In mid-February, a major infant formula recall and factory closure occurred, leading millions of families with essentially no way to feed their infants safely. Texans felt this shortage acutely as the contract for infant formula for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) was held by the company that had the recall and factory closure. The shortage led to families using homemade formulas that fail to meet infant nutritional needs.
After a slow start to respond, the federal government put into place a short-term partial resolution largely using imported formulas. Unhelpful and inaccurate political blaming of both sides for the shortages, rather than understanding the decades-long systematic causes of it, has not put formula back on the shelves. At the same time, importation of formulas using special Food and Drug Administration temporary rules has not led to any meaningful long-term solutions and has only marginally improved the situation in Texas and other states where the shortage has been severe.
In other words, we keep putting a Band-Aid on a big bleed and keep forcing families — especially low-income ones — to suffer.
These families cannot order formula online via WIC, and oftentimes, they can’t easily find the formula they need in stores without using time and gasoline to do a large search. We can do better.
The FDA must use its rule-making processes, in conjunction with Congress and the White House, to allow foreign infant formula manufacturers to permanently market in the U.S. without the need for excessive and unneeded additional research or paperwork. The current special allowance that is making formula brands appear on store shelves expires in November.
A permanent change in FDA rules, including accepting international guidance and supervision of overseas factories, needs to be implemented quickly. Factories and formulas used in Europe, Australia and New Zealand, for example, are already tightly regulated. We don’t need added layers of regulation in the U.S. other than ensuring safe means of transportation to the U.S. In fact, the FDA recently stated a plan related to this but has not given any details or assurances that the agency will make it straightforward or feasible for companies to stay in the country.
More of us need to realize that the severe shortage of specialized formulas Americans are facing for allergic and other special needs babies has affected multiple countries and thus requires a global solution. For example, it is currently affecting Canada, which has urged families to limit the purchase of these products. We need to prioritize the production of these formulas, which are needed for about 5% of all infants, as well as financial incentives to make this occur.
We also need to begin a long-term reevaluation of the contracting and other processes of the WIC program. WIC programs, such as the one in Texas, are operated using inadequate technology and rules that prevent online purchases and severely limit formula choices for almost half of all families. This system needs to be overhauled by the U.S. Department of Agriculture with congressional oversight including a complete modernization of the computer systems that allow families to make purchases.
I am a pediatrician who serves high-risk infants and conducts research on food insecurity and infant nutrition. Simply put, we need to bring our support of breastfeeding women and families in line with what most other countries do. This includes increased paid leave after birth, increased support for lactation counseling, and breast pumps for workers who are trying to successfully return to work while feeding their infant. Our society has made it difficult for families who wish to breastfeed.
If we don’t make changes now and imagine that the eventual reopening of one factory will make everything OK, then we will undoubtedly be in the same or worse situation again soon due to ongoing supply issues and the near certainty that another factory issue will develop somewhere again. Let’s get pediatricians, dietitians and others together with policymakers to create long-term solutions to this long-term problem now, instead of bandaging up a clearly gaping wound.
Dr. Steven Abrams is a professor of pediatrics in the Dell Medical School at The University of Texas at Austin.