The Deadlock of Harm Reduction in Asia: The Misalignment of Culture and Policy

Core Insights:
The fundamental reason for the stagnation of policies on tobacco harm reduction (THR) in the Asian region is not the lack of scientific evidence or widespread resistance to innovation, but a deep-seated “framework mismatch”. Policy formulation is shaped by strong cultural inertia, bureaucratic structures, and political incentives, framing new nicotine products as a threat to “social order” rather than an opportunity for “public health,” resulting in a serious disconnect between scientific facts and policy direction.

Drivers:

1. Priority of cultural moral framework: Influenced by Confucian values or collectivist traditions, many Asian political cultures prioritize maintaining social order and stability over individual choices. Therefore, the issue of nicotine is highly ‘moralized’ and seen as a non-essential commodity that should not exist in society. This cognitive framework makes policies instinctively tend to limit rather than assess risks, even though new products have much lower scientific risks.
2. Misalignment of bureaucratic jurisdiction: Unlike countries like the UK that include e-cigarettes in public health and smoking cessation services, Asian countries often entrust the management of new nicotine products to law enforcement agencies such as anti-drug, customs, internal affairs, and police. This “document attribution” directly determines that the default response of policies is law enforcement and prohibition, rather than proportional public health supervision based on risk assessment, which excludes harm reduction strategies from the mechanism.
3. Unidirectional political incentives: In the political environment of Asia, taking a tough and uncompromising stance on nicotine products is often seen as “responsible leadership” with almost no political cost. Unlike Western democratic countries, the risk of political punishment for blocking a life-saving technological innovation is extremely low. This has created a high-return, low-risk political environment for the strict policy of ‘one ban’.

Key Evidence:

• The seriousness of the problem: Asia “has the vast majority of smokers in the world and consumes the vast majority of cigarettes in the world”, which is the core battlefield for global harm reduction opportunities, but the policy trend ” tends to ban rather than reduce harm”.
• From the perspective of culture and bureaucracy: “Nicotine has been moralized. It is encoded as something that society ‘should not need'”; In Asia, new nicotine products are typically handled by anti-drug agencies, customs, the Ministry of the Interior, police, and anti-smuggling teams… The default response becomes law enforcement rather than proportional public health regulation.
• Specific policy actions:
  • Cambodia: issues a comprehensive ban covering imports, sales, advertising, and consumption.
  • Malaysia: proposes to increase the tax on electronic cigarettes by 900%, making them more expensive than cigarettes.
  • Thailand: The authorities’ solution is to “strengthen law enforcement, enhance inter-ministerial coordination, and strengthen control over the supply chain” rather than adopting a harm reduction path.
• A counterexample of effective harm reduction: Contrary to the common practice in Asia, Japan’s smoking rate “significantly decreased within a decade” due to the widespread use of heated tobacco products. The UK and New Zealand have also demonstrated that actively utilizing electronic cigarettes can help adult smokers quit smoking on a large scale.

Strategic Takeaways:
The future of tobacco reduction in Asia depends on a battle to reshape the narrative framework. Relying solely on piling up scientific evidence cannot shake deeply rooted cultural and political structures.
The key to breaking the deadlock lies in shifting the discourse system of harm reduction strategies from Western-style “individual freedom” to “national interests” that fit the logic of Asian governance. Advocates need to repackage safer nicotine products as modern public health tools that enhance the modernization of the national health system, safeguard sovereign safety, and effectively reduce the burden of disease.
If this framework is successfully reshaped, the strong system deployment and rapid execution capabilities of Asian governments may make it the fastest engine for global harm reduction. On the contrary, if harm reduction tools continue to be seen as socially controlled “drugs” or “cultural pollution”, the high smoking rates in Asia will be difficult to shake, the illegal market will continue to expand, and the grand goal of global tobacco harm reduction will be cast a huge shadow as a result.