Measures to Mitigate Alcohol Harm During the COVID-19 Pandemic in Uganda
According to World Health Organization (WHO), the basic COVID-19 Standard Operating Procedures (SOPs) for preventing the spread of COVID-19 include proper use of face masks, ensuring hygiene through proper and frequent hand washing/sanitization, vaccination, and social distancing. The public is advised to improve their diet to cater for essential vitamins, minerals, and body-building foods. At the height of the pandemic, people were encouraged to adopt a positive lifestyle (such as resting and regular body exercising) to build immunity against the novel coronavirus. On the other hand, scientists discouraged alcohol consumption during this time as it was proven to weaken a person’s immune system as well as increase the risk of adverse health outcomes. In alcohol environments adherence to coronavirus-related hygiene rules and physical distancing requirements is often reduced or entirely absent.
Alcohol control as COVID-19 counter measure
Possibly in recognition of the disadvantageous role of alcohol, countries around the globe apportioned a significant part of their COVID-19 counter measures towards limiting the availability of alcohol.
Similarly, when the President of Uganda issued the first directives for COVID-19 control, several measures were meant to directly reduce the trade and consumption of alcohol. In his maiden speech on COVID-19, dated March 18, 2020 His excellency, Yoweri Tibuhabura Museveni said:
Drunkards sit close to one another. They speak with saliva coming out of their mouth. They are a danger to themselves…”His excellency, Yoweri Tibuhabura Museveni, President of Uganda
It is outdated, stigmatizing language to use. At the same time it alluded to the lethal interaction between alcohol and the coronavirus.
The President consequently banned on-premise alcohol consumption, prohibited gatherings of more than 10 persons, and closed hotels, lodges, restaurants, and non-food shops. Public recreation, entertainment, and various alcohol consumption avenues such as discos, functions, sports, music shows, cinemas, and concerts were also banned. Mr. Museveni further introduced night curfews “to prevent high-risk nocturnal activities/establishments like Bars, Nightclubs, etc., from conducting businesses”.
The lockdown was a tension-packed time where all people were expected to stay at home except for the essential workers. Task forces were put in place from the national level to mobilize resources and guide the public. The population was educated about these measures through various media forums. Surveillance and enforcement mechanisms from the national to the local committees were instituted to ensure strict adherence. Civil society and community organizations came out in strong support of a public health-oriented approach.
Did the lockdown reduce alcohol-related related harm?
For purposes of analyzing the alcohol industry compliance, the Presidential directives can be divided in three phases each with distinct features.
While phase one marked the initial intervention characterized by total lockdown measures with a ban on public and private transport and closure of all activities except essential services, in phase two there was the gradual opening of private transport and selected services. Finally, phase three saw the opening of private transport and public transport and a variety of business enterprises while other non-essential sectors and those capable of bringing together large gatherings remained closed. Adherence to health precautions, closure of bars and night pubs, the ban on gatherings and night curfews was cutting across the different stages of the lockdown. Roadblocks were put on major roads and security agencies made regular field operations to arrest those who violated the directives.
The lockdown effort to curb alcohol use and harms in Uganda achieved mixed results. Various media and numerous informal reports showed that many Ugandans continued to consume alcohol throughout the lockdown period. The presidential directives on COVID-19 would have been sufficient to help reduce alcohol use but were most effective in the first phase. Alcohol use during the first phase of the lockdown seems to have declined due to reduced accessibility and affordability. Movements were restricted during the lockdown and the income for many was reduced as a result of loss of employment. At the height of the lockdown, supermarkets were closed and only shops were allowed to sell essential products such as food and soap, etc.
The decline in alcohol use in the initial period of the lockdown was attributed to strict enforcement measures as many offenders from all over Uganda were arrested and others charged in courts of law.
Lapse in implementation and escalation of alcohol harm during the lockdown
To a very large extent, the lockdown measures failed to curb alcohol use and related harm in the COVID-19 period. Compliance remained a major concern especially in the remote areas. The redundancy caused by the lockdown down was another reason for continued alcohol use. While some countries, like South Africa and India, temporarily banned alcohol sales to efficiently enforce their lockdown, in Uganda, it was almost business as usual for alcohol industries and alcohol outlets remained open with exception to the total lockdown period. Alcohol production, trade, and consumption remained legal. Defiant businessmen kept bars operational and people devised means of dodging the directives. Extreme laxity in surveillance and enforcement were observed especially in phase two and three of the lockdown.
The role of the alcohol Industry in escalating alcohol use and harm during the lockdown period in Uganda
In the wake of the Public Health Crisis (increased hospitalization, duress, and deaths) that was caused by COVID-19, the alcohol industry continued with mass production, promotions, and distribution of their products. The alcohol industry’s motives of profit maximization in total disregard of public interest were exposed as they enticed people to spend the little they had on their products.
Even when the industry disguised to be offering support for fighting COVID-19, more publicity went towards their brands and they shamelessly disregarded health warnings and continuously encouraged people to consume their products.
The alcohol industry’s motives of profit maximization in total disregard of public interest were exposed as they enticed people to spend the little they had on their products.”David Kalema
1. Change of tactics.
New approaches were devised to increase alcohol sales and these included vigorous social media marketing and new delivery methods, such as those through the foodservice apps. Alcohol adverts on regular media channels, such as TVs, radios, and newspapers were not stopped and instead were reinforced by more aggressive social media interfaces. New Social media ventures supplemented the existing ones and encouraged the population to place orders for home alcohol delivery. A case in point is where Uganda Breweries – owned by Big Alcohol giant Diageo – partnered with Uganda’s biggest online retail store Jumia Uganda to enable customers to purchase spirits online.
