Asian Harm Reduction Dilemma: Culture Comes Before Science

Core Insights:
The widespread boycott of new nicotine products in Asia is not rooted in scientific controversy, but in deep cultural, political, and bureaucratic frameworks. These frameworks moralize nicotine as a social threat rather than a public health opportunity. Therefore, the key to changing the future of Tobacco Harm Reduction (THR) in Asia lies in reshaping policy discourse, rather than just presenting scientific evidence.

Drivers:

• Cultural & Moral Framework: Many Asian political cultures are influenced by Confucian values or collectivist traditions, prioritizing the maintenance of social order over allowing individual choices. Nicotine is seen as a moral issue that society “should not need,” making any form of nicotine product face natural resistance.
• Bureaucratic Misalignment: Unlike countries like the UK that include e-cigarettes in their public health and smoking cessation systems, Asian countries often entrust new nicotine products to law enforcement agencies such as drug control, customs, and police for management. This ‘path dependence’ leads to regulatory default options of prohibition and enforcement, rather than proportional public health strategies based on risk assessment.
• Political Incentive Mechanism: In the political environment of Asia, taking a tough stance on nicotine is seen as responsible leadership that can earn the image of a “protector” at a very low political cost. On the contrary, promoting a controversial innovation such as THR carries high risks and uncertain returns.

Key Evidence:

• Background: Asia has the largest number of smokers, the highest cigarette sales, and the fastest-growing consumer group in the world. If innovation is hindered here, global harm reduction opportunities will sharply shrink.
• Regulatory Attribution: In Asia, new nicotine products are often 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 is law enforcement rather than proportionate public health regulation.

Policy Example:

• Cambodia has issued a comprehensive ban on electronic cigarettes and heated tobacco.
• Malaysia proposes to increase the tax on electronic cigarettes by 900%, making them more expensive than cigarettes.
• The Thai authorities hope to revise the National Tobacco Control Law to strengthen the regulation and enforcement of electronic cigarette devices.
• Successful Counterexample: Contrary to the mainstream trend in Asia, the smoking rate in Japan has significantly decreased due to the widespread use of heated tobacco products, demonstrating the feasibility of harm reduction strategies in the regional cultural context.

Strategic Takeaways:
Asia is at a crossroads in its tobacco control strategy. Following the current ban pattern will only lead to high smoking rates and the proliferation of black markets. The breakthrough in the future lies not in the automatic victory of scientific evidence, but in a profound ‘discourse reconstruction’.

Tobacco harm reduction must be transformed from a Western-style discourse of “individual freedom” or “consumer choice” to a narrative of “national capacity” that conforms to Asian governance logic – positioning it as an advanced public health tool that can reduce medical burden, improve national health, and demonstrate the country’s modern governance capabilities. Only when harm reduction products are seen as enhancing “national power” rather than challenging “social order,” can Asia transform from a global obstacle to harm reduction to the fastest engine.