Prohibition only drives demand for illicit alcohol and all its social ills

The Covid-19 pandemic has upended economic life across the world and led to incredibly difficult decisions for governments about what freedoms to curtail in order to best protect public health and welfare. That these decisions are difficult and contested is proved by the vast differences in approaches taken by different countries. Most have by now launched a form of lockdown, but there are many different varieties, and even more differences of opinion about how to phase in the lifting of restrictions.

One area that has generated particular controversy is the classification of essential goods, and particularly whether access to alcohol should be restricted. Nowhere has this controversy been more apparent than in SA, which is one of the only countries in the world to have implemented a total ban on the production, transportation, and sale of beer, wine, and spirits.

Advocates say this policy of prohibition will help combat alcohol abuse and decrease medical resources devoted to alcohol-related injuries. Some reports indicate trauma-related admissions to SA’s hospitals have fallen, but the likely contribution of dramatically decreased injuries arising from road traffic accidents, workplace accidents and other incidents is not yet clear.

Non-Covid-related admissions have dropped remarkably in hospitals across the world, even in those countries who have not implemented a total ban on alcohol sales. According to the British Medical Journal, emergency room visits dropped by 25% in the first week of the lockdown in the UK, even though the UK adopted a much softer approach to the issue of alcohol — closing bars, nightclubs and restaurants but allowing restricted sales in supermarkets and liquor stores.

In the UK, 41% of alcohol is usually sold in licensed on-consumption premises. In SA, the figure is 45%. Just closing this channel has led to significant drops in consumption in most markets.

With the announcement that SA’s level 4 Covid-19 restrictions will maintain the total prohibition of alcohol sales, it is worth examining some of the perhaps unintended consequences and risks of this policy approach.

SA, like many countries, has long had a thriving informal market for often dangerous bootleg alcohol. This informal sector includes many small producers of cheap home brews selling to the poor. But prohibition also entices more organised, criminal elements who profit as illicit alcohol becomes the only option for consumers.

Already we have seen a significant spike in smuggling from neighbouring countries, as well as evidence of more sophisticated operations of refilling of branded alcohol bottles with concoctions derived from neutral spirits.

The World Health Organisation (WHO) conservatively estimates that, even before the pandemic, roughly one in four drinks consumed around the world was home-brewed, illicitly manufactured, or smuggled illegally across borders. Illicit alcohol accounts for up to 60% of consumption in some parts of Africa and the WHO estimates it to be 24% of the South African market. Similar figures are reported for most neighbouring countries, except for Mozambique, where the illicit market is estimated at 46%.

Unlike legally produced beer, wine and spirits, illicit products do not comply with standards for quality and integrity. In some places, the use of embalming fluid to increase potency has been reported. Dangerously high alcohol content, contamination during production, and toxic ingredients like methanol and methylated spirits make mass poisonings an all-too-common occurrence.

There are reasonable concerns that the Covid-19 pandemic could worsen alcohol abuse due to stress and anxiety. But cutting off access to legal products will only add to the burden, as the heaviest drinkers are least likely to reduce their drinking and will seek whatever alternatives are available. The impact will be greatest on many who are already in poor health.

Unfortunately, history clearly shows that, however wellintentioned, prohibition drives demand for illicit alcohol. Not only does it deny consumers access to drinks of known and regulated quality, it increases criminal activity, creates unintended health risks, and deprives governments of much-needed tax revenue.

Now more than ever, governments and public health authorities must carefully weigh the costs and benefits of interventions. The unprecedented challenges of Covid-19 and the extraordinary demands on government resources should be a reminder that seemingly easy solutions are not always best, and that one-size-fitsall approaches can do more harm than good.

Martinic is an international expert on alcohol policy who has served as an independent scientific adviser to the European Commission, on the OECD Task Force on Illicit Trade, and on the International Council on Alcohol & Addictions