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Tobacco Harm Reduction: A Burning Issue for Asia

Tobacco Harm Reduction: A Burning Issue for Asia
©Knowledge-Action-Change 2021

Written and edited by Harry Shapiro

Data compilation: Tomasz Jerzyński

Production coordinator: Grzegorz Król

Briefing design and layout: WEDA sc: Urszula Biskupska

Project management: Professor Gerry Stimson, Kevin Molloy and Paddy Costall

The briefing is available at:

Knowledge-Action-Change, 8 Northumberland Avenue, London WC2 5BY

© Knowledge-Action-Change 2021

ISBN: 978-1-9993579-9-3

Tobacco Harm Reduction: A Burning Issue for Asia.
London: Knowledge-Action-Change, 2021.

The conception, design, analysis and writing of this briefing was undertaken independently and exclusively by Knowledge-Action-Change.

We are very grateful for the information offered, on a voluntary basis, by Samrat Chowdhery of Association of Vapers India (AVI), Nancy Loucas of the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA) and other individual consumer advocates living across the region.

Copyright in original material resides with K•A•C, except where otherwise acknowledged. Material can be reproduced subject to fair usage without first acquiring permission from K•A•C and subject to acknowledgement using the citation above. The briefing was produced with the help of a grant from the Foundation for a Smoke-Free World Inc. The contents, selection and presentation of facts, as well as any opinions expressed, are the sole responsibility of the authors and under no circumstances shall be regarded as reflecting the positions of the Foundation for a Smoke-Free World Inc.

Key messages

  • 60% of the world’s smokers live in Asia, half of whom will die prematurely from a smoking-related disease.
  • Most countries in Asia have adult smoking rates above the global average, and three countries have smoking rates in excess of 30%.
  • Nearly half of the annual global deaths from smoking are among people living in this region.
  • Asia plays host to the world’s major state-owned tobacco companies, which produce nearly 50% of the world’s cigarettes and other combustible tobacco products.
  • Consequently, smokers in this region suffer disproportionally from the devasting effects of smoking.
  • 89% of the world’s consumers of the more dangerous forms of smokeless tobacco (SLT) products live in Asia leading to high rates of oral cancers in the region.
  • For people who smoke, it is the toxins released by the combustion of tobacco that is the problem – not the nicotine.
  • For people who use the more dangerous forms of SLT products consumed in Asia, it is the carcinogenic compounds released when the product is chewed that is the problem – not the nicotine.
  • Tobacco harm reduction, using safer nicotine products, offers new choices to millions of people who want to reduce risks to their health but want to continue using nicotine.
  • Millions of people in Asia have already switched from smoking to a variety of safer nicotine products – despite a range of legislative and regulatory responses in the region that include outright prohibition.
  • A well-orchestrated and well-funded campaign by apparently credible agencies continues to dispute and undermine the evidence supporting the use of safer alternatives to tobacco.
  • Governments in the region are starting to come under scrutiny as the scale and impact of US-led philanthropic funding on domestic policy-making is exposed.

About the Global State of Tobacco Harm Reduction (GSTHR) project

Harm reduction is a range of pragmatic policies, regulations and actions which either reduce health risks by providing safer forms of products or substances or encourage less risky behaviours. Tobacco Harm Reduction (THR), using safer nicotine products (SNP), offers new choices to millions of people worldwide who want to switch away from smoking or other dangerous forms of tobacco use, but have been unable to with the options previously available.

Since 2018, the UK-based public health agency Knowledge-Action-Change (K•A•C) has produced two biennial reports examining progress in and barriers to tobacco harm reduction around the world:

No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018 and Burning Issues: The Global State of Tobacco Harm Reduction 2020. Executive summaries of both reports are available in multiple languages and Mandarin translations of both the 2018 and 2020 editions are available.

Tobacco harm reduction, using safer nicotine products, offers new choices to millions of people worldwide who want to switch away from smoking or other dangerous forms of tobacco use

In addition, K•A•C publishes briefings such as this, driven by the key principles of the GSTHR project. The first, Tobacco Harm Reduction and the Right to Health, was published in January 2020 and can be read in 12 languages. All the GSTHR publications and translations can be downloaded at the GSTHR website,

As well as hosting GSTHR publications and providing access to downloadable charts and infographics, the GSTHR website allows users to search, compare and build bespoke data visualisations using regularly updated smoking and tobacco harm reduction statistics for more than 200 countries and territories.
Visit to find out more.


This briefing covers 15 Asian countries.

15 asian countries

Data and information from some countries such as India, China, Japan, Thailand and the Philippines are covered in more depth, while data from others illustrate more general issues and contrasts.

A number of terms are used for THR products, including ‘reduced risk products’ and ‘electronic delivery systems’ (ENDS). This report uses the term safer nicotine products (SNP) as a collective expression for nicotine vaping devices, heated tobacco products (HTP) and safer oral nicotine products such as Swedish-style pasteurised snus and non-tobacco nicotine pouches.

Unless quoting from documents, we do not use the term ‘e-cigarettes’ to describe vaping devices. The term is misleading for health professionals, politicians and the wider public, as it closely associates these new products with cigarettes. However, vaping devices do not burn tobacco and do not emit toxic smoke which harm bystanders. Many modern vaping devices bear no physical resemblance to traditional cigarettes.