Alcohol Policy and Coronavirus: An Open Research Agenda
There are many implications from the COVID-19 counter-measures for research on alcohol consumption, harms, and policies – in high- and low-income countries – related to rapid changes in the supply, demand, marketing, alcohol consumption contexts, associated risks, and other environmental factors known to influence alcohol-related outcomes.
Possibility of less alcohol use and harm
With reduced working hours, layoffs, and the reduction of physical contact as a result of the suspension of large gatherings, sports events, cultural events, and service at bars and restaurants, one would predict that the expected outcome will be less alcohol consumption and, as a result, less alcohol-related mortality and morbidity.
Possibility of increased alcohol harm
However, negative impacts can also increase in certain areas. Iran has reported at least 194
- Deaths from illicit and adulterated alcohol poisoning as a result of misinformation about the benefits of alcohol use to prevent COVID-19 infection;
- Soaring off-premise sales of alcohol, particularly the cheapest and brands with high alcohol concentrations in jurisdictions;
- Commencement of home delivery of alcohol in markets that had previously banned, but now made it part of the COVID-19 response.
Concerns over alcohol industry tactics during COVID-19
Alcohol companies are helping with the fight against COVID-19 with corporate social responsibility (CSR) activities while still promoting their brands, and it is unknown what other marketing promotions will be implemented to compensate for the loss in sales. CSR is a known strategy of the industry to market their brands, stimulate consumption, and get public support for their businesses and products. There are likely to be calls for deregulation, such as freezing alcohol duties.
Concerns about the temporary and permanent weakening of alcohol laws
Alcohol sales can go up by means of drive-throughs, home delivery, internet sales, and lowering of prices to stimulate purchases. How will household expenditures change? Will more be spent on alcohol or less? Will unrecorded alcohol increase or decrease? Where and under which conditions?
As it is now known, alcohol weakens the immune system in a dose-dependent manner, thus facilitating infections from coronaviruses. COVID-19 is particularly affecting those with underlying noncommunicable diseases, many of them causally linked to alcohol as well. Reducing risks should continue to be on the global health agenda while the pandemic is being addressed swiftly.
As experience with natural disasters and other crises has shown, alcohol may be used by the affected population, including health workers, to cope with stress and other mental problems. Some heavier alcohol users may stockpile alcohol and increase consumption at home. Consumption at home has been associated with domestic violence, violence against children, child neglect, and misguided parental modeling. Allowing home delivery may increase those harms. Children and adolescents could be exposed to the notion that alcohol can be used to cope with stressful life situations, as well as to celebrate “isolation.” Children can become even more exposed to alcohol marketing by their increased use of the internet, social media, and TV viewing, all known to contain considerable amounts of alcohol advertising.
Concerns over the lack of treatment for alcohol use disorders
Alcohol treatment is already limited and may become unavailable, including supports such as self-help groups. In many locations, there will be no virtual options. Depending on the region, it is hard to find accurate information and resources on the internet if people decide to seek help. Home withdrawal management will need to be supervised by a health professional, but the current shortage may become another barrier to people who decide to take self-quarantine as a good opportunity for quitting. Quitting strategies at home may be easier when the social cues decrease, but will that be supported by the media and the person’s social network? Screening and brief interventions online could be boosted in such situations, but resources are required to scale them up and make the public aware of these options and their effectiveness.
Concerns over shifts in the alcohol norm
Telework has become the new normal for millions. However, it is unknown if alcohol use during working hours will become another new norm. Many women who plan to become pregnant or are now pregnant may not know about the risks of alcohol consumption to the unborn child. Working from home may facilitate alcohol use that otherwise would not happen.
A host of research issues
Alcohol-related public disturbance is likely to go down, as well as interpersonal violence, which is often associated with alcohol use in public places. Alcohol-attributable homicides could go down, and alcohol-attributable suicides could go up. Young people could consume more or could reduce their alcohol use. Where restrictions to social life have been imposed, driving will decrease, but will driving under the influence of alcohol decrease proportionately as well? Will the police continue to do sobriety checkpoints or random breath testing given the nature of this epidemic? If no enforcement will be done, will the relative role of alcohol in crashes increase? Will driving be so reduced that it will not matter? Will those who consume alcohol at home remember to not use alcohol and drive in the absence of controls or prevention campaigns?
How will the industry balance losses to keep afloat? One would expect new and creative ways to deliver alcohol to consumers, when alcohol festivals, sports events, and other activities sponsored by the industry will be halted. It is imperative to measure and evaluate the current situation because so much can be learned to inform alcohol policy and advocacy. Monitoring the promotion of alcohol in social media, misinformation about the health benefits of alcohol, and the new marketing strategies being used in high- and low- to middle-income countries is absolutely necessary.
Evaluating the impact of COVID-19 containment measures on the availability of alcohol (physical, economic, social), as well as alcohol consumption, harms, and policies is a must. For that, research funds need to be made available as soon as possible. For a whole of society approach, as envisioned by the agenda of sustainable development and reinforced by the WHO-led SAFER initiative, policy coherence is needed so we do not reverse any gains already achieved.