Asia’s Nicotine Policy Paradox: Cigarettes Remain Available While Safer Alternatives Face More Restrictions

Across Asia and the Pacific, a growing divide is emerging between tobacco harm reduction science and nicotine regulation. While evidence supports giving adult smokers access to lower-risk alternatives, several governments are adopting policies that could restrict or eliminate legal access to them.

Currently, this contrast is particularly visible in Malaysia and Taiwan. Malaysia has unexpectedly found itself facing what advocates call an “accidental” nicotine vape ban, while Taiwan is considering substantial penalties for possessing vapes. In response to these developments, the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA) has launched its Asia-Pacific Declaration, calling for nicotine regulation to reflect differences in product risk rather than relying on blanket prohibition.

Malaysia’s situation stems from the legal classification of liquid nicotine. After the government withdrew its appeal against a High Court ruling, nicotine reverted to the Poisons List.  Naturally, this creates a direct conflict between two pieces of legislation. The Poisons Act 1952 (Act 366) now makes the ordinary commercial supply of nicotine vaping products legally problematic, even though the Control of Smoking Products for Public Health Act 2024 (Act 852) was designed specifically to regulate products including e-cigarettes.

The consequences could extend beyond vape retailers. Malaysian MPs have reportedly called for a refund of approximately RM354 million in previously collected vape excise. Industry groups also claim insurers are questioning whether they can cover businesses handling products containing a restricted substance, while banks may become reluctant to finance manufacturers and retailers.

These remain potential and very likely consequences rather than demonstrated outcomes, but they illustrate the uncertainty produced by contradictory regulation. The Malaysian Organization of Vape Entity (MOVE), which represents more than 55,000 members, rightly argues that prohibition could also strengthen illicit supply.

Professor Sharifa Ezat Wan Puteh of the Malaysian Society for Harm Reduction similarly advocates for regulated adult access, highlighting that licensed vendors, age restrictions and technology can help prevent youth sales—controls that become harder to impose when consumers move underground. CAPHRA urges the government to urgently reconcile Act 366 and Act 852 while concentrating enforcement on illicit drug-containing products such as Piu Piu, rather than focusing on nicotine.

Taiwan provides another example of what tobacco harm reduction researcher Dr Konstantinos Farsalinos describes as “risk-inverted” nicotine regulation. Vapes have been banned since 2023, yet combustible cigarettes remain widely available, and some heated tobacco products have gained authorisation. Taiwan is now considering fines of up to NT$100,000 for possessing prohibited e-cigarettes.

The tougher approach comes amid concern over illicit “zombie vapes” containing etomidate, an anaesthetic associated with serious health risks. Farsalinos supports action against drug-adulterated cartridges but argues that the problem exposes a weakness in prohibition. With no regulated nicotine-vape market, consumers who continue vaping depend on suppliers operating outside conventional manufacturing, ingredient and quality controls. And while it cannot be established that Taiwan’s ban caused the etomidate market, Taiwan and Malaysia do raise the same question: if demand remains after legal supply disappears, who fills the gap?

These developments come as evidence supporting vaping for smoking cessation continues to strengthen. Cochrane’s recent living systematic review found high-certainty evidence that nicotine vapes help more people quit smoking than conventional nicotine replacement therapy, with approximately four additional quitters per 100 people.

Importantly, the findings relate to regulated nicotine vaping products—not illicit cartridges containing other active substances. That distinction is particularly relevant to the problems emerging in Asia. A regulated nicotine product with known ingredients should not automatically be treated as equivalent to an illicit cartridge containing an anaesthetic or other psychoactive drug.

CAPHRA’s Asia-Pacific Declaration places these disputes within a broader regional context. It calls on governments across the WHO South-East Asia and Western Pacific regions to maintain regulated access to lower-risk products for adults who smoke or use hazardous forms of oral tobacco. This represents an enormous but often overlooked health burden in the region, where traditional products, including gutka, khaini, paan, naswar, zarda, and mawa, contribute substantially to oral disease.

Kuwait illustrates another version of the regional inconsistency. New regulations taking effect in 2027 retain legal pathways for regulated vaping and heated tobacco but impose substantially tougher requirements on non-medicinal nicotine pouches, despite their absence of combustion. Across these different policies, the central question remains the same. Protecting young people and tackling illicit products are legitimate public-health objectives, but they do not necessarily require removing regulated alternatives for adults.

Tobacco harm reduction experts advocate for regulations that reflect a continuum of risk, along with strict age-of-sale enforcement and marketing measures to deter young people from starting. Yet while protecting youth and addressing illicit products are valid public health goals, they don’t necessarily mean that regulated alternatives for adults need to be eliminated.

The more coherent strategy is to combine strict youth protections, product standards and enforcement against illicit suppliers with realistic access to lower-risk alternatives—and regulate nicotine products according to the harms they cause rather than treating them all as equivalent.