Integrating harm reduction in health policy can help reduce smoking-related illnesses and deaths

Integrating harm reduction in health policy can help reduce smoking-related illnesses and deaths


Makati City, 15 November 2018– Experts attending the 2nd Asia Harm Reduction Forum urged governments in Asia to adopt harm reduction in public health policies to help reduce illnesses and deaths caused by smoking.

“I commend the forum organizers for holding this regional event to promote acceptance of harm reduction as part of tobacco control initiatives. Tobacco harm reduction is currently not maximized and implemented as policy. There is much work to be done in encouraging society and legislators to adopt harm reduction in public policy,” said Congressman Anthony Bravo (Coop-NATTCO Party-list), who delivered the keynote speech during the forum.

Bravo is among several local legislators who are advocating for the integration of tobacco harm reduction measures, particularly the use of electronic cigarettes (e-cigarettes or vapes), in the country’s National Tobacco Control Strategy.

Prof. Ron Christian Sison, Lead Convenor, Harm Reduction Alliance of the Philippines (HARAP)


“There are currently about 16 million Filipino smokers. Only a small percentage of them want to quit smoking, and an even smaller number will actually succeed in quitting smoking. Harm reduction must be integrated in public health policies to help reduce smoking-related illnesses and deaths in the country,” said Prof. Ron Christian Sison, Lead Convenor, Harm Reduction Alliance of the Philippines (HARAP).


HARAP and Yayasan Pemerhati Kesehatan Publik Indonesia (YPKP – Indonesian Public Health Observer Foundation) held the 2nd Asia Harm Reduction Forum on November 15, 2018 at the Dusit Thani Manila Hotel in Makati City.

Addressing barriers and challenges

“Evidence shows that tobacco harm reduction products are at least 95 percent less harmful than cigarettes. Switching completely from smoking to vaping provides substantial health benefits,” said Prof. Tikki Pangestu, Lee Kuan Yew School of Public Policy, National University of Singapore,

Prof. Pangestu identified six barriers and challenges to crafting evidence-informed public health policies for harm reduction. The polarized and confrontational debate among key stakeholders is compounded by fake news misinformation, all of which is underpinned by a legacy of bad behavior by the tobacco industry. As a result, rational dialogue is almost impossible. There is difficulty to communicate and understand the science behind tobacco harm reduction, secrecy and exclusion in the Framework Convention on Tobacco Control (FCTC) process, misperceptions of risks and safety of reduced harm products (RHPs), inconsistencies and lack of harmonization in regulations, and concerns about RHPs serving as a gateway to tobacco smoking.

To help address these barriers, Prof. Pangetsu recommended several policy options and actions that governments in Asia can consider. First, develop a continuum of  “smart”, risk-proportionate regulations at the country level. Bring changes to global policy instruments, particularly by promoting more transparency and inclusiveness in the FCTC processes. Work with “sympathetic” countries to advance the policy change agenda        at the World Health Organization (WHO). Implement effective outreach, communications and advocacy to consumers through            mainstream and social media and         through credible, influential champions. Lastly, continue to drive technological innovation and research to develop more effective, safe and affordable smoking cessation products, as most smokers live in developing countries.

According to Prof. Pangestu, there is much confusion and fear in making the right decision on tobacco harm reduction, and this has resulted in inertia and paralysis. Quoting the German theologian Meister Eckhart, he said that the price of inaction is far greater than the cost of making a mistake. “Smokers have the right to information. Banning e-cigarettes denies access to those whose lives may be saved or whose health could be improved,” Prof. Pangestu said. “It is tantamount to human rights abuse.”

New Zealand’s national smoking prevalence rate is now down to 15.7 percent, but there are serious inequities in smoking cessation, said Dr. Marewa Glover, Director, Centre of Research Excellence: Indigenous Sovereignty & Smoking (New Zealand). “The indigenous people of New Zealand, the Maori, have the highest smoking prevalence among cultural groups at 35 percent. Since 1993, smoking prevalence among the Maori has only gone down by 19 percent, which is a measly 1 percent per year.”

After initially banning e-liquids and Swedish snus, the New Zealand Ministry of Health (MOH) changed its position and now considers vaping products as having the potential to help lower the country’s smoking prevalence rate to less than 5 percent by 2025. The MOH encourages smokers in New Zealand to use vaping products as a smoking cessation aid, and to seek the support of local quit smoking services. It also provides smokers with support on how to use vaping products to quit smoking by referring them to accredited vape shops in their locality.

Appropriate regulation needed to advance tobacco harm reduction

In the policy panel session, experts from India, Indonesia, Singapore and Sweden called on governments to develop appropriate regulation of alternative products in order to advance tobacco harm reduction.

“In Japan and South Korea where alternative tobacco products are widely available, smoking prevalence rates have dropped sharply. In Singapore and Australia which have banned e-cigarettes, smoking prevalence rates have remained unchanged,” said Mr. Andrew Da Roza, Promises Healthcare (Singapore). He stressed that there is no evidence supporting concerns that young people who use alternative nicotine products go on to become tobacco smokers. “Global data show that smoking prevalence rates have decreased among youths who use alternative products such as e-cigarettes.”

Da Roza lauded Congressman Bravo and other local legislators who have introduced bills advocating e-cigarettes as harm reduction tools. “Please support Congressman Bravo and his colleagues in their advocacy to advance tobacco harm reduction in the Philippine Congress.”

Every year, one million people in India die because of smoking-related illnesses, according to Mr. Samrat Chowdery, Association of Vapers India. “Despite government bans and restrictive policies, awareness on tobacco harm reduction is increasing and more smokers are switching to reduced harm products.”

Dr. Khamami Zada of Nahdatul Ulama Research Center (Indonesia) underscored the need for research and scientific evidence to justify the switch from smoking to alternative tobacco products in Indonesia, which has the world’s highest smoking prevalence among adults.

Mr. Atakan Erik Befrits, COO of the Swedish nongovernmental organization INNCO, pointed out that Sweden has one of the lowest smoking prevalence rates in the world. “This is because of Swedish snus. Not one single person has died from using it.”