[COLUMNIST] GEG a comprehensive enforcement plan is needed

Malaysia’s age-limited smoking ban based on a tapering down strategy (analogous to the Fed’s quantitative tightening or QT in progressively reducing its purchases of the US Treasury’s long-term bonds) – which parallels New Zealand’s – has been dubbed as the “Generational End Game” (GEG). It’s motivated by the fact that smoking is one of the leading causes of death nationwide and globally.

In a research paper, “Prevalence and factors associated with smoking among adults in Malaysia: Findings from the National Health and Morbidity Survey (NHMS) 2015” published by Tobacco Induced Diseases (2018), it’s highlighted that the percentage of those who smoked (15 years and above) was at 22.8%.

However, as pointed by Code Blue, Malaysia’s 2020 Report to the World Health Organization (WHO)’s Framework Convention on Tobacco Control (FCTC) showed that the country’s smoking rates have barely declined. The percentage of those that smoked dropped from 22.8% in 2015 to only 21.3% in 2019 (among individuals aged 15 years and above).

The 2020 Report to the WHO’s FCTC is based on the National Health and Morbidity Survey (NHMS) 2019 – whereby 21.3% is roughly equivalent to some 4.9 million Malaysians aged 15 years and older.

According to WHO, about 22.3% of the earth’s population used tobacco products in 2020 and over 80% of the world's tobacco users are from the low-and middle-income countries.

Now, smoking in eateries has been prohibited since January 1, 2019 – which came under the Control of Tobacco Products Regulation 2004 (a ministerial or executive order made under the parent legislation) that was amended in December 2018 to expand the smoking ban to extend the coverage of the ban from air-conditioned eateries to non-air-conditioned and outdoor outlets such as open-air hawker centres and street stalls.

In a study entitled, “Influence of smoking ban in eateries on smoking attitudes among adult smokers in Klang Valley, Malaysia” published by the Malaysian Journal of Public Health Medicine (2020), it’s found that “… smoking ban in restaurants and eateries was significantly associated with intention to quit smoking. 73.8% of smokers agree that the smoking ban in eateries and restaurants have reduced their daily smoking frequency and 58.3% of smokers agreed that the nationwide smoking ban at eateries and public places aspire them to quit smoking”.

The researchers concluded that the “[s]moking ban is beneficial to help reduce prevalence of smoking among smokers that in turn helps to reduce secondary smoking and burden of non-communicable diseases [NCDs] in the long run”.

On the other hand, anecdotal evidence and news report have suggested that the results are also rather mixed. According to a survey by Berita Harian (BH) in 2020, strict enforcement was only done at the beginning of the policy implementation but soon slackened post-first quarter.

Overall, this seems to suggest – in taking into consideration the time gap between the study and survey respectively – that the positive results of the smoking ban can only be ascertained in the longer-run.

The bottom line, remains, however.

And that is, the government can’t afford to relax or lapse on its implementation and enforcement efforts.

Towards that end, the government may need a bit more time to come up with a more comprehensive plan to ensure that this GEG ban will always be strictly implemented and enforced. Hence, it was perhaps apt that the government decided to push the year limit to 2007 instead of 2005 as originally intended as this will allows more time for the government to prepare accordingly.

We can’t afford not to go all out and all the way.

Health Minister Khairy Jamaluddin reportedly said that if nothing was done to overcome the country’s smoking problem, it will cost the government RM8 billion by 2030 to treat lung cancer, heart disease, and chronic obstructive pulmonary disease and other forms of NCDs.

Vested interests in the tobacco industry are naturally up in arms. The Confederation of Malaysian Tobacco Manufacturers (CMTM) stated that the ban could cause the government to lose more than RM5 billion in revenue.

On the other hand, according to the Health Minister, the tobacco industry is relatively small as it contributes only 0.18% of the gross domestic product (GDP). Its value-added output generated in 2021 was only RM2.8 billion.

