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Int J Health Policy Manag 2022, 11(9), 1616–1624 doi 10.34172/ijhpm.2021.25

Scoping Review

E-Cigarette Markets and Policy Responses in Southeast

Asia: A Scoping Review
ID ID ID
Yvette van der Eijk1* , Grace Tan Ping Ping1 , Suan Ee Ong1,2 , Grace Tan Li Xin3, David Li4, Dijin
Zhang5, Loo Min Shuen6, Chia Kee Seng1

Abstract
Article History:
Background: The global e-cigarette market has proliferated and is increasingly dominated by transnational tobacco
Received: 19 October 2020
companies. While Southeast Asian countries have received relatively little attention in e-cigarette research, the region Accepted: 13 March 2021
represents an area of potentially untapped growth for the industry. We review the e-cigarette situation in Southeast Asia ePublished: 13 April 2021
in terms of the e-cigarette markets, advertising and promotion of e-cigarettes, reported health impacts of e-cigarette use,
and policy responses in the region.
Methods: We examined e-cigarette market data from the Euromonitor Global Market Information Database (GMID)
Passport database, searched in the academic literature, grey literature and news archives for any reports or studies
of e-cigarette related diseases or injuries, e-cigarette marketing, and e-cigarette policy responses in Southeast Asian
countries, and browsed the websites of online e-cigarette retailers catering to the region’s active e-cigarette markets.
Results: In 2019, e-cigarettes were sold in six Southeast Asian markets with a total market value of $595 million, projected
to grow to $766 million by 2023. E-commerce is a significant and growing sales channel in the region, with most of the
popular or featured brands in online shops originating from China. Southeast Asian youth are targeted with a wide
variety of flavours, trendy designs and point of sale promotions, and several e-cigarette related injuries and diseases have
been reported in the region. Policy responses vary considerably between countries, ranging from strict bans to no or
partial regulations.
Conclusion: Although Southeast Asia’s e-cigarette market is relatively nascent, this is likely to change if transnationals
invest more heavily in the region. Populous countries with weak e-cigarette regulations, notably Indonesia, Malaysia,
Vietnam and the Philippines, are desirable targets for the transnationals. Regulatory action is needed to prevent
e-cigarette use from becoming entrenched into these societies, especially among young people.
Keywords: E-Cigarettes, Industry, Health Policy, Nicotine, Tobacco, Vaping
Copyright: © 2022 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article
distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/
by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Citation: van der Eijk Y, Tan Ping Ping G, Ong SE, et al. E-cigarette markets and policy responses in Southeast Asia: a *Correspondence to:
scoping review. Int J Health Policy Manag. 2022;11(9):1616–1624.  doi:10.34172/ijhpm.2021.25 Yvette van der Eijk
Email: [email protected]

Introduction smoking cessation in others,12-16 while other studies were

E-cigarettes are devices that heat a solution, ‘e-liquid,’ to create inconclusive.17-41 While some studies are inconclusive on the
an aerosol which is inhaled (‘vaped’). Although the earliest long-term health impacts of vaping,42-49 others suggest that it
e-cigarette devices resembled cigarettes, many of the newer may cause cardiovascular50-55 or respiratory56-61 diseases. In the
varieties take on a wide range of forms, often resembling pens, short term, vaping e-liquids in combination with marijuana
tech gadgets, and other everyday items. The e-liquids, which oil, often sourced informally, is potentially fatal; in the United
usually (but not always) contain nicotine, frequently contain States in 2019, 68 e-cigarette users died and over 2,800 were
flavours and additives, usually dissolved into a propylene hospitalised with ‘e-cigarette or vaping product use associated
glycol or glycerine solution. E-cigarettes are therefore not a lung injury’ (EVALI), an illness which resembles acute
homogenous group of products but a broad category of devices, pneumonia.62
e-liquids, and product components that, when assembled, are E-cigarette use among youth is another issue that has
intended to be used in a similar manner as tobacco products.1 made the use and advertising of e-cigarettes controversial.
The global e-cigarette market has proliferated from around In countries such as the United States, e-cigarette use among
$50 million (USD) in 2005 to over $20 billion in 2019, and is high school students has more than doubled (from 12% to
expected to grow to $34 billion by 2024.2 28%) in just two years (2017-2019).63 The US’s e-cigarette
E-cigarettes remain controversial as the evidence base epidemic was fuelled by the popularity of e-cigarette brands
remains inconclusive on their long-term safety and such as Juul, which dominates the global e-cigarette market
effectiveness as a smoking cessation aid. Among recent with a 19% share.2 In the United States, Juul targeted youth
studies published between 2018 and 2020, e-cigarettes were with social media campaigns, a wide variety of e-liquid
found to aid smoking cessation in some studies3-11 and hinder flavours, and a trendy, youthful brand image. Juul e-liquids

