Picture: GETTY IMAGES
Picture: GETTY IMAGES

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.

The alcohol industry last Monday 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.

Parry is adamant the model must be transparent – even though it wasn’t released before the ban was instituted. In fact, the model presented to the government and the MAC argues that “sharing the model and the rationale behind the model is key to winning the public over”. It says: “It is imperative to maintain absolute transparency and inform the public of the rationale behind its decision to reimpose a ban or tighter restrictions.”

After being given the go-ahead by MAC head Professor Salim Abdool Karim on Friday morning to release his six-page model, Parry wrote to the alcohol industry and said: “I have always been transparent, as you will see from my tweets and in my interviews with the media. I am pleased to be able to do this now.”

However, there was no discussion with the industry prior to the ban being instituted last Sunday night. As a result, it was unforeseen by the industry as well as small businesses like liquor outlets and shebeen owners, who are expected to be hardest hit.

The National Liquor Traders Council, representing 34,500 taverns (legal, licensed shebeens) wrote to President Cyril Ramaphosa this week, fuming. “It was our expectation that as a president who thrives on consultation [you]… would at least have [consulted us] on such an important matter as this, which is literally our livelihood.”

The industry and the tavern owners feel the government needs to balance the aim of reducing trauma patients at hospitals with the cost to the economy and the number of jobs involved in alcohol production and sales.

Parry explains he was given the remit of modelling in a “day and a half” what banning alcohol would do to alleviate the burden on hospital resources, but was not asked to examine the ban’s impact on the economy and jobs. “We work in silos,” he says. He admits that an approach that looks at all aspects of the alcohol ban is preferable.

“I would have assumed the national command control council would have an economics group looking at the financial implications,” he says.

Based on estimates

The alcohol industry is likely to try to pick apart the model, which is based on many assumptions, rather than focus on the hard data. 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. “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.

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 tells the FM 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.

While this would give the government actual figures on alcohol’s impact on the health system, it is unclear how practical this is, as it would require hundreds of thousands of alcohol blood tests to be conducted on injured patients.

Paying the price for government inaction

The consensus view from the SAMRC group, which did the modelling with Parry, was that a ban be proposed for eight weeks. Parry says, however, that he personally believes that imposing tighter restrictions on the sale of alcohol, rather than an outright prohibition, is the better approach.

While the purpose of the ban is to reduce patient numbers in hospitals, not all provinces are suffering equally, since some areas do not have the staff and other resources to cope with the added influx of patients while other regions do. For example, Parry says the Western Cape isn’t short of hospital beds. The province’s premier, Alan Winde, said on Thursday that the epidemic had flattened and the numbers of Covid-19 hospital patients had decreased from the peak.

The SAMRC’s model says that if provincial liquor bans were in place allowing some provinces to sell booze but not others, the government would need to strengthen policing at provincial borders

The strains on the health system, however, 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 says.

It means that the tavern owners and Western Cape residents are paying the price for a weak and unprepared health system in the Eastern Cape, KwaZulu-Natal and Gauteng, which is now short of doctors, nurses and even oxygen to deal with Covid-19.

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