The government’s reimposition of an alcohol sales ban as South Africa’s coronavirus epidemic surges has eased the pressure on hospital staff but cast a bleak spotlight on the country's booze culture, writes AFP in EWN. Meanwhile, the SA Medical Research Council has released its model that was used to justify the new alcohol ban. The MRC is also arguing for much tighter further controls on alcohol once the current sales ban is lifted.
In few other countries in the world have COVID-19 and alcohol consumption become so dangerously intertwined. With 364,328 cases reported on 20 July, the country is the sixth most infected country in the world for coronavirus, according to an AFP tally.
It also typically ranks among the countries with the highest per-capita alcohol consumption – a phenomenon, partly fuelled by the easy availability of drink, that also carries a high medical cost, says the EWN article published on 17 July 2020.
The staggering scale of that bill was brought home after the country imposed a moratorium on alcohol sales, to go hand-in-hand with a virus lockdown on 27 March, according to EWN.
The ban was lifted on 1 June and emergency rooms suddenly teemed with alcohol-related cases: car crashes, gunshot wounds, stab injuries and accidents, which filled beds and diverted manpower from the soaring load of coronavirus patients.
On Sunday 13 July and without notice, President Cyril Ramaphosa reinstituted the prohibition. "When the alcohol restrictions were lifted… facilities reported up to 60% of increase in trauma emergencies admissions and up to 200% increase in ICU on trauma admissions," Health Minister Dr Zweli Mkhize said, as reported by EWN.
The renewed ban should free up just under 50,000 beds in public hospitals over the next eight weeks, according to Charles Parry, director the Medical Research Council's alcohol research unit.
Don’t say cheers
Experts say South Africans need to re-examine their relationship with alcohol, reports EWN.
"There is significant information that allows one to say that South Africa has a drinking problem," said clinical psychologist Sinqobile Aderinoye, who specialises in this matter.
"The country needs to address some of the fundamentals of alcohol abuse," such as easy access, aggressive marketing and the legal age of drinking, which currently stands at 18 years, she said, according to the EWN article.
SA has been silently struggling with a drinking problem for some time. Mkhize said 31% of South Africans over 15 drink alcohol, and according to Parry, 170 people die per day of alcohol-connected problems. Retailers and consumers are enraged by the ban.
Booze ban may be in place for eight weeks – Here’s the model used to justify it
The SA Medical Research Council (SAMRC) has released its model that was used to justify the new alcohol ban. It projects that an eight-week ban would lead to an 18% reduction in trauma patients in hospitals and free resources for Covid-19 patients, writes Katharine Child for Financial Mail.
Click this link for the SAMRC modelling: [link url="https://www.scribd.com/document/469707024/Alcohol-Advisory#download&from_embed"]Alcohol Advisory for the National Coronavirus Command Council: Report to MAC. 7 July 2020[/link]
The alcohol industry last Monday 14 July collectively asked the SAMRC for the modelling and the calculations used by the health ministerial advisory committee (MAC) when it advised the government to ban alcohol again.
The eight-week time frame detailed in the model may give frustrated consumers an indication of how long they can expect to wait before they can buy alcohol again.
“We are happy to debate our numbers. They are defendable,” says Charles Parry, the SAMRC’s director at the alcohol, tobacco and other drug research unit, according to the Financial Mail article published on 18 July
After being given the go-ahead by MAC head Professor Salim Abdool Karim last Friday morning to release his six-page model, Parry wrote to the alcohol industry and released his research. The article continues later:
Based on estimates
The alcohol industry is likely to try to pick apart the model, which is based on many assumptions, rather than focusing on hard data, writes Katharine Child.
For example, the blood of the victims of gunshots, stabbing and car accidents is not tested at hospitals, so the percentage of how many trauma patients were under the influence of alcohol when hospitalised are estimates. Also, the estimates of alcohol-related injuries comes from studies of patients at academic hospitals like Cape Town’s Groote Schuur, which may see more severe injuries than smaller hospitals.
Parry is upfront about this, and says that in some cases he has adjusted the numbers downward, the Financial Mailreports. “Models are always based on assumptions [and] sometimes on prior information.”
Some of the numbers used in the model, such as the total number of trauma cases seen in the country’s hospitals, date as far back as 1999 and have been adjusted for population growth to represent what it would be in 2020. The model also states that not every patient with alcohol-related injuries seen in a casualty ward lands up staying overnight in hospital.
Gearing up for battle
It’s clear the alcohol industry is gearing up for a battle. Already the industry has asked Parry if his model and data were peer reviewed – a scientific process in which other experts test and critique assumptions.
Parry told the Financial Mail that it was not peer reviewed by a journal – something that can take years – but was heavily debated in the MAC and within the SAMRC.
He suggests that alcohol-related injuries should be notifiable in future, which would legally require doctors to report injured patients who had been drinking to the National Institute for Communicable Diseases. But is unclear how practical this is, as it would require hundreds of thousands of alcohol blood tests to be conducted on injured patients.
The consensus view from the SAMRC group, which did the modelling with Parry, was that a ban be proposed for eight weeks.
The strains on the health system relate to SA’s wider problem of alcohol abuse. Parry says this is something the country should have addressed “years ago”, along with the violence and drunk driving problems related to it. “It is impossible to deal with and fix in the middle of a pandemic,” he told Financial Mail.
MRC wants legal drinking age in SA to be raised and liquor prices hiked
The SA Medical Research Council is arguing for much tighter controls over the sale and advertising of alcohol once the current sales ban is lifted. According to Eyewitness News, the SAMRC is advocating raising the legal drinking age from 18 to 19 or 21, higher prices and taxes on alcohol, limiting the number of liquor outlets, advertising only at the point of sale and other measures, including steps to curb drunk driving.