Full list of authors’ affiliations is available at the end of the article.

van der Eijk et al

also contain nicotine salts which potentiate the nicotine ‘hit’ (vap* OR e-cigarette*) AND (Singapore OR Indonesia OR
and make the aerosol easier to inhale for first-time e-cigarette Malaysia OR Philippines OR Myanmar OR Thailand OR
users.63,64 There are also concerns that e-cigarettes may act Cambodia OR Vietnam OR Lao OR Brunei OR Taiwan OR
as a gateway into smoking, with a gateway effect reported in ‘Hong Kong’). Our inclusion criteria were as follows: (1)
some places,65,66 although the evidence base for this remains contains information on e-cigarettes, and (2) this information
inconclusive.54,67-72 is specific to the Southeast Asia context. Papers that did not
As of 2019, most e-cigarettes were sold in high-income contain such information were excluded. The search yielded
Western countries where the e-cigarette industry, much 158 papers. After title and text screening, we excluded 146
of which is owned by the tobacco industry,2 is becoming and 14 papers respectively, leaving a final set of five papers
increasingly regulated. The United States, the world’s biggest (Figure 1). Given the dearth of Southeast Asia-specific
e-cigarette market, started imposing federal e-cigarette information on e-cigarettes in the academic literature, we also
regulations in the wake of its 2019 EVALI cases.73 In the searched grey literature sources (Google News archives and the
European Union (EU), which contains some of the world’s website of a regional tobacco control NGO) using keywords
largest e-cigarette markets (the United Kingdom, France, such as ‘vaping’ or ‘e-cigarette’ in combination with keywords
Germany, Poland, Italy), e-cigarettes are partially regulated related to location (eg, ‘Malaysia,’ ‘Singapore’). Where relevant
by the EU Tobacco Products Directive which came into full information was found, we conducted snowball searches, in
force in 2020.74 Southeast Asian countries, in contrast, have which search results inform subsequent searches, in Google
large smoking populations and undeveloped e-cigarette or other sources (eg, government websites) as appropriate.
markets which make them desirable targets for the e-cigarette These searches yielded a further 77 articles from government
industry.75 Juul, which is partly owned by Altria Group websites, media archives, and case report depositories. All
(formerly Philip Morris), has also set its sights on Southeast relevant data were extracted and synthesized into a narrative.
Asian markets,76 with the President of Juul’s Asia-Pacific Details on our search strategy can be found in Supplementary
South division, in a 2019 interview, describing Asia as a file 1.
“high-priority region.”77
Southeast Asian countries have received relatively little Online E-Cigarette Retailers
attention in e-cigarette research, despite the fact that the In June 2020 we searched for online e-cigarette retailers
region represents a potential area of untapped growth for the catering to the region’s active e-cigarette markets (Malaysia,
e-cigarette industry. This study aims to examine the e-cigarette Indonesia, the Philippines, Vietnam, Taiwan, and Hong
situation in Southeast Asia in terms of the e-cigarette markets, Kong). Specifically, we searched for ‘buy e-cigarette’ in the
advertising and promotion of e-cigarettes, reported health country’s respective language and Google search engine. We
impacts of e-cigarette use, and policy responses in the region. browsed online stores listed in the first 30 search hits for the
We did not include heated tobacco products, such as IQOS, in most popular or featured e-cigarette products. We recorded
our analysis. We defined Southeast Asia as the geographical the names of the most popular or featured brands and their
region that includes Singapore, Indonesia, Malaysia, the country of origin, details of common product features, and
Philippines, Myanmar, Thailand, Cambodia, Vietnam, Laos, screenshots of the online stores. For variety e-cigarette stores,
Brunei, Taiwan, and Hong Kong. With the exception of we took a screenshot of the first page of products shown when
the two Special Administrative Regions, Taiwan and Hong searching for e-cigarettes. For specialty e-cigarette stores, we
Kong, all of the countries are members of the Association took screenshots of the store’s featured or most popular items,
of Southeast Asian Nations (ASEAN). We included nearby home page, and any e-cigarette advertisements. Further
Taiwan and Hong Kong in our analysis due to their economic details of our search strategy can be found in Supplementary
similarities with Singapore and Brunei, the only high-income file 1.
nations in ASEAN.
Results
Methods Southeast Asian E-Cigarette Markets
Market Data According to Euromonitor data (Figure 2), in 2019
We retrieved and analyzed e-cigarette market data from e-cigarettes were sold in six Southeast Asian markets
the Euromonitor GMID Passport database, which included (Malaysia, Indonesia, the Philippines, Vietnam, Taiwan and
country-level data on annual e-cigarette market size from 2010- Hong Kong) with a total market value of $595 million (USD).
2019 and projected figures for 2020-2023, as well as country- The total e-cigarette market in these places was projected to
level data on e-cigarette market shares from e-commerce. grow by 29% (to $766 million) by 2023, mainly led by growth
Euromonitor collects these data from company reports, in Indonesia and the Philippines. No e-cigarette sales were
customer surveys, government statistics, trade associations, reported in Brunei, Cambodia, Singapore and Thailand, and
trade interviews, and trade press. Data was available for all data was not available for Laos and Myanmar.2
countries/territories except Laos and Myanmar. Despite its relatively small population, Malaysia (population:
32 million) had the largest e-cigarette market among the
Literature Search countries listed. Its e-cigarette market grew almost five-fold in
In March-June 2020 we conducted searches in PubMed and 2012-2015 (from $106 million to $514 million), before falling
SCOPUS for academic publications using the search string to less than half ($229 million) in 2016.2 The sharp drop was

