What lessons does the COVID-19 pandemic hold for global alcohol policy?
Commentary
Summary
- The COVID-19 pandemic has highlighted inequities in the global burden of non-communicable diseases and the relative lack of attention to policy addressing alcohol use.
- While a Framework Convention for pandemics has been suggested, a proposal for a similar instrument for alcohol was rejected in favour of a non-binding global action plan to strengthen implementation of the WHO Global Alcohol Strategy.
- To reduce health inequities, stronger and independent leadership by WHO is vital, backed by high-income countries acting in solidarity with low- and middle-income countries (LMICs) and civil society, to sustain support for LMICs and counter interference by entities with conflicts of interest.
- To achieve these goals, governments and civil society should continue to advocate for a Framework Convention for alcohol, given alcohol meets the same conditions that formed the basis for WHO’s Framework Convention on Tobacco Control.
What can be learnt from the COVID-19 pandemic that may be applied to global alcohol policy?
1. Actions prioritising national interests risk widening health inequities and worsening global burden of disease. ‘Vaccine nationalism’ among HICs has exacerbated insufficient COVID-19 vaccines for LMICs, prolonging the pandemic for all countries. HICs that oppose a Framework Convention on Alcohol Control (FCAC) are usually exporters of alcohol or headquarters of transnational alcohol corporations, suggesting primacy of commercial interests over health in these countries. Here an FCAC would serve to counter the negative effects of commercial interests on alcohol policy.
3. Continued solidarity with civil society is needed in responding to global health threats. Civil society organisations (CSOs) have played a key role in the pandemic response, for example, by providing information to the public, supporting the needs of vulnerable groups, and facilitating accountability over state and private sector decisions. CSOs fill similar roles in alcohol control, and many international CSOs, such as the Global Alcohol Policy Alliance, Green Crescent, Movendi International, NCD Alliance, Union for International Cancer Control and World Medical Association, have shown strong support for an FCAC. Locally, CSOs must also advocate for their governments’ backing of an FCAC. A broad coalition of CSOs would enable mobilisation of political will globally, although importantly, organisations funded by the alcohol industry employ sophisticated strategies to position themselves as ‘partners’ in addressing alcohol-related harm, including sponsoring intergovernmental events, educational interventions and alcohol research. While CSOs should be recognised as important partners, their roles must be clearly distinguished from entities with potential conflicts of interest in alcohol control.
2. The interests of LMICs must be better represented in global health policy development. The concentration of manufacturing capacity of vaccines, diagnostics and therapeutics in HICs has been a major contributor to inequity in the COVID-19 pandemic. Similarly, LMICs suffer disproportionately from alcohol-attributable burden of disease, are the targets for market expansion by the transnational producers of alcohol, and yet are under-represented in the negotiation processes for alcohol policy at WHO. At the WHO EB meeting in 2020, while the proposal in favour of an FCAC by Thailand and other LMICs (Bangladesh, Bhutan, Indonesia, Iran, Sri Lanka and Vietnam) failed to gain support early on, HICs (Australia, Canada, European Union, New Zealand, Norway and USA) were the key actors in bilateral consultations during the subsequent negotiations with the chair (Japan), also a HIC. On the other hand, the formation of alliances between HICs and LMICs was essential to the success of the FCTC negotiations. The FCTC was initially championed by Canada, with the backing of Finland, Mexico and Tanzania. Brazil then played a leadership role in the FCTC negotiations, expanding the participation of LMICs. An FCAC will require support from governments of HICs to uphold equity for LMICs.
4. Stronger and independent leadership by WHO is critical. Alcohol control is severely under-resourced at the WHO level, with member states reporting insufficient technical assistance and lack of coordination as barriers to implementation of effective alcohol policies. In contrast, tobacco control being the top priority of a former WHO director-general meant that resources could be devoted to the development of an FCTC. The COVID-19 pandemic has also exposed structural problems with WHO, especially its precarious funding, with the Independent Panel noting that WHO’s current financing model ‘is a major risk to the integrity and independence of its work.’ WHO requires much stronger financial support from member states, particularly HICs, to maintain its independence and integrity. Against the backdrop of the United Nations’ promotion of public–private partnerships and WHO’s continued dialogue with the alcohol industry, a Framework Convention enabling clearer rules of engagement with the industry is now more important than ever.