Impact of the pandemic on the local manufacture, distribution, and consumption of alcohol and alcohol-related harms per media coverage
Brasilia. In mid-March the government of the federal district, the area within Brasilia containing the three communities constituting the intervention site, mandated that bars, liquor stores, and restaurants close to the general public, but they were allowed to continue home delivery services. However, we know anecdotally that compliance with this regulation was limited, particularly as the President of Brazil made a speech dismissing the importance of sequestration policies, which immediately and substantially decreased social distancing practices. The President of the Brazilian Association of Studies on Alcohol and Substance Abuse did warn, however, of the risk of increased alcohol consumption during the pandemic . Further, the Panamerican Health Association rebutted rumors that alcohol consumption might reduce the probability of contracting the virus . The local beer manufacturer noted significant losses in sales in bars and restaurants, most of which remain closed. Altogether, the Brazilian Beverage Association reported that revenue from alcohol beverages nationwide decreased by 50% in the second half of March. That said, there was a significant increase in direct sales of alcohol to households, although they represented less than 1% of total alcohol consumption prior to the pandemic. Indeed, there is little evidence of any increase in alcohol consumption;.
Reports of alcohol-related harms were noted, and community pilot sites described the harms most salient to their locality. At least one news story warned of the danger of an increase in interpersonal violence as a result of pandemic-related restrictions on movement . Further, reports of gender-based violence increased 45% relative to last year in the nearby province of Sao Paulo . While no information is available concerning the incidence of drink driving in Brazil, the use of breathalyzers to detect drink driving has stopped because of the lack of personal protective equipment for law enforcement officers and, thus, the prevalence of drink driving is unknown.
In Columbus, local reports of the effects of the pandemic on alcohol sales and consumption varied considerably. One local distributor reported a significant decrease in sales due to the closing of restaurants and bars and the cancellation of sports events and music festivals. There is also anecdotal evidence that the closing of colleges in the Columbus area has resulted in reductions of binge drinking. However, restaurants with liquor licenses that prepare takeout meals can now sell up to two prepackaged drinks with each meal sold, and businesses with existing liquor permits may sell and now deliver alcohol. Outdoor patios serving alcohol re-opened May 15, 2020, with flagrant violations of social distancing .
As in Brasilia, early evidence suggests that alcohol-related harms outside the home (e.g., drink driving) are decreasing, while harms inside the home (e.g., domestic violence) increase. In the city, sequestration orders have greatly diminished the number of drivers and the length of their trips, which have had a commensurate decrease of 46% from 2019 to 2020 in citations for drink driving, according to conversations between the City Pilot and the Columbus city police. The number of these citations has also been reduced by a law enforcement policy that during the pandemic officers should avoid enforcing minor violations to prevent unnecessary contacts with the public. In Mexico, we were advised that law enforcement first detects a drink driver by placing one’s head in the car window and inhaling. Indeed, police halted the use of these traditional methods and breathalyzers altogether. Columbus also noted an increase in homicides attributable to domestic violence .
Johannesburg. In mid-March the government of South Africa imposed evening closing hours on restaurants, clubs, and off-premise establishments licensed to sell liquor. A week later the government completely banned the sale of all alcohol, and further prohibited consideration to grant new liquor licenses for special events. In so doing the government enacted some of the most stringent regulations of any nation in the world . In response, some bars and restaurants called for the alcohol ban to be lifted . At least one non-governmental organization (NGO), the South African Drug Policy Initiative, expressed concern that the ban on alcohol sales may harm individuals with alcohol dependency . Plans to maintain social distancing while reinstating alcohol sales have been met with public outcry . There was local anecdotal evidence of home brewing (which has led to at least one death in the country) , illicit alcohol sales, and alcohol stockpiling , all of which raised concerns about the utility of the ban on alcohol sales and the potential for binge drinking. In Alexandra, an impoverished township within Johannesburg that constitutes the primary focus of the City Pilot, some residents have continued to drink in public.
Generally speaking, prohibitions against alcohol sales, coupled with vigorous and visible law enforcement, have contributed to declines in reported crimes , and both interpersonal  and gender-based  violence. However, NGOs in South Africa that would normally serve victims of domestic violence are unable to do so as they are not considered an essential service by the governing authorities. Significant reductions in drink driving crashes have led to calls to regulate alcohol consumption once the pandemic recedes, and President Cyril Ramaphosa said that alcohol was “a hindrance to the fight against coronavirus” . The premier of Gauteng Province, in which the Johannesburg City Pilot is located, expressed his concern about the negative social impacts caused by the consumption of alcohol. “South Africans drink too much, just too much, and it causes accidents and fights. Our hospitals are reporting they no longer have people arriving there with stab wounds, gunshot wounds and wounds sustained in motor vehicle accidents. We must find ways to deal with the negative impacts of alcohol in our society” .