International Journal of Health Policy and Management, 2022, 11(9), 1616–1624 1617
van der Eijk et al

Figure 1. Selection Process in Literature Search. Abbreviation: SEA, Southeast Asia.

likely due to a 2015 ban on nicotine-containing e-liquids,78 and is projected to become Southeast Asia’s largest by
the Malaysian National Fatwa Council declaring e-cigarettes 2021. E-cigarette markets in the Philippines (population:
as ‘haram’ (forbidden),79 and bans on vaping in the states of 109 million) and, to a lesser extent, Vietnam (population:
Penang, Kedah, Johor, Kelantan, and Terengganu in 2015- 96 million) have been growing steadily since 2013, and are
2016 covering a third of Malaysia’s population.80 Despite projected to continue growing into the 2020’s. Meanwhile, the
these regulatory developments, Malaysia’s e-cigarette market e-cigarette markets of Taiwan (population: 24 million) and
is projected to remain stable into the 2020’s at around $260 Hong Kong (population: 7 million) are expected to remain
million per year.2 relatively small.2
The large populations of Indonesia, the Philippines
and Vietnam provide ample marketing opportunities for E-Cigarette Advertising and Promotions in Southeast Asia
e-cigarette companies. The e-cigarette market in Indonesia While e-cigarette advertising and promotion has not been
(population: 274 million) started growing steadily in 2015 widely studied in the Southeast Asian context, a 2014 study of

E-cigarette market sizes in Southeast Asia, observed (2010-2019) and

projected (2020-2023). Source: Euromonitor.
US$ Mn
600.0

500.0

400.0

300.0

200.0

100.0

0.0
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023
Malaysia Indonesia Philippines
Vietnam Taiwan Hong Kong, China

Figure 2. E-cigarette Market Sizes in 2010-2019 (Observed) and 2020-2023 (Projected) in Malaysia, Indonesia, the Philippines, Vietnam, Taiwan and Hong Kong.

