Alcohol and the COVID-19 public health crisis

The need to combat COVID-19 has facilitated an exceptional process in Southern Africa. Governments in the region have introduced emergency regulations on the basis of public health evidence. But the way they have done it has demonstrated possibilities for future alcohol policy.

In an effort to contain the spread of COVID-19, Southern African countries including but not limited to Botswana, Lesotho, Madagascar, Malawi, Namibia, South Africa, Zambia and Zimbabwe introduced emergency laws involving closing schools, limiting public gatherings, restricting/ banning the sale of alcohol, preventative hygiene measures, physical distancing and complete lockdowns for periods ranging from 21 days or more. The restrictions on alcohol sales, in many cases a complete ban on alcohol trading during lockdown, demonstrate the ability of governments in the region to make difficult but sound, evidence-based public health and safety decisions.

Imposing lockdown measures was always going to be a risk for countries characterized by largely informal economies, high unemployment, food shortages and limited access to running water. Nevertheless, the Southern African leaders went ahead, knowing that lockdowns were necessary, despite their genuine fears that the measures could fail or have unintended consequences. An added challenge is that most governments in the region are unable to provide social safety nets for their most vulnerable people who live from hand to mouth in densely populated settlements where physical distancing is difficult, if not impossible. Despite this, they knew they had to make bold political choices to save the lives of their citizenry.

One of these choices relates to alcohol.

Alcohol is being addressed as a potential obstacle to the effective adoption of the key tools in the fight against COVID-19 – physical distancing and regular washing of hands. To address this problem, there is, in most countries in the region, at least a partial ban on alcohol. Common to almost all is that bars, restaurants and nightclubs are shut down but, in some at least, bottle stores and other retail outlets that sell liquor are allowed to be open for a legislated period of time.

Overview of Southern African countries’ alcohol policy measures as part of the COVID-19 response

In South Africa, during the first week of a declared State of Disaster, there were restrictions on the operating hours of liquor outlets (both on-consumption and off-consumption). The following week, a lockdown was announced which, inter alia, ruled that all liquor outlets, on and off, should shut completely, thereby allowing no liquor to be purchased at all. The COVID-19 epicentre in the region with over 2 600 infections and 48 deaths by April 16, 2020, the country implemented some of the most stringent lockdown restrictions in the world. At the time of writing, the original 21-day lockdown in South Africa has been extended by another 14 days to the end of April. In response to the extension, there have been calls by the alcohol industry and others for the ban to be lifted because of the economic hardship it is causing for liquor traders.

In order to control citizens who were defying phsyical distancing measures, Zimbabwe had sought to expand its initial restrictions to include a total ban on the sale of alcohol, but were forced to backtrack within 24 hours as a result of alcohol industry interference. While on-consumption outlets remain shut, the government continues to allow retail outlets to sell takeaway alcohol to be consumed at home.

In Zambia, the initial response to the novel coronavirus was to reduce the operating time of bars to two hours a day. Since the 14-day lockdown started, the President has declared an almost complete ban on alcohol in the country. No work is being conducted by the alcohol industry and bars are supposed to be completely closed. Reports suggest that the regulations do not specifically prevent supermarkets, which are allowed to stay open to sell food and other essential items, from selling alcohol. So people are able to buy alcoholic products and consume them at home. As in other countries, there are those who are violating the directive. They are being arrested and locked up and will be prosecuted using the fast-track courts set up for that purpose.

Like South Africa and other countries, Botswana initially limited access to alcohol as part of the fight against COVID-19. But on April 2, following the death of three COVID-19 patients, the President of Botswana ordered a 28-day lockdown and an indefinite State of Emergency with a ruling that no alcohol may be sold during the lockdown.

