Asian Harm Reduction Dilemma: Culture Comes Before Science

Core Insights:
The general trend towards conservatism or even prohibition in tobacco harm reduction (THR) policies in Asia is not due to a lack of scientific evidence, but rather a deep-seated “framework mismatch”. Policy formulation is not dominated by public health and risk assessment, but is shaped by cultural traditions that emphasize social order, bureaucratic structures centered on law enforcement, and political incentives that pursue a “tough” stance, resulting in safer nicotine products being seen as a social threat rather than a public health tool.

Drivers:

1. Moralization of cultural framework: Influenced by Confucian or collectivist values, many Asian political cultures prioritize social order over individual choices. Nicotine is seen as a moral issue that should not be needed by society, rather than a public health issue, and therefore restrictions are seen as a legitimate measure to protect social stability.
2. Misalignment of bureaucratic structure: Unlike the model in which electronic cigarettes are managed by public health and smoking cessation departments such as the UK, Asian countries often entrust new nicotine products to law enforcement agencies such as drug control, customs, internal affairs, and police. This ‘ownership’ determines that the default response of policies is enforcement and prohibition, rather than scientific public health regulation.
3. Unidirectional political incentives: In the political environment of Asia, taking a tough stance on nicotine products is seen as “responsible leadership” that can bring political returns with almost no political costs. On the contrary, supporting innovative harm reduction tools that may cause controversy faces greater political risks.

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 structures, the default response becomes law enforcement rather than proportional public health regulation.”
• The dominant role of cultural values: “In many Asian political cultures influenced by Confucian values or collectivist traditions… legitimacy comes from protecting social order rather than allowing individual experimentation.”

Specific policy examples:

• Cambodia: A comprehensive ban has been issued, covering the import, sale, advertising, and consumption of electronic cigarettes and heated tobacco.
• Malaysia: Proposes to raise e-cigarette taxes by 900%, making them more expensive than traditional cigarettes and weakening conversion incentives.
• Thailand: Seeking to strengthen the regulation and law enforcement coordination of electronic cigarettes, citing the rising usage rate among teenagers.
• The counterevidence of successful harm reduction: In contrast to the widespread failures in Asia, “in Japan, smoking rates have significantly decreased due to the widespread use of heated tobacco products,” proving that harm reduction strategies can also be successful in Asian cultural contexts.

Strategic Takeaways:
The key to changing tobacco harm reduction policies in Asia lies not in providing more scientific evidence, but in conducting a thorough ‘strategic restructuring’. Advocates for harm reduction must shift their discourse system from “individual freedom” to “national capacity”. If safer nicotine products can be positioned as powerful tools for modernizing national health systems, maintaining social stability, and reducing the economic burden of disease, it may align with the priorities of Asian governments. Once this framework is accepted, with the efficient deployment capabilities of Asian governments, the region may quickly transform from a laggard in global tobacco reduction to the fastest engine. The future of global tobacco harm reduction largely depends on this ‘cognitive war’ in Asia.