1618 International Journal of Health Policy and Management, 2022, 11(9), 1616–1624
van der Eijk et al

brick-and-mortar e-cigarette shops in Hong Kong, Malaysia, range of goods, as well as e-cigarette specialty shops, while
Thailand, and the Philippines found that e-cigarettes were in Vietnam, Taiwan and Hong Kong, e-cigarettes were sold
widely promoted at the point of sale with posters, billboards, mainly by specialty shops. In all six countries the vast majority
banners and pamphlets. Shops tended to take the form of of the popular or featured brands were from China, with a
stand-alone stores or booths. Rather than selling e-cigarettes smaller number from Korea, Malaysia, Taiwan, the United
alongside tobacco products, they were sold alongside States, and the United Kingdom (Table 1). Brands well-known
common consumer products such as books, cosmetics, in Western countries, such as Juul, Vuse, Blu, and MarkTen,
batteries, and hobby paraphernalia, making them appear like featured rarely or not at all. These differences reflect the
lifestyle products.81 nascency of the industry in the region and underscore that
According to a Reuters report, prior to February 2020, there is room for the transnationals to compete.
when Juul announced its decision to stop all sales in Screenshots from these websites (Supplementary file 2)
Indonesia, Juul was aggressively marketing its products in the illustrate the wide variety of e-cigarette designs sold in the
country. Juul targeted young people in Indonesia with fruit region, often resembling items such as pens, perfume bottles,
and dessert flavoured e-liquids, cinema adverts and young flash drives and small tech gadgets. E-liquids were sold in a
brand ambassadors. Through a contract with Nava Plus, an wide variety of flavours, most commonly fruits, desserts (eg,
Indonesian marketing firm, the ambassadors charged 2000 custard, cheesecake) and beverages (eg, caramel macchiato,
rupiah ($0.15) for sample hits of Juul in trendy locations such creamy lychee), although tobacco flavours (eg, Marlboro,
as the Omnia Bali nightclub. Juul was promoted in shopping Cuban Cigar) were also available. E-liquids also catered to the
malls, bars, nightclubs, restaurants, convenience stores, and region’s tastes, with flavours such as ‘boba milk.’ The products
sleek Juul-branded stores reminiscent of Apple stores. Juul were marketed with price promotions and user ratings.
also installed kiosks at office buildings to cater to young tech Although most websites did not feature specific adverts, an
employees. Juul was, as at February 2020, reportedly still online specialty store in the Philippines featured images of a
selling its products in the Philippines and exploring expansion young female model vaping on its front page (Supplementary
into Vietnam.82 file 2), suggesting that young females are a target group.
