MC: Given your pivotal role in establishing both SEATCA and GGTC, what initially inspired you to dedicate your career to tobacco control?

Ms. Ritthiphakdee: My journey in tobacco control began over three decades ago in Thailand, where I co-founded Action on Smoking and Health Thailand in 1990. Through strategic programs and public mobilization, we successfully advocated for the implementation of tobacco control laws and strengthened the capacity of networks within the country.

Recognizing that tobacco control is a global challenge, we established the Southeast Asia Tobacco Control Alliance (SEATCA) in 2000 to foster collaboration and learning across Southeast Asian nations. SEATCA played a pivotal role in sharing best practices, strengthening regional tobacco control policies, and countering the influence of transnational tobacco companies.

Building on our regional achievements, we founded the Global Center for Good Governance of Tobacco Control (GGTC) in 2017. The GGTC serves as a global knowledge hub and thinktank to address tobacco industry interference and promote good governance in tobacco control.

MC: Based on your experience with SEATCA, how would you assess the current state of cigarette consumption in Southeast Asian countries in general, and the Vietnamese situation in particular?

Ms. Ritthiphakdee: The current state of cigarette consumption in Southeast Asian countries presents a mixed picture, with both positive developments and ongoing challenges.

On the positive side, most ASEAN countries have made significant strides in implementing strong tobacco control policies. Vietnam, for example, passed a tobacco control law in 2012, and other countries like Cambodia and Laos have followed suit. Thailand and Singapore have long been leaders in tobacco control, with comprehensive measures in place. This progress in policy implementation represents a significant advancement compared to three decades ago when such measures were largely absent.

Overall, the region has made commendable progress in adopting comprehensive tobacco control measures, such as bans on advertising, smoking restrictions in public places, and graphic health warnings on cigarette packs. Nevertheless, continued efforts are crucial to further reduce tobacco consumption and address new challenges like E-cigarettes.

MC: Despite notable progress in tobacco control efforts and a decline in smoking rates, Southeast Asian countries continue to confront significant challenges, particularly those without robust regulatory frameworks. From your perspective, what are the most pressing obstacles hindering effective tobacco control in these nations?

Ms. Ritthiphakdee: One of the most pressing issue is tobacco taxation which is the most effective measure in reducing tobacco consumption. While Singapore and Thailand have implemented high tax rates on cigarettes, exceeding 75% as recommended by the World Bank, countries like Vietnam, Laos, and Cambodia still maintain relatively low taxes. This disparity is largely attributed to the aggressive lobbying efforts of the tobacco industry, which opposes tax increases to protect its profits.

Another major challenge stems from the tobacco industry’s introduction of new products, such as e-cigarettes and vaping devices. These new products, often targeted towards youth, pose a significant threat and have created a new global epidemic.

While we have made strides in the fight against traditional tobacco products, the emergence of e-cigarettes and vaping represents a new battlefront. It is crucial for countries to adopt strong regulatory frameworks to address this evolving challenge and protect future generations from the harms of nicotine addiction.

MC: The young populations remain particularly susceptible to nicotine consumption, especially through the use of Electronics Nicotine Delivery Systems (ENDS), more commonly known as electronic cigarettes, or vapes. Could you elaborate on the negative health consequences associated with vaping compared to traditional smoking?

Ms. Ritthiphakdee: It’s crucial to understand that conventional cigarettes have been around for nearly a century, with extensive research demonstrating their detrimental health effects like lung cancer and heart disease. While the evidence on e-cigarettes isn’t as vast due to their relatively recent emergence, however many existing researches clearly indicate they are not safe.

One concerning aspect of e-cigarettes is the vast array of flavors they offer. There are currently over 16,000 flavors available, including strawberries, apples, and chocolate. These flavors, coupled with the misconception that vaping is not smoking, contribute to their appeal among teenagers and young adults who may not have otherwise considered traditional cigarettes.

However, despite the attractive flavors, e-cigarettes are far from harmless. The global health community, including the World Health Organization, has documented cases of severe lung injuries, such as EVALI (e-cigarette or vaping product use-associated lung injury) linked to e-cigarette use. While I don’t know about specific cases in Vietnam, Thailand and other countries have reported such incidents.

It’s important to remember that e-cigarettes, like traditional cigarettes, contain nicotine, an addictive substance. Their use can lead to nicotine dependence and potentially long-term health consequences.

MC: The proliferation of electronic cigarettes on social media platforms, particularly those targeting young populations in developing Southeast Asian regions, raises significant public health concerns. How would you explain the beginning of this “trend” and could you elaborate on the potential negative consequences of it?

Ms. Ritthiphakdee: One of the factors, particularly for teenagers, is that they start vaping because they believe, or they think, that vaping is not dangerous. This means we need to do more comprehensive public education, especially through digital and online media. We need to make sure the public is aware of the risks.

The popularity of vaping has really exploded in many countries over the past 10 years. However, the damage from using e-cigarettes isn’t as well recognized compared to conventional cigarettes. This lack of awareness is a risk we’ve seen.

For me, there are two main types of damage caused by vaping. One is the visible damage to your health, like EVALI. These conditions can have a significant impact on your well-being. But the other type of damage, which is very worrisome, is the damage to your brain.

Actually, one of the main reasons Singapore banned e-cigarettes is because they didn’t see any real benefit to them. They had concerns and some evidence suggesting that e-cigarettes can damage the brain, especially in young people. The younger you are when you start vaping, the greater the risk of brain damage. They wanted to protect their future generations, and that’s why they decided to ban e-cigarettes.

MC: Many individuals are eager to attend your upcoming presentation at the VinFuture’s InnovaConnect. Can you share a few keynotes you’re going to share to the Vietnamese audience this September?

Ms. Ritthiphakdee: I will share several key points regarding e-cigarettes, particularly emphasizing their potential dangers and the need for effective regulation.

Firstly, I will challenge the notion that e-cigarettes are less harmful than traditional cigarettes. Evidence suggests that they can lead to dual use or even a return to conventional smoking, undermining their purported role in smoking cessation.

Secondly, I will highlight the alarming trend of e-cigarette use among teenagers and young adults, many of whom have never smoked before. The presence of nicotine in e-cigarettes makes them addictive, potentially creating a new generation of nicotine-dependent individuals.

To address this growing epidemic, the World Health Organization and many countries recommend the strongest regulations wherever possible which is a complete ban on e-cigarettes. While five ASEAN countries have already implemented the ban, challenges remain, especially with illegal products entering the market through online platforms.

Research has shown that countries with e-cigarette bans have lower prevalence rates among teenagers compared to those that allow their sale. However, if a complete ban is not feasible, strict regulation is crucial. Australia’s approach, which allows e-cigarettes under certain conditions, necessitates a robust enforcement system and significant resources.

My presentation will emphasize the importance of recognizing the risks associated with e-cigarettes and taking decisive action to protect public health, particularly among young people. Governments must prioritize effective measures to prevent a new epidemic of nicotine addiction.