The open burning of plastic wastes is a practice that is highly prevalent across the globe, toxic to human and environmental health, and a critical—but often overlooked—aspect of plastic pollution. Most of the countries where such burning is widespread have laws and policies in place against it; open burning continues nevertheless. In this article, using data from ethnographic fieldwork in urban and rural sites in India, Indonesia, the Philippines, and Zambia, we examine local practices of open burning and investigate why regulations to tackle it have proven largely ineffective. Adopting a harm reduction approach, we then suggest preliminary measures to mitigate the health risks of open burning by targeting those plastics and packaging types that are most toxic when burned.