OPINION | Does the data support the alcohol ban?

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Restricted mobility during the Level 5 lockdown is what led to fewer cases in hospitals, not the alcohol ban, argues Marjana Martinic.

As the number of Covid-19 cases continues to grow, so does the need to manage demands on the healthcare system, protect the fundamentals of the economy, and ensure that other public health objectives aren’t disregarded. 

In South Africa, the government has taken various well-advised emergency actions, but also others that are both less popular and less well founded. One such measure is the reintroduction last week of a controversial ban on alcohol sales. 

The rationale for the measure was a significant decline in trauma admissions during the initial lockdown, notably from road traffic crashes and interpersonal violence, both of which rose once the alcohol ban was lifted. Banning alcohol again would, the argument goes, dramatically reduce hospital admissions so that priority can be given to Covid patients. 

It is hard to argue with providing relief to the healthcare system, and equally hard to argue with the need to address South Africa’s high rates of interpersonal violence and road traffic crashes, and its pattern of heavy drinking, particularly among younger males. What is less clear-cut is whether a renewed ban on alcohol sales will open up needed hospital beds.

Restricted mobility 

Data points to a decrease of more than 50% in the overall hospital admission rate in recent months, coinciding with the severe lockdown measures imposed. Among these were a 40% decline in non-elective procedures and a 60% drop in surgical interventions. These figures are very much in line with trends seen in other countries that did not prohibit the sale of alcohol. 

Common sense would suggest that, where physical movement and congregating are limited, the likelihood of traffic crashes and violence drops. According to data collected from smartphones, the mobility of South Africans during the first lockdown (and alcohol ban) decreased by 80%. Put simply, restricted mobility means restricted opportunity for harm.

Data from the Medical Research Council does show that, following a drop at the beginning of the crisis, South Africa’s mortality rate has increased. But closer examination suggests that the increase was independent of the availability of alcohol, and began in April: five weeks before the first alcohol ban was lifted.

There has also been some inconsistency in available data. 

Chris Hani Baragwanath Hospital in Johannesburg, for example, reported a 30% increase in trauma admissions in May 2020, a month during which alcohol was not on sale. And there is always a question about how "alcohol-related" cases are defined and the difficulty in attribution of trauma and violence.

Like other alcohol bans throughout history, South Africa’s experiment with prohibition offers important lessons. Before it was lifted at the beginning of June, the original ban resulted in an upsurge in the production of dangerous "home brews" and boosted alcohol smuggling. Neither is a new development. Criminals were already profiting from this lucrative trade, but their profits have been multiplied by the government’s decision to outlaw alcohol sales. 

Illegal alcohol 

Illegal consumption presents further major risks to public health which the country can ill afford. Given the absence of safety regulations and quality controls within the black market sector, poisoning deaths have been recorded in South Africa.

The renewed alcohol ban also has significant implications for the already strapped economy.

The increase in illicit trade has deprived the state of billions of rand in excise. But, as the South African Revenue Services Commissioner Edward Kieswetter has publicly acknowledged: "Alcohol is still for sale… We  are not raising this because of the revenue, but because illicit trade and criminal activity is a scourge which also distorts our economy and robs South Africans of thousands of honest work opportunities."

The ban is also severely jeopardising the future of many small businesses, which survived the first ban, but may not survive this one.

In fact, 15% of the National Liquor Traders Council’s members had closed permanently by the time the first ban was lifted, a figure that translates directly into jobs and livelihoods.

Evidence justified the South African government’s original decision to lift the ban on alcohol sales.

It is now more important than ever that it calmly assesses its options and heed evidence and advice from leading scientists.

If this is not done, the unintended consequences for public health and for the economy could be vast.

 - Marjana Martinic is an international expert on alcohol policy. She holds a Ph.D in Neuroscience from Harvard and Northwestern Universities and led the science and policy work of the think tank ICAP and the organization IARD, dedicated to reducing alcohol misuse worldwide. She is widely published on alcohol issues and has served as an independent Scientific Advisor to the European Commission, on the OECD Task Force on Illicit Trade, and on the International Council on Alcohol and Addictions.

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