On May 27, during the 74th session of the World Health Assembly, the World Health Organization Regional Office for Europe, Movendi International, the NCD Alliance and the Pan American Health Organization (PAHO) jointly organized a virtual event on the lessons learned about alcohol policy needs from the coronavirus crisis.
The groundbreaking event brought together high-level decision-makers from member states, WHO regions and opinion leaders from civil society and intergovernmental organizations to discuss the role of alcohol prevention and control for building back better in the coming months and years.
More than 600 participants had registered and more than 200 joined the event.

Purpose of the joint event

The coronavirus crisis has brought into sharp focus the burden alcohol harms place on health systems in particular and societies in general. The pandemic has also shown that evidence-based alcohol policy interventions are impactful in protecting people and promoting health system functioning. But the alcohol industry is attempting to exploit the crisis for their commercial benefits.

Three major reports have provided unique and timely insights into these lethal interactions between alcohol and COVID-19.

And key guidance from the World Health Organization has provided advice to people and member states on how to prevent and reduce alcohol harm during the pandemic and how to get through the crisis better through alcohol prevention and control.

As such, the purpose of the event was to provide key insights and to chart the way forward.

Objectives of the joint event

The event sought to take stock of the state of the art of global and regional experiences and knowledge regarding the lethal interaction between alcohol and the pandemic.

The event also sought to map the needs for addressing alcohol harm going forward. What is the role of alcohol prevention and control for building back better in the coming months and years?

Key points raised by the expert speakers

Dr Maristela Monteiro, Senior Advisor on Alcohol and Substance Abuse, PAHO, spoke about the Americas situation: Alcohol consumption, harm, and policy in the region and the lessons learned during the COVID-19 so far.

Dr Monteiro’s key insights:

  • Minority of countries have a national alcohol policy;
  • The region is seeing both: increases and decreases in alcohol consumption and with this comes shifting alcohol harm;
  • Reduction of public violence (road injuries, in public venues and locations);
  • Increase in domestic violence and child abuse*;
  • Increased exposure of young people to alcohol use and online alcohol marketing and promotions; this is likely changing norms;
  • Less access to treatment and services for alcohol use problems; and
  • Growing concern that alcohol-related diseases could be linked to severe COVID-19.

Maria Neufeld replaced Dr Carina Ferreira-Borges, Acting Head of the European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office), at WHO Europe. Dr Neufeld spoke about the European situation: Alcohol consumption, harm, and policy in the European region and the lessons learned during the coronavirus crisis so far.

Dr Neufeld’s key insights:

  • There was big uncertainty among Member States about how to address alcohol policy in the beginning of the pandemic;
  • There was a serious spread of myths and misinformation about alcohol and COVID-19;
  • Therefore, the WHO European office, together with PAHO and EMRO mounted an big effort to develop and publish quickly WHO factsheets advising both individuals and governments
    • alcohol is not “essential”,
    • additional measures are needed and existing regulations should be improved (not weakened), and
    • the best ways to reduce the total amount of alcohol consumed in a society are:
      • to increase alcohol excise taxes,
      • to restrict access to retailed alcoholic beverages – for example, by banning alcohol sales on the internet and home deliveries, and
      • introduce comprehensive bans on alcohol advertising, promotion and sponsorship 
  • During the pandemic, alcohol sales should be restricted;
  • Governments may consider specific prevention campaigns on the risks of alcohol consumption during the COVID-19 pandemic.

Per Leimar, Alcohol Policy Advisor at IOGT-NTO, spoke about key findings of the groundbreaking report about the lethal interaction between alcohol and the coronavirus crisis.

