How Ireland beat the odds to introduce cancer warning labels on alcohol

Bottles of alcohol with alcohol warning labels

Despite opposition from industry groups at home and internationally, Ireland will soon be the first country to warn drinkers of the links between cancer and any alcohol consumption on the drinks label. How did they do it?

From 2026, all alcohol products sold in the Republic of Ireland will be required to state: “There is a direct link between alcohol and fatal cancers”. This measure makes Ireland the first country in the world to mandate a warning linking any level of alcohol consumption to cancer.

Alcohol is linked to cancer and more than 200 diseases and injuries. In 2020, alcohol accounted for over 4% (equivalent to 740,000 new cases) of all global new cases of cancer. Despite evidence establishing there is no safe level of alcohol consumption, research indicates that public awareness of the link between alcohol and cancer is quite low.

Health warning labels for alcohol

Over the last 2 decades, countries have increasingly introduced warning labels to inform consumers about the health risks of alcohol. The WHO Global Status Report for Alcohol and Health 2018 reported that 47 member states mandated health and safety warnings on alcohol, up from 31 in 2014. Before Ireland’s initiative, warning labels largely focused on issues such as underage or excessive drinking, drink driving and drinking while pregnant – and didn’t mention cancer.

The Irish cancer warning labels are part of comprehensive alcohol control measures introduced in Ireland by the Public Health (Alcohol) Act 2018 (the Act) which seeks to address the enormous burden of public health, social and economic harm caused by alcohol in Ireland. In addition to the new cancer labels, the Act introduced minimum unit pricing; the regulation of advertising, marketing and sponsorship; structural separation of alcohol products in mixed trading outlets (eg alcohol is kept separate from food and other products, or is stored in its own container with visibility restrictions in place); and measures regulating the sale and supply of alcohol in certain circumstances (such as restrictions on promotions).

Ireland’s comprehensive approach

Regulations introduced by the Minister for Health, Stephen Donnelly, in May 2023 specify that from 26 May 2026, all alcohol products sold in Ireland must contain the cancer warning statement as well as a pregnancy warning, a warning that drinking alcohol causes liver disease, information on the quantity of alcohol and number of calories contained in the product, and details of a website on alcohol and related harm. The purpose of the Regulations is to ensure that Irish consumers have necessary information to allow them to make informed decisions about their alcohol consumption.

The Regulations also specify details about the appearance and location of the health warnings. They are to be printed in Times New Roman bold type on a white background, printed in red, capital letters. The text must occupy the greatest possible proportion of the surface reserved for the warning, they are to be printed in normal, weighted, regular typeface and positioned at the centre of the surface reserved for such warnings and in the same direction as the majority of other information on the container.

Ireland is the first country in the world to require comprehensive health warning labels on alcohol products, and the second to mandate cancer warning labels. The only other country that has mandatory cancer warning labels on alcohol is South Korea. While English translations of the Korean labels are hard to obtain, (as far as the author is aware) alcohol products sold in South Korea are required to contain 1 of 3 warning labels with 2 warnings noting the link between excessive alcohol consumption and cancer. Irish labels are set to take this a step further, by linking any level of alcohol consumption with cancer.

Opposition to the warnings

Ireland’s comprehensive alcohol laws have faced significant opposition within Ireland and internationally from the alcohol industry and some alcohol-exporting countries. The alcohol industry is using a range of strategies and activities to try to weaken, delay and defeat the laws. These have included being at the table when the legislation was being developed, lobbying, and mobilising coalitions to oppose specific measures, such as a ban on sports sponsorship.

The alcohol labels have been contentious at the World Trade Organization (WTO). When Ireland notified the WTO’s Technical Barriers to Trade Committee of the Regulations in 2023 — a requirement for Ireland as a WTO member — several WTO member states raised concerns.

Opposition is not new, as the threat of litigation is a common industry tactic. From 2010–12, Thailand faced strong opposition at the WTO about introducing graphic health warnings for alcohol. As a result, Thailand’s measure has not been implemented. In 2017, the alcohol industry halted the first real-world research study looking at the effectiveness of cancer warning labels in Yukon Territory in Canada by threatening legal action. While this research was unable to proceed, results obtained before the study was stopped found that cancer warning labels increase knowledge of the link between alcohol and cancer.

How Ireland overcame opposition

One of the reasons for the success of the Irish labels is the Irish government’s determination, with champions within government committed to alcohol control. Beyond political support, the adoption of a multisectoral approach to the alcohol control measures in Ireland has proved critical. The active involvement of civil society, including cancer organisations, has played an important role in ensuring the cancer warnings have proceeded.

Ireland’s alcohol labels are also based on evidence and have been introduced in accordance with WHO guidance on alcohol and non-communicable diseases (NCDs). The 2010 WHO Global Strategy to Reduce the Harmful Use of Alcohol and WHO 2022-2030 Global Alcohol Action Plan (PDF) both suggest labels to inform consumers about harms associated with alcohol consumption. Labels and health warnings on alcoholic beverages are also a recommended intervention for NCD prevention and control. Details in the Irish Regulations specifying the appearance and location of the warning, such as the requirement to be in red and the phrasing of the warnings, are also based on evidence. Ireland has received backing from the WHO, which has issued statements in support of Ireland and their alcohol labels at the WTO.

Ireland’s cancer warning labels still face opposition at the WTO. However, no formal dispute has been initiated against Ireland’s labels. With or without a formal dispute, Ireland’s labels are free to come into effect in 2026 as planned. Whether, in the next few years, other countries follow Ireland’s lead and introduce cancer warning labels, one thing is clear, Ireland – the first country in the world to ban smoking in the workplace – is again leading the way in public health, using labels to warn consumers about the link between any level of alcohol and cancer.