Leuven. The federal government of Belgium closed all bars, restaurants, and non-essential businesses in mid-March. There have been only a few reports of bars that have remained open illegally. However, alcohol continues to be available in supermarkets. At the beginning of the outbreak, there were media reports that people were crowding into bars for “lockdown parties” prior to their anticipated closing. Data collected from smartphones suggest that most people have respected lockdown regulations. There has been local speculation that alcohol consumption would increase at home as a result of the lockdown, and that residents would engage in online “happy hours” and “aperos” (an abbreviation of “aperitifs”). However, the City Pilot reports that preliminary results of a study conducted by Katholieke Universiteit Leuven, the local university, have indicated that overall alcohol consumption has not increased, although the study did identify two high-risk groups: employees working at home instead of at their office and those temporarily laid off by the shuttering of local businesses. The study attributed this increase to the use of alcohol in response to negative emotions such as stress and anxiety that are linked to the crisis. Further, local reports of the number of people who “struggle with alcohol” have increased. It is believed that this increase may be linked to alcohol consumption. Local police have informed the public that traffic controls remain in place, and a truck driver has been arrested for drink driving .
Zacatecas. In late March, the government of Mexico decreed a health emergency and suspended all non-essential activities, which included alcohol production. The distribution and sale of alcoholic beverages, as well as the operation of bars and clubs where alcohol was sold and consumed were restricted by the state governments and Mexicans complained of a national beer crisis . Those that failed to comply were threatened with a revocation of their permits to sell alcohol, and distributors who transported alcohol to private homes were subject to fines . The government also sponsored a “National Campaign of Healthy Distance” that warned citizens against all private and public social gatherings. These included festivals at which alcohol was customarily consumed, such as the annual Fiesta de Jerez. However, restaurants were informed that they could continue to operate at 50% capacity and to sell alcohol, if they had an existing liquor license. In Mexico, municipal governments can create and enforce their own restrictions. For example, in Guadalupe, one of the communities participating in the City Pilot project, hours of sale were restricted at first to 10 p.m. (statewide) and then further restricted to 8 p.m. following complaints about aberrant behavior in the streets. There is anecdotal evidence that the public initially responded to reductions in the accessibility of beer with a temporary surge in purchases. Alcohol sales taxes were also halted. Stories are emerging of deaths due to tainted, home-brewed alcohol .
It has been reported that the prevalence of DUI in the center of Zacatecas has increased, particularly among drivers who consume alcohol in their cars . In May, the State announced and enforced a “no circulation” regulation designed to enforce sequestration decrees by restricting driving to a limited number of days per week based on the final numerals of vehicles’ license plates and to prevent any driving whatsoever between the hours of 11:00 p.m. and 8:00 a.m. Police officers have been instructed to identify drunk drivers, and to administer fines of $450 to those who fail breathalyzer tests .
Shuttered to production, the local distributor in Zacatecas donated personal protective equipment (PPE) made from unused plastic bottles and alcohol extracted from the production of its non-alcoholic beer to the public health institute for distribution to the community .
Regarding interpersonal violence, the state of Zacatecas has reported over 2500 cases of family violence that have targeted women; in almost two-thirds of these cases the aggressors have been their spouses. Of these cases, almost half have been in the form of emotional violence, and an additional third have been physical in nature. Altogether, reports of family violence have increased by one-quarter since 2019 according to the Sub-Secretary for Crime Prevention of the State. The temporality between COVID-19 and femicide is concerning as advocates consider the long-term impacts of this wave of violence .
Impact of the pandemic on the programs sponsored and the SteerCos’ response
Altogether, plans submitted by the five SteerCos to, and approved by, the Foundation prior to the pandemic included a total of 37 interventions to be implemented in 2020. Of these, 10 are continuing without interruption, 14 have been suspended with the expectation that they might be continued once the pandemic subsides sufficiently, and the residual (13) have been halted altogether pending review in 2021. With the availability of the Foundation’s community fund (described above), SteerCos in Johannesburg, Zacatecas, Columbus, and Leuven pivoted rapidly from primarily focusing on reducing alcohol-related harms to considering how the fund might be used to mitigate the effects of the pandemic in their communities.
Meanwhile, in Brasilia, SBI and responsible beverage service (RBS) trainings are being adapted for delivery through online platforms. Consideration is being given to how to respond to increased reports of gender-based violence and to car crashes attributable to delivery service employees. In addition, the SteerCo is providing mental health support to public health workers, supporting the prevention of gender-based violence, and addressing underage drinking by providing an online service for students at home who are isolated by the pandemic.