Mr Leimar’s insights:

  • Alcohol depresses immune system functioning of individuals;
  • Alcohol and alcohol-centric social contexts fuel the coronavirus spread;
  • Alcohol burdens healthcare system functioning (already before and especially during the pandemic);
    • Alcohol-attributable ”ordinary” hospitalizations are larger than COVID-19 hospitalization rates in 2020 in some countries;
  • Deregulation agenda of the alcohol industry on full display during the pandemic:
    • Declaring alcohol an ‘essential’ product, and off-trade alcohol retailers as essential services,
    • Allowing internet sale and on-demand home delivery, and
    • Permitting ‘take-away’ alcohol from on-trade establishments.

Lucy Westerman, Policy and Campaigns Manager at the NCD Alliance, spoke about key findings from the Signalling Virtue report. They had received 760 submissions, and 363 on alcohol industry marketing activity during the first phase of the pandemic.

Ms Westerman’s key insights:

  • Four main health harmful industry strategies were identified:
    • Adapting marketing and promotions, increasing availability
    • Corporate social responsibility and philanthropy
    • Shaping policy environments
    • Pursuing partnerships, coveting collaboration.

The alcohol industry is one that will stop at nothing to position their brands and products as essential parts of communities, culture and solutions to the pandemic. 

They are not. 

They are part of this pandemic problem and many, many other problems, and governments must beware and put public health priorities ahead of their profit interests.”

Lucy Westerman, Policy and Campaigns Manager, NCD Alliance

Michele Cecchini, Senior Health Policy Analyst, Project Leader Public Health, Organization for Economic Collaboration and Development (OECD), spoke about key findings from OECD’s most recent report on alcohol harms and policy solutions.

Mr Cecchini’s key insights:

  • Investing in policies to prevent and reduce alcohol harm would save millions of lives and yield substantial returns on investment benefitting the health care system, the economy and society overall;
  • An average of 2.4% of health spending goes to dealing with the harm caused by alcohol – figure is much higher in some countries;
    • additionally, poor health due to alcohol has detrimental consequences on labour participation and productivity
  • Combined with the impact on labour force productivity, it is estimated that GDP will be 1.6% lower on average in OECD countries annually over the next 30 years;
  • Reduced productivity of employees amounts to US$ 595 billion (adjusted for purchasing power);
  • Triple dividend of preventing alcohol harm: Investing in evidence-based, high-impact alcohol policy solutions helps achieve three positive outcomes, in the context of the pandemic:
    1. Alcohol policy solutions help protect people’s immune system during COVID-19,
    2. Alcohol policy solutions help protect societies’ health system functioning, and
    3. Alcohol policy solutions contribute to a healthier and more productive population.
  • Strong economic case for upscaling investment in alcohol policy. So called prevention packages are recommended:
    • could save 3.5 million life years and US$ PPP 16 billion every year.

Dr Mercy Wacera Karanja, Focal Person, Substance Use Management, at the Ministry of Health in Kenya, provided the country perspective from the African region, speaking about Kenya’s plans and needs for alcohol policy development going forward.

Dr Karanja’s insights:

  • Kenya has been well positioned to tackle alcohol harm during the coronavirus crisis because of the comprehensive alcohol law that has been in place for a decade.
  • But a clear emerging risk is increasing alcohol use at home and the exposure and early initiation of children.
  • Alcohol use at home has also lead to rising cases of domestic violence.
  • Another major concern is the rush of people back into bars after the lockdowns which could fuel even more alcohol harm.
  • Kenya is in the process of developing a national alcohol strategy, modelled after the WHO Global Alcohol Strategy.
  • A key concern for the way forward is also to tackle alcohol within the work on improving mental health in Kenya.

Dr Rohan Ratnayake, Director, Directorate of Mental Health, at the Ministry of Health in Sri Lanka provided a country perspective from the South-East Asian region, speaking about Sri Lanka’s plans and needs for alcohol policy development going forward.

