From black markets to better health: New path for Maldives

If the goal of public health policy is to save lives, then the metrics of success must be measured in health outcomes, not just the number of regulations passed.

For the past year, the Maldives has been the site of an aggressive experiment in prohibition. We have seen import duties skyrocket, vape bans enacted, and generational bans signed into law. The intent, which was to curb smoking is noble and undisputed. But the outcome, as evidenced by recent customs seizures and the thriving illicit trade on social media, tells a more complicated story.

We are left with a paradox: The government has never been tougher on tobacco, yet the black market has never been more accessible. The question we must now ask is uncomfortable but necessary: Is our current strategy actually saving lives, or is it merely driving nicotine consumption into the shadows?

According to local health data, tobacco-related diseases claim roughly 150 to 200 Maldivian lives every year. These are not just statistics; they are family members, colleagues, and friends. For decades, the message to these smokers has been binary: "Quit completely, or suffer the consequences."

While this "quit or die" approach works for some, the stubborn prevalence of smoking in the Maldives (particularly among men) proves it does not work for everyone. When we ban safer alternatives like regulated vapes, we effectively trap these smokers. We leave them with only two choices: the most harmful product (combustible cigarettes, now likely bought illegally) or nothing.

Data from the region suggests we are missing a massive opportunity. A recent report focusing on Malaysia estimated that adopting Tobacco Harm Reduction (THR) policies could save approximately 416,000 lives in that country alone. While our population is smaller, the principle remains identical: providing a pathway away from combustion saves lives.

Critics often argue that allowing alternatives like vapes or nicotine pouches "normalizes" smoking. However, the experience of countries like Sweden and the UK suggests the opposite. By regulating these products, governments gain control. They can set age limits, enforce quality standards, and tax the products appropriately.

In contrast, our current prohibitionist environment has created a "Wild West." As recent parliamentary committee hearings revealed, the illicit market does not check IDs. It does not pay taxes. And it certainly does not care about product safety standards.

By refusing to regulate alternatives, we have inadvertently handed the monopoly of the nicotine market back to the cigarette and the criminal networks that supply it.

Tobacco Harm Reduction is not about promoting nicotine; it is about reducing death. It acknowledges a simple medical reality: people smoke for the nicotine, but they die from the tar and combustion.

If the Maldives were to pivot toward a harm reduction model, the policy framework would look different:

The "Future Forward" approach isn't about surrendering to the tobacco industry; it's about leveraging innovation to solve a public health crisis that prohibition has failed to fix.

We cannot ban our way to a healthier population. But we can regulate our way there. If we look at the global evidence, the path to saving Maldivian lives doesn't require us to force every smoker to quit overnight; it requires us to give them a safer way to live.