According to Euromonitor data (Figure 3), e-commerce is a
significant and growing sales channel in the region, especially Reports of E-Cigarette Related Health Effects in Southeast
in Hong Kong, Indonesia and Vietnam.2 A 2014 study of Asia
online e-cigarette sales in Hong Kong, Malaysia, Thailand and While it is difficult to establish the number of cases of
the Philippines found that e-commerce sites and sites with e-cigarette related disease or injuries in Southeast Asia
user-generated content, such as YouTube and Reddit, were due to a lack of academic research, under-reporting and
the preferred channels for promoting e-cigarettes online. In uncertainties regarding disease aetiology, several cases of
the study, the highest-ranking online shops and forums were diseases and injuries potentially related to e-cigarette use have
mostly based in China for Hong Kong, and in the United been reported in the region.
States and the United Kingdom for Malaysia, Thailand and Malaysian newspapers reported three suspected cases of
the Philippines. The e-commerce sites promoted e-cigarette vaping-related illness in October and November 2019. The
devices and e-liquids with price cuts, coupons, wide varieties first two cases were men who had switched from traditional
of flavours, and user testimonials.81 cigarettes to e-cigarettes. One had developed fluid in his lungs
In June 2020, we browsed online e-cigarette retailers catering after using a water-based e-cigarette for two weeks,83 while the
to the six active e-cigarette markets in the region (Malaysia, other developed a nose tumour after using a Uwell Caliburn
Indonesia, the Philippines, Vietnam, Taiwan and Hong Kong). e-cigarette for three months.84 The third case was a 17-year-old
In Malaysia, Indonesia and the Philippines, e-cigarettes were boy with asthma who developed severe internal lung damage,
widely available in general e-commerce stores selling a wide
Table 1. Name and Country of the Most Popular or Featured Brands in E-Commerce
Stores
E-cigarette market shares from e-commerce in 2018.
% Country of
Source: Euromonitor. Brand Name
70.0 Origin
60.0 Aleader, Artery, Aspire, Asvape, Augvape, Digiflavor, Dovpo,
50.0 Eleaf, Freemax, Geek Vape, Hellvape, Hotcig, iJoy, Joyetech,
KangerTech, Lost Vape, Mimo, Oukitel, Ovanty, Oxva,
40.0 China
Rincoe, Sigelei, Sikary, Smoant, SMOK, Snowwolf, SX Mini,
30.0 Teslacigs, Thinkvape, Ukeri, Uwell, Vandy Vape, Vapefly,
20.0 Vaporesso, Vaporstorm, Vladdin, VooPoo, Wismec
10.0 Asmodus, dotMod, Hexohm, Juul, Vgod, Volta USA
0.0 Nanostix, Relx, Rev Tech UK
Hong Kong, Indonesia Malaysia Philippines Taiwan Vietnam
China JustFog, Lil Korea
NCIG Malaysia
Figure 3. 2018 E-Cigarette Market Shares From E-Commerce in Malaysia,
Indonesia, the Philippines, Vietnam, Taiwan and Hong Kong. Suorin Taiwan