And as also highlighted by economist Lee Heng Guie, employment in the tobacco industry accounts for only 1,200 workers or 0.05% employment in the wider manufacturing sector. He is quoted as saying that “Malaysia is a net importer of tobacco products, which represent about 0.05% of total imports. The share of exports is even smaller at 0.02% of total exports” (as reported in “Generational endgame a bold beginning to end tobacco use but is there an economic cost?”, The Edge Markets (March 10, 2022). As it is, tobacco consumption is the leading cause of cancer as it contributes to 22% of cancer deaths. The Ministry of Health (MOH) reported that there’s 11% rise in the number of cancer cases. From 2007 to 2011, there were 103,507 cancer cases while from 2012 to 2016, there was 115,238 cancer cases.

MOH has estimated that to treat lung cancer alone, it costs about RM132.7 million annually. The Edge Markets reported that YB Dr Lee Boon Chye, a former Deputy Health Minister, argued that research had indicated that treating smoking-related diseases, overall, that is including lung cancer and heart problems costs the government and the private sector between RM7 billion and RM8 billion annually.

Clearly, the negative consequences of smoking are far greater than the economic gains.

Towards that end, EMIR Research would like to recommend several policy measures to improve on the GEG ban policy in Malaysia.

New Zealand has a lower number of smokers compared to Malaysia where only 9.4% of adult New Zealanders aged 15 and above are smokers.

Apart from the GEG ban, New Zealand also aims to drastically reduce nicotine content in tobacco so that it won’t be so addictive as to make it difficult to quit. Moreover, New Zealand plans to set a maximum number of shops allowed to sell tobacco in designated zones. We should emulate New Zealand in this regard too – in discouraging existing smokers from continuing their filthy habit.

For starters, we can include a serial number for every cigarette and vape packet/packaging. This way, every retailer can keep records of the buyer and the serial numbers, i.e., the transactions, through an online system that’s inter-faced with the enforcement authorities’ own database.

As such, there should be made compulsory and mandatory for all smokers (purchasers/buyers) to download an app which would host the online platform (that’s inter-operable and shared with the enforcement authorities) whereby the transaction details (e-form) can be recorded.

The next step will be for the retailer to deploy a special radio frequency identification (RFID) scanner to scan the serial number as imprinted like any barcode (found on typical shopping products that’s checked out at the counter) on the cigarette packaging alongside the national registration identity number (NRIC or IC) of the buyer (which can subsequently be substituted by a future national biometric or digital ID). The scanning of the IC no. – as captured by the “gold” coloured/”plated” (micro)chip - will enable the online system to determine the authenticity of the details provided by the buyer.

Currently, under the proposed track and trace measure, an end-to-end system called Tobacco Track and Trace (TTT) is to be implemented. Under the TTT system, a security label will be used which will contain multi-level security with “ultra-thin definition image enabling three levels of authentication” based on advanced holographic technologies – that will then be integrated with the pre-existing digital tax stamps to combat illicit cigarettes.

Nonetheless, the TTT system – which enables access to the complete supply-chain is inadequate enough as it doesn’t seem to actually address the enforcement of the point of sale (POS) issue, i.e., in specific relation to the GEG ban.

The authorities can then cross-check on the regularity and legality of the transactions through the online system by tracking and tracing the serial numbers.

It can’t be stressed strongly enough that the implementation of an online system must be conducted via open tender (only).

There are reliable suggestions emerging recently that the proposed TTT system will be directly awarded by way of a direct negotiation basis to either one of the two parties – said to be Green Packet Bhd or Privasia Technology Berhad.

At the same time, perennial issues relating to the protection and privacy of consumer data must be seriously addressed. This area of grave concern serves only to reinforce the critical and absolute necessity of an open tender system.

We don’t want to see a repeat of the imbroglio and shambles associated with the MySejahtera app’s ownership and development and, by extension, the concomitant issues relating to possible data breach. Incidentally, the MySejahtera app also falls under the same purview of MOH as the lead player in the GEG ban policy and legislation.