It is estimated that by 2030 tobacco use will be responsible for 8 million deaths per year. Eighty percent of these deaths will occur in low and middle-income countries where nearly two thirds of the world’s smokers live. In Vietnam, 45% of adult men are current smokers, a prevalence that is the second highest among Southeast Asian countries. The smoking rate among women is only 1.1%, which reflects a persistent gender norm that cigarette smoking is unacceptable among women. Cigarette smoking rates are highest among low income, less-educated populations. It is estimated that if current smoking rates are not addressed within the next 10 years in Vietnam, tobacco will be responsible for nearly 25% of adult male deaths.
Against this backdrop of high smoking rates, e-cigarettes entered Vietnam’s market as perceived safer alternatives, with some smokers switching from traditional cigarettes. However, Vietnam’s year-old prohibition on e-cigarettes and heated tobacco products now exposes an uncomfortable truth: removing products doesn’t automatically create pathways to recovery. Whilst six ASEAN nations have now implemented bans, the missing infrastructure for genuine cessation support reveals a fundamental flaw in regional tobacco control strategies.
The ban took effect 1 January 2025 following alarming health data from 2023: 1,224 hospitalisations related to e-cigarette and heated tobacco use, including 71 cases involving minors. Some patients presented with synthetic drug poisoning, evidence that the e-cigarette market operated beyond simple nicotine delivery. Nearly twelve months later, the question isn’t whether prohibition succeeded but whether anything meaningful replaced it.
The Substitution Crisis Nobody Discusses
Evidence from jurisdictions implementing flavour restrictions reveals a troubling pattern Vietnam must heed. When daily vaping dropped 3.6 percentage points following bans, daily cigarette smoking increased 2.2 percentage points among the same young adult population. For every five individuals who quit vaping, three to four switched to combustible tobacco.
This substitution effect undermines decades of progress reducing smoking rates across Southeast Asia. Traditional cigarettes carry far greater health risks than e-cigarettes: lung cancer, heart disease, respiratory illnesses. Vietnam’s healthcare workers noted similar dynamics throughout 2025. Patients previously using e-cigarettes as perceived safer alternatives returned to conventional cigarettes following the ban. Without accessible cessation programmes offering genuine recovery pathways, prohibition simply redistributed nicotine dependence rather than addressing it.
Enforcement Struggles and Regional Fragmentation
Mr Nguyen Tu from Ha Dong district Hanoi captured the implementation challenge in November 2024: “There are still no penalties in effect, and many buyers and sellers are waiting to see how strict the enforcement will be.” This wait-and-see dynamic characterised much of 2025, with enforcement varying dramatically across regions.
Urban centres like Hanoi and Ho Chi Minh City witnessed aggressive raids on vape shops and penalties on retailers. Yet smaller cities and rural areas saw minimal action, creating geographic disparities that undermined the ban’s effectiveness. The Ministry of Health’s amendments to Decree 117/2020/ND-CP established penalty structures mid-2025, though large-scale operations faced prosecution whilst individual users and small sellers often escaped consequences.
Vietnam’s experience starkly demonstrated how isolated national policies struggle within regionally integrated economies. Six ASEAN nations now prohibit e-cigarettes (Singapore, Thailand, Cambodia, Laos, Brunei and Vietnam), yet four others permit regulated sales, creating enforcement nightmares. Products legally sold in Indonesia, Malaysia and the Philippines regularly entered Vietnam through travellers and small-time traders exploiting porous borders. Thailand’s experience proved cautionary: despite strict penalties including imprisonment, authorities never eliminated black market trade. Singapore achieved stronger enforcement through substantial resource investment, infrastructure Vietnam lacks at comparable scale.
Online Retailers Expose Global Enforcement Gaps
Online marketplaces emerged as the most challenging enforcement frontier, a pattern repeated globally. Social media platforms and encrypted messaging services became primary distribution channels throughout 2025, with sellers advertising through group chats and private messages. Transactions occurred through mobile payment systems or cash on delivery, complicating enforcement tracking.
Regulatory authorities in developed markets with sophisticated enforcement capabilities face identical challenges: online retailers exploiting jurisdictional gaps, using stealth packaging to evade detection and adapting faster than regulators can respond. Online retailers based in permissive jurisdictions shipped directly to Vietnamese addresses, exploiting gaps in customs screening. If well-resourced enforcement agencies in high-income countries struggle to control online sales, Vietnam’s challenges become clearer.
Youth Access and Cultural Motivations
Throughout 2025, young people obtained devices through social media platforms, encrypted messaging services and informal networks. School-based prevention programmes brought anti-tobacco education to Vietnamese classrooms, reaching millions with information about e-cigarette risks. Yet access remained surprisingly easy for determined young people.