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van der Eijk et al

rhabdomyolysis and kidney failure after using an e-cigarette Policy Responses in Southeast Asia
for two weeks.85 News reports also detailed two possible cases Southeast Asian countries vary considerably in terms of their
of EVALI. The Philippines reported its first case of EVALI e-cigarette policy responses, ranging from strict bans to no or
in November 2019, a 16-year-old girl who was hospitalised partial regulations (Table 2).
after a sudden onset of breathing difficulties. She had used The countries also differ in terms of their regulatory
e-cigarettes for four months, and subsequently became a dual approach. In Singapore, Brunei and Thailand, e-cigarettes
user of cigarettes and e-cigarettes for two months before she were pre-emptively classified as imitation tobacco products.
was hospitalised.86 That same month in Thailand, a 48-year- These regulations were subsequently tightened, with
old lung cancer patient was reportedly struck with EVALI additional laws covering the import, sale and distribution of
after smoking an e-cigarette with marijuana.87 e-cigarettes.103 Cambodia and Laos, in contrast, did not have
In Hong Kong, a 2012-2013 survey of e-cigarette and an existing regulation covering e-cigarettes but issued notices
tobacco use in 45 128 high school students age 12-17 found to ban e-cigarette import, sale and use in 2014 (Cambodia)
that e-cigarette users had a higher prevalence of respiratory and 2018 (Laos).104 Taiwan has no blanket ban on e-cigarettes
symptoms, such as cough and phlegm, regardless of their as a predefined product category, but regulates e-cigarettes
smoking status.88 Irritation to the eyes, nose and upper under its Pharmaceutical Affairs Act. Only e-cigarettes that
respiratory tract associated with e-cigarette use were reported meet Pharmaceutical Affairs Act standards for medicines or
by respondents in a survey among e-cigarette users in Surabaya, medical devices can receive approval for import and sale in
Indonesia.89 Taiwan.105 In May 2020, Taiwan proposed to add a category
Several cases of accidents and injuries caused by for ‘cigarette-like products’ to its tobacco legislation to ban
e-cigarette explosions were reported in the news in the their import, sale, use and advertising.106
Philippines, Malaysia, Indonesia and Brunei in 2015-2018. Singapore’s e-cigarette policy, which also bans e-cigarette
In the Philippines, three cases of e-cigarette explosions were purchase and possession, is the strictest in Southeast Asia.
reported,90-92 including an e-cigarette battery explosion inside It evolved in parallel to the developing global e-cigarette
a shopping mall which caused a stampede that injured ten market and evidence base. Singapore’s Tobacco (Control of
people.91 In Malaysia, three e-cigarette related injuries were Advertisements and Sale) Act (TCASA), first introduced in
reported,93-95 and in Indonesia, a middle aged man was 1993 to regulate tobacco advertising and sale, was amended in
reportedly hospitalised with burns to his chest, eyelids, and 2010 to include e-cigarettes as a pre-emptive step. At the time,
fingers after his e-cigarette exploded during use.96 In Brunei, TCASA defined them as products believed by the Minister
two cases of electrical fire in buildings caused by e-cigarette of Health to promote smoking or harm public health.107,108
explosions were reported.97 In 2015,109 2016,110 and 2017,111 TCASA was progressively
Academic literature on the effects of e-cigarette use on amended to broaden its definition of e-cigarettes. The 2016
smoking initiation and quitting in Southeast Asia was limited, amendment covered products and components that, when
generating mixed results. Taiwanese studies reported a assembled, may be used in a manner that mimics the act
prospective association between e-cigarette use and smoking of smoking.110 The 2017 amendment extended the punitive
initiation,98 as well as e-cigarette popularity and decreased measures of TCASA to also cover e-cigarette possession,
smoking among adolescents.99 In Malaysia, a higher purchase and use.111
susceptibility to smoking among young people was correlated Southeast Asian countries/territories that regulate but
to ever-use of e-cigarettes.100 E-cigarettes were correlated permit e-cigarette use include Vietnam, Malaysia, Hong Kong
to quit attempts in Taiwan,101 while e-cigarette use did not and the Philippines. In Vietnam, e-cigarettes are classified
predict abstinence in Hong Kong.102 as tobacco products under its tobacco control law which

Table 2. E-Cigarette Regulations in Southeast Asian Countries/Territories as at June 2020

Country Status of E-Cigarette Regulation

Singapore Ban on import, sale, use and possession
Cambodia Ban on import, sale and use
Laos Ban on import, sale and use
Brunei Ban on import and sale; use banned in no smoking areas
Thailand Ban on import and sale; use banned in no smoking areas
Taiwan Partial ban on import and sale
Import, sale and use permitted; restrictions on advertising, flavours, use in public places and youth access (minimum legal age of 21);
The Philippines
health warnings; taxes; ban on sale in city of Balanga
Import, sale and use permitted; restrictions on sale of nicotine-containing e-liquids; ban on sale in provinces of Penang, Kedah, Johor,
Malaysia
Kelantan, and Terengganu
Import, sale and use permitted; restrictions on sale of nicotine-containing e-liquids; use banned in no smoking areas; proposed ban on
Hong Kong
import and sale
Vietnam Import, sale and use permitted; some restrictions on advertising, youth access, and use in public places
Indonesia No specific regulations
Myanmar No specific regulations

