The Deadlock of Harm Reduction in Asia: The Game between Culture and Policy

Core Insights

The fundamental reason for Asia’s stagnation in the global tobacco harm reduction (THR) field is not the lack of scientific evidence, but a “policy inertia” driven by deep cultural concepts and bureaucratic structures. Several Asian countries have moralized new nicotine products and placed them under the framework of law enforcement rather than public health management, resulting in strict prohibition becoming the default option. The key to breaking this deadlock lies in strategically reshaping discourse, transforming harm reduction from “individual freedom” to a modern tool for enhancing “national governance capacity” and “public health efficiency.”

Driving factors

1. Cultural and Moral Framework: Influenced by Confucianism or collectivist traditions, many Asian political cultures prioritize maintaining social order over encouraging individual choices. Nicotine is seen as a moral issue that society “should not need”; therefore, even if the scientific risks of new products are extremely low, the government instinctively tends to “limit first and then” to demonstrate its legitimacy in protecting social stability.
2. Misalignment of bureaucratic structure: Unlike countries like the UK that include e-cigarettes in public health and smoking cessation services, Asian countries often entrust new nicotine products to law enforcement agencies such as drug control, customs, and police for management. This institutional arrangement fundamentally determines the policy direction – the focus is on “law enforcement and crackdown” rather than “proportional public health supervision” or “incentive conversion strategies,” leading to the failure of the harm reduction concept at the starting line.
3. Political incentive mechanism: In the political environment of Asia, taking a tough stance on nicotine has almost no political cost but can instead shape a “decisive and responsible” leadership image, thereby gaining political rewards. In contrast, promoting a potentially controversial innovation (even if it can save lives) carries higher risks. This incentive mechanism has created great resistance for the implementation of tobacco harm reduction policies.

Key evidence

• Regional Policy Trends: The policy trend in most Asian countries (excluding a few such as Japan) continues to lean towards prohibition rather than harm reduction, despite having the world’s largest number of smokers and fastest-growing consumer groups.
• Bureaucratic attribution of law enforcement priority: “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 within these frameworks, the default response is law enforcement.”
• Specific national level strict policies:
  • Cambodia: A comprehensive ban has been issued, covering the import, sale, advertising, and consumption of electronic cigarettes and heated tobacco.
  • Malaysia: Proposes to increase the tax on electronic cigarettes by 900%, making them more expensive than traditional cigarettes.
  • Thailand: Authorities seek to revise national tobacco control laws to strengthen regulation of electronic cigarette devices, with the solution being ‘enhanced law enforcement.’
• Successful reverse case: In sharp contrast to the prevailing trend of prohibition in Asia, “Japan’s smoking rate has been severely impacted by the widespread use of heated tobacco products,” proving that harm reduction strategies can also be successful in the Asian cultural context.

Strategic insights

The future of global tobacco harm reduction largely depends on the success of “agenda reshaping” in Asia. Scientific evidence alone cannot shake deeply ingrained political culture. The core task for the future is to align the discourse on tobacco harm reduction with the core concerns of Asian governments, namely modernizing national health systems, maintaining social stability, and effectively reducing disease burden.

If Asian governments can view the new nicotine products as modern, regulated medical industrial tools to reduce hospital burden and prevent premature death, rather than a threat to social order, then with their strong system deployment capabilities, the region has the potential to become the fastest engine for global harm reduction. On the contrary, continued bans will only lead to high smoking rates and create a huge illegal market. The essence of this game is a battle of alignment between evidence and regional policy culture.