With increasing population densities and expanding urban boundaries, the potential for explosive volcanic eruptions to have adverse impacts upon urban areas is on the rise. This is particularly true for volcanoes along subduction zones, because they are almost exclusively explosive and often coincident with large populations. Explosive eruption hazards such as tephra fall have the potential to affect very large areas and numbers of people; populations in volcanic areas may therefore be exposed to tephra falls from more than one volcano. In this study we have simulated large numbers of plausible explosive eruptions of Volcanic Explosivity Index (VEI) 4 or greater for each of 141 volcanoes in the Asia-Pacific region. Tephra fall footprints are aggregated for 16 major cities, according to their probability of occurrence. This addresses an emerging need for international agencies and organizations to conduct regional-scale assessments, where at-risk areas can be compared on a like-for-like basis. Hazard in cities near subduction zones is two to three orders of magnitude greater than for those farther away. By combining our hazard estimates with indicators describing the exposure and vulnerability of people and infrastructure, tephra fall risk scores were calculated for each city. Risk is evaluated separately for human populations and potential economic impact, with the highest human risk scores calculated for Manila and the highest economic scores for Tokyo. The volcanoes with the greatest hazard contribution in the very populous cities of Manila, Tokyo, and Jakarta were identified as Taal (Manila), Fujisan (Tokyo), and six volcanoes equally (Jakarta). While this study provides a transparent and consistent method for assessing regional volcanic hazard and risk, there are challenges associated with the data-poor setting and we conclude by discussing what is required in order to improve regional tephra fall hazard and risk assessments. This study provides a regional-scale assessment that cannot replace hazard and risk information provided locally by official organizations.