Dr Ratnayake’s insights:

  • Alcohol policy is important for the development of the country in general and for public health in particular.
  • Sri Lanka, like Kenya, also has a comprehensive alcohol law in place that served as good protection against certain alcohol harms during COVID-19.
  • According to a study, conducted by ADIC, the Alcohol and Drug Information Center in Sri Lanka, during the first wave of COVID-19 in the spring of 2020, 80% of individuals who consume alcohol reduced their alcohol consumption. And 37% said they were prepared to continue their change in future even after the situation normalizes.
  • To respond to the consequences of COVID-19 in Sri Lanka, the government plans to develop and implement improved alcohol taxation, already in 2021.

Lessons learned for the way forward

The lessons learned for the way forward were many as each expert identified crucial points for alcohol policy development and implementation, from their unique vantage points.

The lessons can be grouped into four categories that hold significance for the way forward:

  1. Changing social norms,
  2. Alcohol policy development,
  3. Regulation of the alcohol industry, and
  4. Improved systems thinking.

1. Changing social norms

  1. Lessons learned from the pandemic should include a careful re-examination of the role that alcohol plays in social interactions.
  2. Finding and exploring ways of denormalizing alcohol use as part of people’s lives and lifestyles as an important aspect of the way forward.
  3. More international collaborative efforts are needed to better understand the changes in alcohol-related social norms, consumptions behaviors and their impacts.
  4. Increasing health literacy on alcohol harms and alcohol industry tactics (using new tools such as social media) should complement alcohol policy development.

3. Regulation of the alcohol industry

  1. The challenge to regulate e-commerce (online retail and om-demand delivery) as well as online alcohol marketing has firmly been placed on the priority list of better regulation of the alcohol industry.
  2. Deregulation and the further weakening of alcohol policy measures would mean a lasting and negative legacy of the pandemic on public health.
  3. Global mechanisms like the FCTC Article 5.3 which protects governments and policy making from commercial and other vested interests, are important to manage harmful commodity industry interference and influence.
  4. Mechanisms and tools to support governments, civil society and multilateral organisations in understanding conflicts of interest, risks and managing interactions with the alcohol industry are needed.

2. Alcohol policy development

  1. It is essential that current alcohol policies are kept and improved.
  2. Especially alcohol taxation will and should play a key part in the work to build back better after the pandemic.
  3. Alcohol policy should be promoted as a catalyst for preparedness and response to public health emergencies.
  4. The pandemic had a clear impact: overall alcohol use declined in many countries (but not all) with lockdowns and physical distancing measures, but not for all groups (young people, women, heavy alcohol users self-report increases). Health inequalities due to alcohol are further exacerbated.
  5. The full impact of alcohol use on COVID-19  transmission and outcomes is not yet clear but the lethal interaction between alcohol and the coronavirus crisis has been well documented already. But still more works needs to be done in this regard.

4. Improved systems thinking

  1. The burden alcohol harm places on the health system has come into sharp focus. So has the lack of services for people who experience alcohol use problems. Therefore, investing in more and better training of health professionals on alcohol-related issues, screening and brief interventions will improve the system response to alcohol harm.
  2. Moving forward out of the pandemic, a better balance between economic and public health interests should be established, as in the case of alcohol harm and the regulation of the products and practices of the alcohol industry.
  3. Decision makers are advised to consider impacts of alcohol consumption across the full economic and social spectrums rather than just to promote the interests of a selected sector.

5. Innovative tools

  1. Increasing the use of innovative technologies to prevent and reduce alcohol harm is a key for the way forward. For example, tele-health to provide support to people with alcohol use disorders and ensure alcohol brief interventions.

The potential of alcohol policy was pointedly summarized in this way:

Prepare. Prevent. Protect. Promote. Participate.

And the event was concluded with the inspiring sentiment shared by Dr Ratnayake:

When we start working on alcohol, we feel isolated and we feel we are a minority. But while the work is going on, there are a lot of people to work with this issue, to lend their hands, to help us.

Like today, I feel we are not isolated and we are not a minority. We are the majority. So we have a lot of people to work with and to help each other.”

Dr Rohan Ratnayake, Director, Directorate of Mental Health, Ministry of Health, Sri Lanka

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