In their first efforts to stop the spread of COVID-19, Lesotho issued a notice which restricted the operating hours of all outlets selling liquor. But then, on March 27, the government declared a State of Emergency and decreed that all liquor outlets had to stop operating. To comply with this, the alcohol industry issued a letter to its customers informing them that Maluti Mountain Brewery (MMB) – the country’s sole alcohol manufacturer and subsidiary of AB InBev – would be closed. There have been reported cases of people selling and consuming liquor in different parts of the country, but police and soldiers are trying to address the situation. In one village, a soldier and two other people were arrested and taken to court for contravening the lockdown by opening a bar owned by the soldier.

In Madagascar, the government declared a health emergency and partial lockdown in three regions from March 21. There, too, is a complete ban on the sale of alcohol. Even supermarkets can no longer sell alcoholic beverages. People do get alcohol clandestinely from bars in their neighborhoods and drink alcohol at home. In addition, the doors of some bars appear closed, but the owners receive people in secret.

Namibia has also been on lockdown since March 28, with the sale of alcohol banned and all liquor outlets ordered to remain closed.  As is the case in all countries in the region, there are attempts to exploit the situation by using illegal outlets, but the law enforcement agencies are responding well, confiscating alcohol and/ or imposing a fine of $5000.

Malawi introduced a lockdown much later than its neighbors, coming into force on April 18. The lockdown declaration includes a ban on all non-essential services. While on-consumption alcohol outlets will be shut, the government will allow retail outlets to sell takeaway alcohol to be consumed at home.

What has shaped Southern Africa’s responses?

As part of their strategic plans to delay and contain the spread of the virus, countries in the region – taking their cue from South Africa – have imposed restrictions on the sale of alcohol to facilitate adherence to physical distancing and hygiene messages.

Two keys issues informed these choices – the culture of binge alcohol consumption from shared containers (bottles and glasses) in social and small, unregulated trading spaces. According to the World Health Organisation (WHO), well over 50% of the population in Southern Africa do not consume alcohol. However, the people who do use alcohol drink at heavy levels. This is a particular problem amongst young people, many of them unemployed, for whom there is a lack of adequate recreational opportunities to occupy their time productively. For many of them, taverns and shebeens within residential areas are the only social and recreational space on offer.

South Africa: High-Risk Alcohol Use Common

Taverns and shebeens are spaces that are usually unregulated, unlicensed, and do not comply with planning, building, zoning and health criteria. They take many shapes, from a room in a shack or an open area with no toilets or water facilities in the backyard of a house to a fully-fledged (and more expensive) restaurant. Some outlets only sell a case of beers a day and have a select customer base. Many are very busy and, on weekends, are packed beyond capacity.

For example, Khayelitsha, a sprawling apartheid-created suburb in the Cape Town municipality in South Africa, has over 1000 alcohol outlets of which only 11% are legal. There are so many that most residents live within three to five minutes walking distance from their nearest outlet. Trading in these conditions not only causes great social harm, it also brings about great rivalry. In Khayelitsha, between January and March 2020, three shoot-outs in shebeens resulted in the killing of 15 people. Police investigations linked the murders to interpersonal conflict.

What are the challenges?

A necessary aspect of emergency regulations is putting in place measures to ensure compliance. Unfortunately, there are widespread reports of human rights violations across the region by overzealous law enforcement agents – confiscations, beatings, arrests – all of which point to a lack of training in human management skills and a skewed and misinterpreted mandate of policing. In one particular disturbing case, South African military personnel assaulted a man in Alexandra, Johannesburg, so badly that he succumbed to his injuries. The soldiers claimed the man was in contravention of the ban on alcohol. His death is being investigated by the Minister of Defence and senior Defence Force officials.

Most countries in the region, excluding South Africa, have poor healthcare systems that are likely to be overwhelmed within the next few weeks as each territory reaches the peak of its curve in infections. This could result in an unprecedented health disaster for individual countries and possibly the region.

The fragile socio-economic dynamics playing out in the region mean a lack of aggressive testing, contact tracing and effective physical distancing. Personal protective equipment (PPE) for healthcare workers and law enforcement agents is scarce or not available at all, leaving many on the frontline with an increased risk of infection.

