Asian Harm Reduction Deadlock: Cultural Resistance Surpasses Science

Core insight: In Asia, the promotion of tobacco harm reduction strategies is not a scientific issue, but a cultural and political game. The traditional values of maintaining social order and the rigid bureaucratic system jointly suppress evidence-based public health innovation, leading to a general tendency in the region to ban rather than regulate new nicotine products.

Driving factors:

• Moral cultural framework: Influenced by Confucianism or collectivism traditions, many Asian countries’ political cultures have “moralized” the nicotine issue as a potential threat to social order rather than a public health issue. The legitimacy of policies stems from “protecting social order” rather than “allowing individual experimentation”, and therefore instinctively tends to restrict rather than explore products with lower risks.
• Misalignment of bureaucratic institutions: New nicotine products are usually managed by law enforcement agencies such as drug control, customs, or police, rather than public health or health economics departments. This structural misalignment leads to default policy options of “mandatory enforcement” and “prohibition”, fundamentally ruling out the possibility of “harm reduction” as a public health goal.
• The political benefits of a ‘stern’ stance: In the political environment of Asia, taking a tough stance on nicotine is seen as ‘responsible leadership’ that can bring political prestige with almost no political cost. In contrast, promoting a controversial harm reduction strategy based on scientific evidence carries higher risks and lower benefits for politicians.

Key evidence:

• The general trend of bans:
  • Cambodia: A comprehensive ban has been issued, covering the import, sale, advertising, and consumption of electronic cigarettes and heated tobacco.
  • Thailand: Seeking to revise laws to strengthen regulation and enforcement of new nicotine products, citing the rising usage rate among teenagers.
  • Malaysia: Proposes to raise e-cigarette taxes by 900%, making them more expensive than traditional cigarettes and weakening conversion incentives.
• Incorrect Regulatory Attribution: The article clearly states, “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 structures, the default response becomes law enforcement rather than proportionate public health regulation.”
• Risk perception and policy disconnect: Despite scientific evidence that the risks of new products are much lower than those of traditional cigarettes, policies still treat the two equally. Indonesian expert Professor Tikki Pangestu has publicly called for products with different risks not to use the same warning labels, but this has not become mainstream policy.

Strategic Inspiration: The key to reducing tobacco harm in Asia lies not in piling up more scientific evidence, but in changing the policy discourse system. The harm reduction strategy must be redefined from “individual freedom” to a strategic tool for “modernization of national health”, “sovereign security”, and “reducing the burden of social diseases”. If the narrative can be successfully reshaped to align with Asia’s culture of valuing national stability and collective interests, the region can not only break the deadlock, but may even become the fastest engine for global harm reduction with its efficient execution.