The 71 minors hospitalised in 2023 represented a baseline advocates hoped would decline sharply. Preliminary 2025 data suggests modest reductions, though distinguishing between genuine decreases and underreporting proves difficult. Parents and healthcare workers noted reluctance amongst young users to seek medical attention, fearing legal consequences or parental punishment.
This illustrates a critical prevention challenge: prohibition without adequate support systems drives problems underground rather than solving them. Young people experiment with nicotine products for reasons prohibition alone cannot address: peer pressure, stress management needs, mental health struggles and desire for social belonging. For many young people, smoking and vaping represent cultural symbols loaded with historical connotations rather than purely health-based decisions. They view these products through aesthetic and identity lenses shaped by social media, celebrity influence and desire for belonging, making health warnings insufficient without addressing deeper motivations.
Product attributes proved particularly salient to regional youth. Research on tobacco control in ASEAN low-income and middle-income countries revealed that NVP flavours align with youth taste preferences, whilst device shape and design align with desires for innovation and technology. Marketing tactics replicate the tobacco industry’s historical strategies targeting youth, with websites and social media promoting devices and associating brands with sociocultural appeals, festivals, celebrities and online influencers. ‘Vape shops’ operate like cafés, where young people try different devices and flavours, discuss products with salespeople and socialise, creating environments promoting experimentation with, and a lifestyle around, these devices.
Recovery Infrastructure Remains Critically Underdeveloped
The most significant oversight in Vietnam’s e-cigarette ban centres on insufficient support for existing users attempting to quit nicotine entirely. Throughout 2025, healthcare facilities reported increased cessation assistance requests, yet few possessed adequate resources or trained staff for effective interventions.
Traditional cessation methods (behavioural counselling, support groups, structured programmes) remained concentrated in major urban hospitals, inaccessible to most Vietnamese outside city centres. Community health clinics lacked training and materials specific to e-cigarette cessation. The Ministry of Health initiated training programmes throughout 2025, though scaling efforts to meet demand proved challenging amid budget constraints and competing public health priorities.
Consequently, many Vietnamese who transitioned from traditional tobacco to e-cigarettes before the ban faced limited options: attempt quitting without professional support, return to conventional cigarettes or continue e-cigarette use through black market channels. Each outcome represents partial failure of the ban’s public health objectives.
ASEAN tobacco control experts predominantly opposed using e-cigarettes for smoking cessation, citing insufficient evidence, concerns about maintaining nicotine dependence, risks of dual use prolonging cigarette consumption and unclear long-term harms. However, several experts were open to supporting limited and controlled use as a component of cessation interventions alongside current treatments, aiming to substitute, reduce and eventually stop nicotine consumption altogether.
With the ASEAN region home to approximately 124.3 million adult smokers (10% of the world’s 1.07 billion smokers), policies may benefit from disaggregated approaches when evaluating potential impacts on different groups. E-cigarettes pose health threats to non-smokers but potential opportunities for better health amongst current smokers unable to quit through existing methods.
Building Comprehensive Prevention Systems
Moving beyond prohibition requires acknowledging that removing harmful products succeeds only when coupled with building positive alternatives. Young people need reasons not to use substances grounded in genuine wellbeing, not just warnings about consequences. Adults struggling with addiction need accessible pathways to recovery, not just legal barriers to their current coping mechanisms.
Prevention education must extend beyond health warnings to develop life skills: stress management, emotional regulation, peer pressure resistance and building healthy social connections. Schools, families and communities all play crucial roles, yet most Vietnamese communities lack infrastructure and facilitators to sustain ongoing programmes without external support.
ASEAN nations should work towards harmonised approaches (whether universal prohibition or consistent regulation) that eliminate cross-border inconsistencies undermining national efforts. Shared resources for research, training and enforcement could strengthen individual country programmes whilst creating economies of scale. A regional prevention framework could establish consistent standards for cessation support, training programmes for healthcare workers and evidence-based intervention models adapted to cultural contexts.
The Path Forward
Vietnam’s e-cigarette ban marks twelve months of mixed outcomes: legal sales channels eliminated, awareness raised about product risks, yet black markets resilient, enforcement inconsistent and recovery infrastructure inadequate. The substitution effect (users returning to more harmful cigarettes) particularly concerns health officials who recognise this outcome contradicts the ban’s fundamental purpose.
The real lesson isn’t about prohibition’s effectiveness but about the critical importance of comprehensive prevention systems addressing both uptake denial and recovery support. Success demands building genuine alternatives: accessible cessation support, youth wellbeing programmes, community resilience networks and regional cooperation frameworks that address demand reduction through positive development rather than simply supply restriction.
The question facing Vietnam and its regional neighbours isn’t whether to ban e-cigarettes but whether they’ll invest in prevention infrastructure that actually prevents harm rather than merely redistributing it.
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