The Deadlock of Harm Reduction in Asia: The Game Between Culture and Science

Core insight: The Asian region generally tends to strictly prohibit tobacco harm reduction (THR) policies, and the fundamental obstacle is not the lack of scientific evidence, but a strong policy inertia shaped by cultural frameworks, bureaucratic structures, and political incentives. The region sees new nicotine products as a threat to social order rather than a public health opportunity, leading to a serious lag in the global harm reduction process.

Driving factors:

• Moralization and cultural constraints: Influenced by Confucianism or collectivist traditions, many Asian political cultures prioritize maintaining social order over safeguarding individual choices. Nicotine is placed in a moralized category, seen as a socially ‘unwanted’ item rather than a health risk that can be managed through technological innovation. This kind of thinking leads to an instinctive reaction of ‘limit first, study later’.
• Misalignment of bureaucratic system: Unlike countries like the UK that include e-cigarettes in their public health and smoking cessation systems, Asian countries often entrust the management of new nicotine products to anti-drug, customs, internal affairs, and police departments. This institutional setup fundamentally defines the problem as law enforcement and smuggling issues, rather than public health regulatory issues, making harm reduction strategies automatically ineffective at the institutional level.
• The bias towards political incentives: In the political environment of Asia, taking a tough stance on nicotine is often seen as “responsible leadership” that can bring political prestige and almost no political cost. Politicians who gain support by displaying a tough and uncompromising protective stance, while pushing for a controversial harm reduction policy based on scientific evidence, lack sufficient political motivation.

Key evidence:

• Bureaucratic affiliation determines policy orientation: “In Asia, new nicotine products are typically handled by anti-drug agencies, customs, the Ministry of the Interior, police, and anti-smuggling teams. Once the issue falls into these systems, the default response is law enforcement rather than proportional public health regulation.”
• Political reward mechanism: “In Asia, political rewards often come from showing a tough, uncompromising, and protective stance. Taking a tough line against nicotine is interpreted as responsible leadership behavior.”
• The universal practice of prohibitive policies:
  • Cambodia has issued a comprehensive ban covering imports, sales, advertising, and consumption, forming a ‘complete ban model’.
  • Malaysia proposes to raise e-cigarette taxes by 900%, making them more expensive than traditional cigarettes and weakening conversion incentives.
  • Thailand seeks to strengthen regulation and law enforcement of electronic cigarette devices, citing the rising usage rate among teenagers.
  • Philippines: Prohibit open cartridge systems and uncertified e-liquids.
• Successful Counterexample: In sharp contrast, Japan has successfully reduced its smoking rate by over 50% within a decade through the widespread use of heated tobacco products, demonstrating the feasibility of harm reduction strategies in Asian cultural contexts.

Strategic insights:

The key to promoting tobacco harm reduction strategies in Asia lies not in piling up more scientific evidence, but in conducting a fundamental ‘narrative reshaping’. Advocates for harm reduction must shift their discourse system from “individual freedom” to “national interests”. Only by shaping safer nicotine products as tools for modernizing national health systems, enhancing social stability, and efficiently reducing disease burdens, in line with the core concerns of Asian governments about “national strength” and “measurable public interests,” can we break the current policy deadlock. If this transformation can be successfully achieved, with its efficient deployment capability, Asia will have the potential to leap from a depression of harm reduction policies to the fastest engine of global public health innovation.