Columbus. Electronic screening and brief intervention (E-SBI) continues to be available at and supported by several post-secondary institutions in the Columbus area, but student participation is voluntary. Our key informants in the City Pilot report that plans to make the course mandatory for first-year students are likely to be suspended. Plans continue to develop an RBS program for servers that will focus on compliance with applicable rules and regulations. Two initiatives were suspended, namely work on developing ignition interlocks for repeat drink driving offenders, and a social marketing campaign designed to support and promote the SteerCo’s purchase of a blood alcohol concentration (BAC) truck which enables police to measure drivers’ BAC at the site of a crash. That said, the use of the BAC truck is likely to be delayed due to cutbacks in the law enforcement personnel who have been trained to operate it.
In Columbus, the SteerCo applied and was approved for AB InBev Foundation’s Community Fund to prepare health and safety bags to be distributed to homeless individuals in shelters, camps, and other locations. Bags will contain the items necessary to avoid infection and encourage harm reduction such as hand sanitizer, masks, first aid kits, sunscreen, and resource material for access to alcohol-, drug-, and mental health-related issues. A screening, brief intervention, and referral to drug treatment (SBIRT) will be offered by a community partner to interested individuals at the points of contact.
Johannesburg. In partnership with the SteerCo, the local AB InBev beer manufacturer, South African Breweries, has pledged to produce 100 thousand liters of alcohol as the basis for sanitizers, as well as to recycle plastic from beer crates to make 100,000 masks to be donated to health care workers. Many of the initiatives planned pre-pandemic by the SteerCo are at least temporarily on hold. The implementation of SBI is suspended, and there are concerns both about the well-being of the health care workers responsible for administering it, and the willingness of the public to visit health care facilities to be screened while the pandemic remains a threat. However, there are plans to finalize training materials and resume operations post-lockdown. Plans were being laid to complete the design of the RBS training and to identify an implementation partner. Regarding RBS, the SteerCo found that a design workshop intended to facilitate planning for server training was not as effective as previous in-person meetings, and thus planning for this intervention will be delayed. Of further concern to the implementation of RBS post-pandemic, the SteerCo is aware that some taverns may never reopen, and that the current liquor black market may persist once sequestration orders are lifted. In addition, there is growing hostility between the government and associations of liquor traders attributable to the continued ban on liquor sales, which may impede engaging the liquor outlets that do reopen. The government is investigating tax relief for the liquor industry to support its emergence from the pandemic. The SteerCo is also seeking an implementation partner for a violence prevention program and may prioritize it post-lockdown because of concerns about increases in gender-based violence. Evidentiary breathalyzer alcohol testing through the police department’s Alcohol Evidence Center, donated by the SteerCo, has also been suspended, as has an accompanying promotional campaign and a plan to build a database related to drink driving. However, both initiatives are expected to be revived post-lockdown.
In Johannesburg, the SteerCo applied for and received support from the AB InBev Foundation’s Community Fund to support three initiatives. The first initiative seeks to prevent binge drinking and violence by purchasing five radio slots on a local FM radio station that include content related to understanding the COVID-19 pandemic and adhering to lockdown regulations and the ban on purchasing liquor, as well as preventing violence. The second of these initiatives would provide PPE to health workers and law enforcement working in 15 clinics and in the Alexandra community, which was specifically requested by the Johannesburg police chief. The last initiative would provide 500 hygiene and nutrition packages to needy and vulnerable families in the township.
Leuven. Since the advent of the city’s lockdown in mid-March, the work of the SteerCo members has changed dramatically, with a new focus on managing the crises by supporting the immediate needs of those who are affected (including bars and restaurants) and drafting a recovery strategy to be put in place once the lockdown is lifted. Regarding the delivery of SBI, the general practitioners (GPs) who have traditionally delivered the intervention have become more important than ever because the crisis has generated a high level of trust in the city’s health care system. The SteerCo believes that their trustworthiness will increase patients’ willingness to be screened for misuse of alcohol as a coping mechanism related to the lockdown. The SteerCo’s plans for reviving RBS are less clear given that local bars and taverns will be focused on economic survival, which will increase challenges related to recruiting bar owners and managers interested in RBS training for their staff. On the other hand, increased attention to matters related to the public’s health may support these recruitment efforts. That is, tavern owners may recognize the importance of preventing their customers from excessive drinking to ensure the maintenance of appropriate social distance. If so, RBS will be integral to the city’s recovery because “smart drinking will become an integral part of social drinking.” Plans for the development and implementation of prevention efforts targeting alcohol-related violence and youth alcohol consumption have been indefinitely delayed.
