Is "Alternative Cigarette" the Solution?

Last update: 04/12/2018

By Sakini Mohd Said

MANILA (Bernama) -- The government’s stricter anti-smoking policies that will be enforced next year may have brought a collective sigh of relief from the victims of second hand smoke.

Smokers, however, have cried foul and called the move “unfair”.

It has been proven through countless scientific research, government data and irrefutable evidence from health organisations and agencies worldwide that smoking has far-reaching consequences. Despite that, there are still those who adamantly fight for the “rights of the smokers”.


There are also groups looking for alternatives that allow smokers to get their nicotine fix through tobacco harm reduction measures, such as by reducing or eliminating the use of combustible tobacco.

This is done by switching to alternative products such as vaping, electronic cigarettes (e-cigarettes) and smokeless tobacco products such as the Swedish Snus. 

“The ‘quit or die’ approach in Indonesia does not work for some smokers. Therefore, it is time to consider the 'quit or try’ approach, which is to try alternative nicotine products.

“These products provide a satisfying and less harmful option for smokers to get their nicotine fix without tar,” said Dr Drg. Amaliya, co-founder of the Indonesian Public Health Observer Foundation.

She was speaking at the Asia Harm Reduction Forum (AHRF) that took place recently in Manila, Philippine.

The forum that was held for the second time was jointly organised by the foundation and the Harm Reduction Alliance of the Philippines. It was attended by 200 participants.

The forum discussed issues of tobacco harm reduction and aims to educate society on harm reduction through better alternative products, in addition to advocating practical solutions that can improve public health. 

The forum wants legislators and the public alike to accept harm reduction as one of the strategies by legislators and the public alike.


Dr Drg. Amaliya when delivering her opening remark at AHRF said that people smoke for nicotine, but die from the tar. Tar is created by the combustion of tobacco in cigarettes while nicotine, although less harmful, causes the addiction.

The experts attending the forum agreed that smoking-related diseases such as lung-cancer, cardiovascular disease and emphysema are caused primarily by inhaling the harmful compounds formed when tobacco is burned. 

They therefore concluded that it was these compounds that should be removed from the alternative nicotine fixes.

However, many Asian countries remain sceptical about tobacco harm reduction. Countries like Singapore and Thiland ban e-cigarettes while some states in India are considering the ban. 

“We need to actively inform policymakers about tobacco harm reduction and the potential benefit of alternative nicotine products to public health,” she said.

Former Biomedical Sciences Expert, University of Malaya, Professor Tikki Pangestu in his presentation ‘Evidence-informed Public Health Policies for Harm Reduction’ said e-cigarettes have evolved into more advance, effective and safer products based on three major reports.

The reports, he claimed, were produced by highly respected and credible organisations that were not linked with the tobacco industry.

He was citing the Evidence Review of E-Cigarettes and Heated Tobacco Products 2018 (commissioned by the Public Health of England); Public Health Consequences of E-Cigarettes (a consensus study report by the National Academics of Sciences, Engineering and Medicine in the United States); and E-Cigarettes by House of Commons Science and Technology Committee in the United Kingdom. 

“They strongly stated that e-cigarettes and vaping are at least 95 percent less harmful than smoking to the individual smoker, immediate family and bystander.

“Switching completely from smoking to vaping conveys substantial health benefits,” said Pangestu, who is also a visiting professor at the Lee Kuan Yew School of Public Policy, National University of Singapore. 

Substance abuse therapist, Andrew John Da Roza during his presentation said countries that allowed e-cigarettes posted faster reduction in smoking prevalence than those that prohibited their use such as Singapore and Australia.

“Japan saw a 27 percent drop in number of cigarettes sold in the fourth quarter of 2017 from a year ago because of harm reduction products.

“In the UK, about 20,000 people give up smoking a year because of e-cigarettes,” he said. 

Based on the latest scientific developments in tobacco harm reduction from leading health practitioners and academics that presented during AHRF 2018, experts urged governments in Asia to adopt harm reduction in public health policies to help reduce illnesses and death caused by smoking. 


Dr Drg. Amaliya, who is also a lecturer and researchers at Periodontology Department of Universitas Padjadjaran in Bandung, Indonesia, said that cigarettes are a public health issue, especially for low-income countries like Indonesia.

“Smoking is an issue of grave concern because the highest number of smokers are in Asia. In Indonesia alone, there are 50 million smokers. The situation in Indonesia can be described as an emergency because of the incredible number of smokers,” she told Bernama.

The biggest consumers of tobacco are China (307 million people), India (106 millions) and Philippines (16 million). The World Health Organisation (WHO) predicts that there will be over 1 billion smokers worldwide by 2025. 

Smoking-related diseases is the leading cause of death worldwide, and Malaysia is no exception. It adversely affects the nation’s economy in various ways. Among it is the economic burden on the public healthcare system to treat smoking-related diseases, decreased work productivity due to poor health and premature death.

The 2015 National Health and Morbidity Survey showed 22.8 percent of Malaysians – that is five million people – aged 15 years and above were smokers, 43 percent of whom are males.

The WHO estimates more than 20,000 male adults in Malaysia die every year due to complications resulting from the smoking habit. By 2025, the government will have to fork out RM7.4 billion to treat major illnesses caused by smoking such as lung cancer and coronary disease.

The amount is based on estimates made by the ministry in 2017 if tobacco control in Malaysia is not enhanced and the prevalence of smoking is not reduced.

Malaysia is not the only country bearing economic losses from the smoking habit of its people. The global cost of smoking-related diseases in terms of healthcare expenses and lost productivity is estimated at USD 1 trillion annually.

Edited and translated by Sakina Mohamed