Bans on smoke-free nicotine alternatives across parts of Southeast Asia may be producing unintended consequences, including the growth of illicit markets, declining government tax revenues, and some users returning to traditional cigarettes, according to several international health advocates and policy experts.
Evidence from different countries suggests that strict regulatory frameworks designed to protect public health could have the opposite effect—contributing to higher smoking rates while leaving cigarette consumption largely unchanged.
Across Southeast Asia, illegal vape markets have continued to expand in countries that impose outright bans or strict restrictions. Thailand, Singapore, Vietnam, and Cambodia all prohibit the sale or import of e-cigarettes, yet reports and studies indicate that the products remain accessible through underground distribution networks.
In Singapore, where vaping has been banned since 2018, a study published in the journal Drug and Alcohol Review documented a persistent “illegal vaping culture” despite strict enforcement and penalties. In Thailand, reporting by the Bangkok Post in February 2023 said vaping devices remain widely available even as authorities continue to penalize users.
Dr. David Khayat, professor at Pierre et Marie Curie University and former adviser to former French president Jacques Chirac, said decades of taxes and health warnings may have reached their limits. Speaking at a 2025 conference in Dubai, he compared nicotine bans to the United States’ prohibition era in the 1920s.
“When you try to prohibit it, what’s going to happen is mob, mafia, illicit trade and everything,” Khayat said.
The Global State of Tobacco Harm Reduction (GSTHR) report estimates tobacco continues to cause about 8 million deaths annually. It noted that in low- and middle-income countries—where most smokers live and where most tobacco-related deaths occur—smoking rates remain high with limited signs of decline.
The report also said strict bans and high taxes may create the perception that smoke-free alternatives are just as harmful as cigarettes. This “misperception of harm,” it said, discourages smokers from switching to potentially less harmful alternatives while pushing sales into unregulated markets.
Dr. Lorenzo Mata Jr., president of the advocacy group Quit for Good, said global anti-smoking strategies have yet to significantly reduce the number of smokers, which remains above 1 billion worldwide.
“Smoking rates remain high, particularly in low- and middle-income countries where smokers are denied better alternatives to cigarettes due to the strategy promoted by the WHO. This also results in widespread smuggling and illicit trade,” Mata said.
Data from the World Health Organization show global tobacco use reached 1.25 billion users in 2022, nearly two decades after the Framework Convention on Tobacco Control was adopted.
India banned vaping in 2019 under the Prohibition of Electronic Cigarettes Act, but unregulated devices remain available in informal markets. Consultant cardio-endocrine physician Dr. Rohan Andrade Sequeira said nicotine replacement therapies have limited success for many of the country’s estimated 250 million tobacco users.
“There’s no way out for these patients who are suffering from behavioral patterns of using tobacco or nicotine,” Sequeira said.
International harm reduction advocate Kurt Yeo, co-founder of Vaping Saved My Life (VSML), said limited cessation support and widespread illicit cigarette trade complicate smoking cessation efforts in several African countries.
JP Solis, president of the Science and Innovation Nicotine Advocacy Group (SINAG), said public health strategies differ between Western and Asian governments. While countries such as the United Kingdom and New Zealand incorporate vaping into smoking cessation strategies, several Asian nations maintain strict prohibitions.
“Instead of reducing nicotine use, the restrictions appear to be shielding or indirectly promoting cigarettes, causing smoking rates to level off or potentially increase as users revert to combustible cigarettes,” Solis said.
“These restrictions can often push consumers towards illicit products while discouraging the development of innovative and less harmful technologies. A balanced approach would protect consumers far more than blanket bans,” he added.
Research from the University of Queensland highlights differences in policies between Australia and New Zealand. While Australia maintains tight restrictions on nicotine vapes, New Zealand allows regulated adult sales. The study found that daily smoking among adults in New Zealand declined by 10 percent annually from 2016 to 2023—double the 5 percent decline recorded in Australia.
Dr. K. Michael Cummings, a researcher at the Medical University of South Carolina, said evidence from the United States, England, and Sweden suggests that consumer access to lower-risk nicotine products within regulated markets can accelerate declines in cigarette consumption.