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van der Eijk et al

restricts some forms of advertising, youth access, and use in regulations at an early stage.
no smoking areas.104 In Malaysia and Hong Kong, e-cigarettes We also observed heavy targeting of youth in the region with
containing nicotine are covered by the countries’ poisons trendy vape pen designs, a wide variety of e-liquid flavours,
regulations which restrict their sale to licensed medical point of sale promotions, and adverts featuring young female
dealers.103 In Hong Kong, e-cigarettes are also covered by models. The targeting of young people, especially females, is
the Smoking (Public Health) Ordinance, which prohibits the inconsistent with the claim that e-cigarettes are intended to
use of e-cigarettes in no smoking areas.112 Both Malaysia and help current smokers quit, especially given the low female
Hong Kong submitted bills in 2019 to tighten their e-cigarette smoking prevalence in Southeast Asia.119 It is also a significant
regulations.113,114 Although Malaysia has yet to adopt a blanket public health concern given the data from international
regulation on e-cigarettes, five Malaysian states (Penang, studies which indicate the potential risks for chronic health
Kedah, Johor, Kelantan and Terengganu) have banned conditions or acute diseases such as EVALI, and uncertainties
e-cigarette sales.80 regarding the efficacy of e-cigarettes as a smoking cessation
The Philippines started regulating e-cigarettes in 2014 with aid.
its ‘E-cigarettes or Vape Regulation Act’ which restricted The widespread use of regional e-commerce platforms for
e-cigarette advertising, flavours and youth access, and selling e-cigarettes may create additional challenges in curbing
mandated health warnings and the registration of e-cigarette e-cigarette use among minors,120 and preventing cross-border
manufacturers operating in the country. Its 2014 ‘Rules e-cigarette promotions on social media.121 Even in countries
and Regulations on Electronic Nicotine Delivery System or with stricter e-cigarette regulations, such as Taiwan122 and
Electronic Cigarettes’ further stipulated that e-cigarettes were Singapore,123,124 young people have purchased e-cigarettes
to be regulated as medicinal products under the jurisdiction from online shops and social media channels such as
of the Food and Drug Administration.103 In February 2020, Instagram. This indicates that, besides regulating the purchase
three months after the Philippines reported its first case of and possession of e-cigarettes, enforcement mechanisms are
EVALI, the Philippine Government signed an executive order also necessary to prevent youth from purchasing e-cigarettes
to expand the nationwide no smoking areas to include vaping online. This will likely require cooperation between the
and to regulate the manufacture, import, sale and marketing countries, given the cross-border nature of illicit e-cigarette
of unregistered e-cigarettes.115-117 sales and promotions in the region.123,124

Discussion Limitations
Southeast Asia’s contrasting policy responses have resulted Due to the scarcity of academic research in the region, we had
in very different e-cigarette market scenarios. The pre- to rely heavily on grey literature such as news reports, which
emptive responses of Singapore, Thailand, Brunei and are less rigorous than peer-reviewed academic studies. This
Cambodia have likely prevented e-cigarette use in these study used information from English-language academic
countries. Early regulatory action in the Philippines has and grey literature; thus, information may be limited where
controlled e-cigarette use to some extent, resulting in a lower e-cigarettes have not been the subject of local research or
per capita consumption than in Malaysia or Indonesia, but media coverage in the English language. Data to compare
its e-cigarette market continues to grow suggesting that its the prevalence of e-cigarette use between Southeast Asian
regulatory approach, based on discouraging e-cigarette use, countries was not available; hence we used e-cigarette
is insufficient. Meanwhile, weak regulations have facilitated market volume data. For our market data analysis, we used
the entrenchment of e-cigarette use in Malaysian society. the Euromonitor GMID Passport database as this was our
A similar situation is likely to transpire in Indonesia, set to only available source which allow comparison between the
become the region’s largest e-cigarette market by 2021, as well different countries. The data covered all countries/territories
as in Vietnam and the Philippines, where e-cigarette markets except Laos and Myanmar; hence we were unable to examine
are growing. These countries, with their weak regulations, the e-cigarette markets of these countries. It must also be
large population sizes and high smoking rates, are desirable noted that, in 2019, Euromonitor received funding from the
targets for e-cigarette transnationals. Foundation for a Smokefree World and PMI Impact, both of
While Southeast Asia’s e-cigarette industry is still dominated which are funded solely by Philip Morris International. This
by regional companies, this could change if e-cigarette funding was for projects on illicit trade and a ‘Smokefree
transnationals such as Juul start investing more heavily in the Index.’125 Our study did not use data from these two projects;
region. In the 1980s, as trade opened up to Asian countries, nevertheless, Euromonitor data on the tobacco industry
tobacco transnationals started targeting Southeast Asia, should be interpreted with caution.
especially populous countries with weak tobacco regulations
such as Indonesia, the Philippines, Vietnam and Malaysia. Conclusion
The transnationals acquired domestic companies, targeted Although Southeast Asia’s e-cigarette market is still nascent
youth with sophisticated marketing tactics, and lobbied and dominated by regional companies, this could change if
against regulation. As a result, Southeast Asia’ smoking rates e-cigarette transnationals start investing more heavily in the
are now among the highest globally with an average male region. Populous countries with weak e-cigarette regulations,
smoking prevalence of 42%.118 A similar scenario may develop such as Indonesia, Malaysia, Vietnam and the Philippines,
with e-cigarettes if the countries fail to establish e-cigarette are especially desirable targets for the transnationals. In

