescents with thousands of flavours, sleek devices, and a strong presence on social media platforms. Many vape products contain higher nicotine concentrations than traditional cigarettes, delivered via nicotine salts that are more readily absorbed and less irritating, enabling deeper and longer inhalation (Benowitz & Fraiman, 2022).

    In Malaysia, data from the National Health and Morbidity Survey (NHMS) 2022 indicated that 14.9% of adolescents aged 13–17 were current e-cigarette users, with a higher prevalence among males (23.3%) compared to females (6.2%) (Institute for Public Health, 2022). Alarmingly, nearly half of these users initiated vaping before the age of 14.

    2. Exposure to Unregulated Chemicals and Aerosolised Toxins

    While cigarettes have known contents, vapes deliver poorly characterised chemical cocktails. Scientific studies have identified harmful substances in vape aerosols, including formaldehyde, acrolein, lead, cadmium, and nickel. These compounds can cause DNA damage, inflammation, and systemic toxicity (Olmedo et al., 2018).

    Additionally, some compounds in vape aerosols, such as vitamin E acetate and benzyl alcohol, have no history of safe inhalation use and have been implicated in severe lung injuries.

    3. Acute Lung Injuries Not Observed in Cigarette Smokers

    Traditional cigarette smoking is associated with chronic lung diseases developing over the years. In contrast, vaping has been linked to acute, life-threatening lung injuries, such as E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI), occurring after weeks or months of use. Patients suffer respiratory failure requiring ventilation, and some have died (Chand et al., 2023). Such rapid-onset pulmonary toxicity is virtually unheard of with cigarette smoking.

    4. Systemic Health Effects Beyond the Respiratory System

    Vaping has demonstrated harmful effects across multiple organ systems, including the gastrointestinal tract, brain, oral cavity, kidneys, and reproductive system. Studies indicate that vaping alters brain structure and impairs memory, attention, and mood, especially in adolescents (Lopez-Ojeda & Hurley, 2024). Animal models have shown that vaping disrupts intestinal barriers and triggers inflammation (Sharma et al., 2022).

    5. Increased Risk of Smoking Initiation and Dual Use

    Rather than replacing cigarettes, vapes are creating a new generation of dual users, individuals who smoke and vape. Adolescents who vape are more than three times as likely to start smoking cigarettes (Soneji et al., 2017). This trend undermines the potential harm reduction benefits of vaping and perpetuates nicotine addiction.

    6. Unproven Efficacy as a Smoking Cessation Tool

    While some trials suggest that nicotine-containing e-cigarettes may aid smoking cessation, real-world studies show mixed results. A Cochrane review noted low certainty of evidence for sustained cessation and highlighted a high risk of relapse and dual use (Hartmann-Boyce et al., 2022). Most adult vapers do not quit smoking; instead, they continue using both products.

    7. Environmental and Secondhand Exposure Risks

    E-cigarette waste, including cartridges, pods, and lithium batteries, contributes to environmental pollution. Aerosol residues accumulate on indoor surfaces, exposing non-users, especially children and pregnant women, to passive vaping. The World Health Organisation has declared secondhand exposure to e-cigarette aerosol unsafe (Jankowski et al., 2019).

    Conclusion

    Scientific evidence confirms that vaping poses serious health risks across the respiratory, cardiovascular, neurological, and gastrointestinal systems. Youth are disproportionately affected, and the claimed benefits of vaping, especially for smoking cessation, are not supported by strong data. Enforcement difficulties undermine regulatory measures, and the mounting health and environmental consequences are a concern. A comprehensive ban on vape products is a necessary and urgent public health action.

    References
    • Benowitz, N. L., & Fraiman, J. B. (2022). Clinical pharmacology of electronic nicotine delivery systems (ENDS): Implications for benefits and risks in the promotion of smoking cessation. Journal of Clinical Pharmacology, 62(1), 1–14. https://doi.org/10.1002/jcph.1982
    • Chand, H. S., Muthumalage, T., Maziak, W., & Rahman, I. (2023). Pulmonary toxicity and the pathophysiology of electronic cigarette, or vaping product, use associated lung injury. Annals of the American Thoracic Society, 20(2), 177–185. https://doi.org/10.1513/AnnalsATS.202209-796ST
    • Hartmann-Boyce, J., McRobbie, H., Lindson, N., Bullen, C., Begh, R., Theodoulou, A., Notley, C., Rigotti, N. A., Turner, T., Butler, A. R., & Hajek, P. (2022). Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews, (11). https://doi.org/10.1002/14651858.CD010216.pub7
    • Institute for Public Health. (2022). National Health and Morbidity Survey (NHMS) 2022: Adolescent Health Survey Highlights. https://iku.gov.my/images/nhms-2022/Report_Malaysia_nhms_ahs_2022.pdf
    • Jankowski, M., Brożek, G., Lawson, J., Skoczyński, S., & Zejda, J. E. (2019). E-cigarettes are more addictive than traditional cigarettes—A study in highly educated young people. International Journal of Environmental Research and Public Health, 16(13), 2279. https://doi.org/10.3390/ijerph16132279
    • Lopez-Ojeda, W., & Hurley, R. A. (2024). Vaping and the brain: Effects of electronic cigarettes and e-liquid substances. The Journal of Neuropsychiatry and Clinical Neurosciences, 36(1), A41–A45. https://doi.org/10.1176/appi.neuropsych.20230184
    • Olmedo, P., Goessler, W., Tanda, S., Grau-Perez, M., Jarmul, S., Aherrera, A., Chen, R., Hilpert, M., Cohen, J. E., Navas-Acien, A., & Rule, A. M. (2018). Metal concentrations in e-cigarette liquid and aerosol samples: The contribution of metallic coils. Environmental Health Perspectives, 126(2), 027010. https://doi.org/10.1289/EHP2175
    • Sharma, A., Lee, J. S., & Dela Cruz, C. S. (2022). E-cigarettes compromise the gut barrier and trigger inflammation. iScience, 25(2), 103818. https://doi.org/10.1016/j.isci.2021.103818
    • Soneji, S., Barrington-Trimis, J. L., Wills, T. A., Leventhal, A. M., Unger, J. B., Gibson, L. A., Yang, J., Primack, B. A., Andrews, J. A., Miech, R. A., Spindle, T. R., Dick, D. M., Eissenberg, T., Hornik, R. C., Dang, R., & Sargent, J. D. (2017). Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: A systematic review and meta-analysis. JAMA Pediatrics, 171(8), 788–797. https://doi.org/10.1001/jamapediatrics.2017.1488