Tobacco use remains a leading cause of preventable death worldwide, with an estimated eight million deaths annually attributed to smoking-related diseases.
In Malaysia, smoking continues to pose a significant public health burden.
The National Health and Morbidity Survey (NHMS) 2023 reported that 19 percent of Malaysian adults were active smokers, equating to approximately 4.4 million individuals.
In Sarawak, smoking rates are similarly high with tobacco use disproportionately affecting indigenous and low-income communities.
These figures highlight the urgent need for innovative and evidence-based approaches to tobacco control and harm reduction.
Scientific advancements in tobacco harm reduction — particularly in the development of heated tobacco products (HTPs) and other non-combustible alternatives — offer promising new avenues to mitigate the health risks associated with smoking.
However, the potential of these technologies can only be fully realised when they are integrated into coherent regulatory frameworks that are informed by rigorous scientific evidence.
A dual approach that combines scientific innovation with adaptive, evidence-based regulation is thus essential for effectively reducing smoking prevalence and its associated health consequences in both Malaysia and the wider global context.
The Synergy of Science and Policy
Public health strategies are most effective when they are informed by the latest scientific discoveries and implemented through robust policy frameworks.
In the domain of tobacco control, innovations in product design and risk reduction offer new possibilities for reducing harm without requiring absolute abstinence in the short term.
Heated tobacco products (HTPs), for instance, operate by heating processed tobacco at lower temperatures than combustion, significantly reducing the formation of harmful and potentially harmful constituents (HPHCs) found in traditional cigarette smoke.
Multiple peer-reviewed studies have shown that switching from combustible cigarettes to HTPs can lower users’ exposure to toxins by 90 to 95 percent (PMI Science, 2024).
This reduction in exposure is primarily due to the elimination of combustion, the process responsible for generating thousands of harmful chemicals in conventional cigarette smoke.
Dr Tom McGrath, Philip Morris International’s Global Head of Combustion and Product Science, emphasis that eliminating combustion and reducing the temperature at which tobacco is heated can significantly lower the levels of harmful and potentially harmful constituents. In the aerosol produced by tobacco heating systems, these harmful substances are reduced on average by 90–95% compared to cigarette smoke.
As such, HTPs and other non-combustible nicotine delivery systems represent a harm reduction strategy that could complement — rather than replace — ongoing smoking cessation efforts.
In Sarawak, the burden of smoking-related diseases is exacerbated by geographical barriers to healthcare access and health literacy disparities between rural and urban populations.
The integration of harm reduction technologies, supported by regulatory guidance, can serve as a pragmatic approach to reducing tobacco-related morbidity and mortality, particularly in hard-to-reach communities.
Evidence-Based Decision Making in Regulatory Design
For harm reduction strategies to be effective at a population level, regulatory responses must be grounded in independent, peer-reviewed scientific research.
While nicotine is the primary addictive component of tobacco, it is not the main cause of smoking-related diseases.
The vast majority of health risks associated with smoking stem from the byproducts of combustion, including carbon monoxide, tar, and carcinogenic compounds such as benzene and formaldehyde.
As established by the Royal College of Physicians (2016) and reiterated by international research bodies, non-combustible alternatives significantly reduce users’ exposure to these substances.
The experiences of countries such as Japan and Sweden offer instructive case studies in the practical application of science-based regulation.
In Japan, the introduction of HTPs in 2015 catalysed a steep decline in cigarette sales, with a reported 42 percent reduction between 2015 and 2020 (PMI Science, 2023).
This shift occurred without a corresponding increase in nicotine consumption, suggesting that users were substituting conventional cigarettes with less harmful alternatives.
Similarly, Sweden’s long-standing policy of permitting the sale of snus — a non-combustible, smokeless oral tobacco product — has resulted in the country achieving the lowest rates of smoking-related mortality and lung cancer in Europe (European Commission, 2025).
These examples illustrate that when regulatory authorities adopt a science-informed approach and allow harm-reduction products to compete with combustible cigarettes, public health outcomes improve.
In contrast, prohibitive or overly restrictive regulations on better alternatives may inadvertently entrench combustible cigarette use and undermine harm reduction goals.
Eliminating Combustion: A Public Health Imperative
The elimination of combustion in tobacco products represents a fundamental shift in how nicotine can be delivered with substantially reduced harm.
From a toxicological perspective, the absence of combustion means a dramatic reduction in exposure to harmful substances.
Regulatory authorities now face the imperative to recognise combustion-free technologies not merely as commercial products, but as tools for tobacco control and public health.
In Malaysia, the Control of Tobacco Product and Smoking Bill 2022 — including the “Generational End Game” (GEG) provision — reflects a growing policy focus on curbing tobacco use through legislative action.
However, while ambitious, such legislation must be complemented by practical, science-based harm reduction pathways.
Rather than relying exclusively on punitive or prohibitionist measures, regulators should provide adult smokers with access to scientifically validated alternatives.
This includes establishing clear standards for product safety, ensuring transparency in product testing, and supporting longitudinal research to monitor health outcomes over time.
In Sarawak, where healthcare delivery is often constrained by logistics and resource limitations, the public health value of preventing disease through harm reduction is especially salient.
By reducing the number of individuals who suffer from smoking-induced chronic illnesses, health systems can redirect scarce resources toward prevention, maternal and child health, and non-communicable disease management.
Global Perspectives and Policy Convergence
International health agencies and regulatory bodies increasingly acknowledge the role of harm reduction in tobacco control.
The United Kingdom’s National Health Service (NHS) has incorporated e-cigarettes into its smoking cessation framework, and New Zealand has adopted a regulatory model that balances access to vaping products with youth protection measures.
These models reflect a convergence toward policy frameworks that are proportionate to the relative risks of different nicotine products.
Malaysia and Sarawak can benefit from adopting best practices that align regulation with emerging scientific evidence.
Regulatory flexibility does not equate to deregulation.
Rather, it involves the creation of adaptive, science-informed policies that respond to evolving product landscapes and population health needs.
Such an approach allows for the integration of emerging technologies into comprehensive tobacco control strategies without undermining public trust or regulatory integrity.
It is essential that public education campaigns also evolve to reflect these shifts.
In Malaysia, where public perception of nicotine products is often shaped by stigma or misinformation, effective risk communication is necessary.
Educational initiatives should be guided by behavioural science and tailored to diverse linguistic and cultural contexts — particularly in Sarawak — to ensure comprehension and trust across all demographics.
The Way Forward
Reducing the health impact of smoking in Malaysia and Sarawak requires a multifaceted approach that is both innovative and pragmatic.
Scientific research has made it clear that combustion is the principal driver of harm in tobacco use.
Therefore, technologies that eliminate combustion offer a transformative opportunity to reduce smoking-related disease at the population level.
However, the successful deployment of such innovations depends on the willingness of regulatory bodies to adopt evidence-based policies that encourage — rather than hinder — the adoption of less harmful alternatives.
A dual approach that aligns scientific innovation with thoughtful regulation holds the greatest promise for a smoke-free future.
By drawing upon international best practices, localising policy responses, and committing to ongoing research and public education, Malaysia and Sarawak can move toward a future where the harms of smoking are not only reduced, but ultimately eliminated.