International Journal of Health Policy and Management, 2022, 11(9), 1616–1624 1621
van der Eijk et al

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YV: conception, design, writing. GTPP, SEO: data analysis. GTLX, DL, DZ, and 16. Kulik MC, Lisha NE, Glantz SA. E-cigarettes associated with depressed
LMS: data acquisition. CKS: conception, design. smoking cessation: a cross-sectional study of 28 European Union
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17. Diemert L, Bayoumy D, Pelletier H, Schwartz R, O’Connor S. E-Cigarette
1
Saw Swee Hock School of Public Health, National University of Singapore,
Use for Smoking Cessation: Scientific Evidence and Smokers’
Singapore, Singapore. 2Research for Impact, Singapore, Singapore.
Experiences. Toronto, CA: Ontario Tobacco Research Unit; 2019.
3
Department of Political Science, Faculty of Arts and Social Sciences, National
18. Erku D, Gartner CE, Morphett K, Snoswell CL, Steadman KJ. Nicotine
University of Singapore, Singapore, Singapore. 4Department of Civil and
vaping products as a harm reduction tool among smokers: Review of
Environmental Engineering, Faculty of Engineering, University of Alberta,
evidence and implications for pharmacy practice. Res Social Adm Pharm.
Edmonton, AB, Canada. 5Department of Biological Sciences, Faculty of
2020;16(9):1272-1278. doi:10.1016/j.sapharm.2020.02.002
Science, National University of Singapore, Singapore, Singapore. 6Department
19. Farsalinos K. Electronic cigarettes: an aid in smoking cessation, or a
of Psychology, Faculty of Arts and Social Sciences, National University of
new health hazard? Ther Adv Respir Dis. 2018;12:1753465817744960.
Singapore, Singapore, Singapore.
doi:10.1177/1753465817744960
20. Franks AS, Sando K, McBane S. Do electronic cigarettes have a role in
Supplementary files
tobacco cessation? Pharmacotherapy. 2018;38(5):555-568. doi:10.1002/
Supplementary file 1. Details of Searches Conducted in the Academic and Grey
phar.2103
Literature and for Online E-Cigarette Stores.
21. Gentry S, Forouhi NG, Notley C. Are electronic cigarettes an effective
Supplementary file 2. Screenshots From E-Cigarette Retailers Catering to
aid to smoking cessation or reduction among vulnerable groups? a
Malaysia, Indonesia, Vietnam, Hong Kong, Taiwan and the Philippines.
systematic review of quantitative and qualitative evidence. Nicotine Tob
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