The SAMRC’s Dr Charles Parry said a comprehensive national strategy on alcohol was needed. “We need a clear, multi-sectoral national plan. Our national liquor policy is not strong or comprehensive enough,” said Parry. “We also need competent empowered leadership to drive the plan. We need to ensure that a plan is properly funded. We also need to be aware of conflicts of interest when engaging with the industry.”
Parry said that as a start, the government should quickly move ahead on liquor legislation that had got stuck in the works and gone nowhere. Parry told Parliament’s Health Committee that only 31% of South Africans drank, lower than the world average of 43%. But those who do, consume five to six drinks each day and nearly 60% of them binge drink at least once a month.
Legalbrief Policy Watch report
Responding to the SAMRC briefing, the National Assembly’s Health Committee intends developing an “action plan” for curbing alcohol abuse, reports Pam Saxby for Legalbrief Policy Watch. The move appears to have been prompted by an “offer of advice” from a broader group of “academics, researchers and policy specialists” on steps government might wish to consider – apparently communicated in a letter to National Assembly Speaker Thandi Modise.
However, a document prepared by Parliament’s research unit (possibly at the request of the committee) tends to suggest that matter has been a concern for some time. In the view of committee chair Sibongiseni Dhlomo, “the rights of individual alcohol users” should be ‘balanced’ against the rights of other people in the country affected by their behaviour.
Among other things, Wednesday’s SAMRC presentation explored measures that might have reduced the spike in alcohol-related trauma admissions during lockdown level three, as opposed to a complete ban on liquor sales. As already reported, they include restrictions on liquor outlets, “drink-driving counter-measures”, limitations on liquor advertising, raising the drinking age and higher liquor prices.
According to the presentation, an approach along these lines might “prevent push-back from the public, … the liquor industry and associated businesses’ and could even ‘make it easier to defend legal challenges should they arise”.
In the committee’s view, South Africa “cannot continue to debate the … GDP benefits of alcohol sales and not talk about the costs of cleaning up after alcohol has been abused”.
Tavern owners give Ramaphosa ultimatum over alcohol sales ban
A representative body for tavern owners has, meanwhile, given President Cyril Ramaphosa a week to respond to its request for relief during the alcohol sales ban, saying it will otherwise resort to its own means to survive the economic impact of COVID-19. The National Liquor Traders Council (NLTC), which represents more than 34,000 tavern owners, is one of many alcohol industry groups that has been up in arms about government reinstating its ban on the sale of alcohol this week, says a Fin24 report.
The NLTC has sent a letter to Ramaphosa asking for financial relief for tavern owners who are battling to keep their businesses running due to the pandemic. The council said 15% of its members had already closed down for good when the initial ban was lifted. Some of its requests include making the Unemployment Insurance Fund available for the duration of the ban, re-inbursement of 75% of the liquor licence, a moratorium on licence fees for the next two years, and a once-off payment of R20,000 to cover lost income.
Its last request is for an immediate consultation with Ramaphosa “to establish agreed terms and conditions for the quick unbanning of alcohol sales”. The letter gives the President a deadline of Friday next week to respond, adding: “Failure of which it will be demonstrably clear to us that you, Mr President, continue to ignore this sector which contributes well over 6% to our country’s GDP. This will also be interpreted to mean that you (are) condemning us to our own means, left with no choice but to devise our own means of survival against both the COVID-19 pandemic and the economic hardship you have set upon us.”
NLTC national convener Lucky Ntimane would not be drawn on what the tavern owners’ means of survival might be.
Tavern owners are not the only ones feeling the pain of the ban. Richard Rushton, CEO of Distell Group, a major producer of spirits, wines, ciders and ready-to-drink beverages, reportedly told Fin24 that the government should have consulted with the industry for alternative solutions before imposing the ban.
The industry slammed the government’s decision to impose the ban, saying that it would fuel illicit alcohol trade. “My concern is that had we been consulted, we may have come up with other proposals, which maybe not everybody wanted to hear,” Rushton said.
LINKS
[link url="https://ewn.co.za/2020/07/17/coronavirus-lays-bare-sa-s-toxic-alcohol-abuse-problem"]Coronavirus lays bare SA’s toxic alcohol abuse problem[/link]
[link url="https://www.businesslive.co.za/fm/features/2020-07-18-booze-ban-may-be-in-place-for-8-weeks-heres-the-model-used-to-justify-it/"]Booze ban may be in place for 8 weeks: here’s the model used to justify it[/link]
[link url="https://www.scribd.com/document/469707024/Alcohol-Advisory#download&from_embed"]Alcohol Advisory for the National Coronavirus Command Council: Report to MAC. 7 July 2020[/link]
[link url="https://ewn.co.za/2020/07/15/parliament-hears-proposal-to-raise-legal-drinking-age-in-sa-liquor-prices"]MRC wants legal drinking age in SA to be raised and liquor prices hiked[/link]
[link url="https://legalbrief.co.za/diary/legalbrief-today/policy-watch/health-parliament-to-develop-alcohol-abuse-action-plan/"]Full Legalbrief Policy Watch report (not open access)[/link]
[link url="https://www.parliament.gov.za/press-releases/health-committee-welcomes-report-effects-alcohol-health-services"]Parliamentary statement[/link]
[link url="https://legalbrief.co.za/media/filestore/2020/07/200715Research_Paper_-_Impact_of_alcohol_on_health_QCd.pdf"]Research paper[/link]
[link url="https://www.news24.com/fin24/economy/tavern-owners-give-ramaphosa-ultimatum-over-alcohol-sales-ban-20200716"]Tavern owners give Ramaphosa ultimatum over alcohol sales ban[/link]