2. Circumvention and defiance of COVID directives
The alcohol industry took advantage of the sanitizing benefits of alcohol to promote their products. Even when public and private transport was banned, trucks that were loaded with alcoholic drinks could move as goods vehicles were generally allowed way. In the later parts of the lockdown, beer, wine, and spirit shops, as well as supermarkets operated throughout the day and allowed much on-premise uses. Some liquor retailers promoted stockpiling of alcohol and thus heavy alcohol use while in quarantine at home. In some cases, people obtained alcohol from shops and would sit in their compounds which was hard to enforce by the police/security teams. Cyclists were employed to do door-to-door deliveries. In defiance of COVID regulations, many bars operated during the COVID-19 lockdown in such a way that owners put off music and lock their customers inside their premises which defied the protocol of social distancing and endangered patrons. Bar owners also developed networks that alerted them to the movements of the enforcement teams.
3. Brand promotions disguised in Corporate Social Responsibilities
The Government of Uganda through its National Taskforce invited individuals and institutions to participate in resource mobilisation to mitigate COVID-19. As expected, the alcohol industry rushed to offer personal protective equipment and other necessary essentials, such as medical supplies, food, and fuel, and used this as an occasion to promote their products and get favors from the government.
A leading alcohol company offered 7.3 million liters of Ethanol into hand sanitizers in return for tax waivers.
In the same period, Uganda Breweries offered its customers a 15% discount on their spirit brands (Uganda Waragi, Johnnie Walker Black Label, Red Label, and Baileys). Ironically, leading alcohol companies partnered with the Ministry of Health to support vaccination among their patrons and converted several bars into vaccination centers.
As such Uganda Breweries reported a 33.3% increase in sales during 2020.
4. Homemade alcohol not touched
Many people thought that Presidential guidelines only affected the bars where they sell industrially produced alcohol. While some areas reportedly restricted home brews, most of the country did not care about this and homemade liquor bars continued operation without any observance of the SOPs.
We also learned that people bought alcohol and consumed it from unexpected places such as forests, banana plantations, and coffee plantations in order to avoid surveillance teams on the ground.
Implications of alcohol industry actions during the lockdown period
Disregarding the Presidential guidelines fueled alcohol consumption and harm at all stages of the lockdown.
According to Uganda Communication Commission, Internet penetration in Uganda stands at nearly 40% of the population.
Expansion of online alcohol marketing without corresponding regulatory measures gave access to underage users and others who would not be in a good health state to reach out for alcohol in bars.
Alcohol consumption from home campaigns in a crisis situation increased alcohol use among the community members as they tried to deal with unemployment, stress, and loneliness and worsened the social effects of alcohol. The lockdown was hence marked by increased cases of domestic violence – often fueled by alcohol. Besides, many children and adolescence were exposed to alcohol.
From the health providers’ perspectives, people with Alcohol Use Disorders (AUDs) continued using to avoid withdrawal symptoms. In several sections, mortalities were reported as a result of acute alcohol poisoning and people with AUDs suffering withdrawals did not have guidance on where to seek assistance. Many others consumed alcohol to cope with the stress and disappointments of that time, while many less well-off Ugandans who were struggling to get food, took a particular local brand ‘Qwete’. It’s a local brew thick in consistency that makes the consumer feel like their stomach was full.
Today there is a surge in cases of treatment and rehabilitation. A case in point is the overwhelming inquiries and admission of students referred to our treatment center (Hope and Beyond) after being found to be in possession of alcohol and other drugs when schools eventually reopened.
After lockdown down. What next?
When bars were finally opened many Ugandans flooded alcohol drinking places and spent nights celebrating. The industry has stepped up its mobilization; sponsoring parties welcoming back people from the lockdown. This is again in total disregard of the COVID-19 dangers, a disease that had by February 5, 2022 killed 3,549 people.
It is clearer than ever before that the capacity of individual and societal protection against COVID-19 is greatly weakened when key alcohol policy rules are not followed. The current binge behaviors are likely to escalate COVID infections and further escalate alcohol-related problems.
The COVID-19 crisis showed the need to quickly enact the alcohol policy and present the alcohol control bill where issues such as trade in homemade alcohol should be clearly addressed. The alcohol industry takes advantage of the crisis situation to white-wash (COVID-Washing) its image and advance its exploitative business. International bodies, government, communities, and individuals should raise efforts to protect the vulnerable members of the population against the selfish motives of the alcohol industrialists.
Considering that consumption of alcohol is largely hazardous in crisis situations, it is important to implement more alcohol policy measures that reduce alcohol availability and affordability, such as a temporary ban on the production, trade, and consumption of alcohol during health emergencies. Public action is also very important in advocating for the discouragement of industry interventions as their actions tend to work against public health interests.
Fortunately for Uganda, the World Health Organization-led SAFER initiative is in the offing and this comes in time to help mitigate the growing alcohol concerns for the country.
In summary, the COVID-19 alcohol policy solutions in Uganda clearly demonstrated that a combination of packages aimed at reducing accessibility and affordability of alcohol, increasing surveillance, and strict enforcement are effective measures in reducing the alcohol burden. To attain the full impact of the alcohol policy solutions, the dynamism and hypervigilance of the alcohol industry must be anticipated, detected in early stages, prevented, and countered by strong measures from public health experts, policymakers, and communities.
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