Alcohol industry interference and lobbying has also been a major issue. In Zimbabwe, the country’s biggest beer manufacturer – Delta Corporation, a subsidiary of global liquor giant AB InBev – received written confirmation from the Ministry of Industry and Trade that it could continue operations and that it was designated as an essential service provider. Perhaps not by coincidence, the company is to have donated $6 million towards Zimbabwe’s COVID-19 response.

In Lesotho, liquor traders have joined other small business owners to lobby the government for financial relief or a reprieve to operate, albeit in line with limited hours. In South Africa, the push has been from traders for permission to operate, with one liquor association threatening to take government to court for ‘unconstitutional’ regulations. Meanwhile, Big Alcohol have presented themselves as benevolent contributors to the fight against COVID-19 by donating pure alcohol for the production of sanitizers. They have, however, been accused of breaking the law, having been caught transporting big consignments of their products, one of which was seemingly for export. As a result, the South African government has amended the lockdown Regulations to prevent this happening in future.

Conclusion

Southern African countries have taken the lead in ensuring that alcohol-related harm is reduced during the COVID-19 lockdown. While the limits on alcohol are helping people to stay sober and mindful of physical distancing and hand-washing requirements, they are also contributing to a dramatic decrease of inter-personal violence, road crashes and hospital admissions. In addition, there is global concern that the lockdown can result in an increase in domestic violence because people are forced into close proximity with each other for 24 hours a day.

There is a concern in all countries that an underground market for alcohol has developed during the lockdown. Takeaways are available and some on-consumption outlets are operating behind closed doors, contravening the ban on gatherings and the need for physical distancing. In some instances, online retailers continue to supply alcohol despite the lockdowns and there are suspicions that some distributors are collaborating with outlets to ensure they have an adequate supply of alcohol despite the bans. It is clear that government bans alone are not enough to deter some alcohol users and sellers who will seek for ways to get around whatever restrictions are in place.

The COVID-19 lockdowns nevertheless provide an unprecedented opportunity for activists, researchers and governments to consider how to manage alcohol in a post-virus world. Lessons can be learnt across the globe and in Southern Africa in particular from the way in which restrictions on access to alcohol, whether through a partial or complete ban, have impacted on the levels of alcohol-related harm and on the ecology of life in neighbourhoods that normally experience high levels of alcohol-attributable harm as a result of the unregulated sale and consumption of alcohol. The particular path chosen by Southern African countries of restricting and banning access to alcohol will provide particular opportunities for research and help to shape evidence-based alcohol policies in the interest of public health and safety and for the effective management of the alcohol trade in the future.

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This blog post has been a collaborative effort by

Mr Maurice Smithers is the Coordinator of SAAPA in South Africa. Follow Maurice on twitter.

Mrs Aadielah Maker Diedericks is the Coordinator of the Southern African Alcohol Policy Alliance (SAAPA). Follow Aadielah on twitter.

Mr Tungamirai Zimonte is the Coordinator of SAAPA in Zimbabwe. He is a Board Member of Movendi International and the Founder of YADD. Follow Tunga on twitter.

The Southern African Alcohol Policy Alliance, SAAPA, is a collaborative initiative between eight Southern African countries. SAAPA is a network which aims to address the challenge of harmonising and accelerating alcohol policy development in the region.

For further reading:

“Alcohol, alcohol harm and alcohol dependency: Putting things in perspective”

Coronavirus Op-Ed in The Daily Maverick by Maurice Smithers, April 13, 2020

“Why alcohol ban is necessary”

Coronavirus opinion and analysis in The Manica Post by Tungamirai Zimonte, April 17, 2020

“The Case for – and Obstacles to – Policy Action To Tackle South Africa’s Alcohol Burden”

Guest expert blog post for Movendi International by Aadielah Maker Diedericks, April 9, 2020