The AB InBev Foundation approved Leuven’s request for a print and social media campaign with an attendant evaluation for “What’s your new happy hour?” This campaign contradicts the premise that new socially distant gatherings must be centered around alcohol and seeks to promote alcohol-free alternatives such as online meetings, pavement visits (going to a friend’s house and staying outside on the sidewalk, respecting the 1.5 m social distancing rule), and garden talks (neighbors gathering in their own garden and talking over their fence or hedge).
Zacatecas. SteerCo communications continue as normal, with planning discussions occurring among key partners and the suspension of larger more formal events until it is safe to gather. Several programs sponsored by the SteerCo have been suspended due to the constraints that the government imposed on social gatherings. These included SBI as implemented both in school settings and as designed for adults attending primary care health centers. Even through a number of medical providers and staff have been trained in SBI and medical providers remain open, and amid reports of increased alcohol use occurring, very little screening is occurring during the pandemic. Both programs are expected to resume once the pandemic recedes sufficiently, and there is a possibility that the delivery of SBI may move to an online format such as “Chatbox.” Other programs that have come to a halt include Empresas que se Cuidan (Businesses that Care), implemented in several area companies, as well as communication and marketing (in support of all interventions), which are expected to be revived, albeit in a somewhat abbreviated form. Still other programs were curtailed but not halted, including the SteerCo’s road safety initiative, which should continue post-pandemic and is likely to include a suggestion made by the Foundation’s program officer that the licenses of drivers arrested for DUI be temporarily suspended. The Zacatecas SteerCo is also considering developing a program to respond to alcohol-related violence, in collaboration with the State’s Sub-Secretary for Crime Prevention.
In Zacatecas, the Governor and the Secretary of Health appealed to the AB InBev Foundation for $50,000 to purchase PPE for health care workers in one large or two small hospitals, stating that existing supplies were inadequate. The request referenced a newspaper article stating that Latin America could become the greatest victim of the pandemic . The PPE itemized list included masks, overalls, safety glasses, thermometers, and sanitary gloves, as well as endotracheal tubes, catheters, and electrocardiogram equipment. The request referenced the importance of strengthening the health care system so that at the pandemic’s conclusion key Foundation-sponsored programs in Zacatecas could be expeditiously restarted. The Foundation approved this request , and Zacatecas concluded that supporting the purchase of PPE “demonstrate(ed) the AB InBev Foundation’s commitment to Zacatecan society and its authorities.”
Impact of the pandemic on the SteerCos’ functioning
Prior to COVID-19, the focus of SteerCos was on developing and supporting interventions designed to reduce alcohol misuse—specifically drinking by underage persons and pregnant women, binge drinking, and impaired driving—and the harms associated with alcohol use. Within the last several months, as directed by the AB InBev Foundation, the SteerCos’ primary purpose has shifted from supporting all 37 interventions in progress prior to the advent of the pandemic to focusing on the limited number that remained active and monitoring the ongoing effects of the pandemic in their communities.
As of the beginning of March, all prevention activities of the City Pilot in Brasilia were suspended, and the leadership focused on developing a new workplan for the year to accommodate a 50% cut in its budget, which was approved by a virtual meeting of the SteerCo. In Columbus, SteerCo business continued as usual, although regularly scheduled monthly meetings quickly transitioned from in-person to videoconference. In Johannesburg, SteerCo meetings have been suspended for the duration of the lockdown and replaced by virtual meetings. Some public officials have been inaccessible or unavailable, either because they lack access to a work computer or are preoccupied with combatting the pandemic as law enforcers or health care workers. One implementation contractor is temporarily using its facilities for COVID-19 screening and is thus unavailable to administer SBI. During this period, the SteerCo is particularly sensitive to the need to protect the health of its members and thus continue and sustain the project. In Leuven, due to the coronavirus, the SteerCo has replaced in-person meetings with videoconferences. While communications among SteerCo members originally decreased following the lockdown, they have now substantially increased, and the Coordinator reports that “there is a closer alliance and willingness to cooperate. The feeling that ‘we’re in this together’ and ‘we have to help each other’ is strongly present.” In Zacatecas, as in the other sites, the SteerCo adapted quickly to communicating online. A strong partnership with the local beer manufacturers’ partner prevention program allowed for good communication about how to best assign now limited resources between funders. Through the social capital built upon strong ties to community leaders and generated by its application for Community Funds, the SteerCo was able to add an additional stakeholder, the Ministry of Migrants for the State of Zacatecas.