IBFAN, WHO, UNICEF and partners breathed a sigh of relief today at the Codex Nutrition Committee in Dusseldorf. After 10 years of tortured discussions in a Committee dominated by food corporations and powerful exporting countries, the main text of the revision of the 1987 Codex Standard for Follow-Up Formula was finalised with the addition of some important safeguards at the last minute. (1) The fact that the meeting was webcast for the first time (private recording was banned previously) might have contributed to the good outcome.
While the standard has also improved its requirements for ingredients (the 1987 standard set no upper limits for sugar!), banned health and nutrition claims and included many other labelling restrictions, there are still unresolved problems. (3)
IBFAN urges governments to waste no time before bringing in strong marketing controls for all products up to 36 months in line with the International Code and Resolutions. If not, the ‘improved’ new Standard will lead to renewed commercial promotion and a slew of new ultra-processed products for young children with all their attendant risks.(4) IBFAN, WHO and UNICEF are ready to help governments achieve this, ideally before these products are allowed on markets.
Governments have the sovereign right to adopt any legislation they consider necessary to protect child health as long as it does not violate international trade principles. The newly added references to the International Code and Resolutions in the Preamble will make it less likely that Code-aligned laws trigger costly, time-consuming WTO discussions or other challenges that have a chilling effect on policy-making. (5)
What happened this week
In a skilfully managed debate, the Chair, Dr Anja Brönstrup, allowed plenty of time – two days – for debate on the final crucial aspects that had been left to the very end of the revision. In the 2019 meeting, the debate was curtailed, resulting in a bad decision on whether Cross Promotion should be forbidden.(6)
The industry notion that there should be two separate standards was quickly rejected, as many countries called for ONE standard with two parts. Many also called for a Preamble that would protect breastfeeding and help governments position the products correctly in their regulatory frameworks. With such strong arguments and a clear majority, Canada, Switzerland, Australia and the EU changed their positions and indicated that they could support or at least ‘live with’ the compromise Preamble proposed by the New Zealand. (7). The 9 reservations will be specified in the report but will not stop the Standard going forward for adoption by the Commission in July.
Some of the statements and written comments from country delegates:
John Oppong-Ottoo, for the African Union:
Gry Hay, for Norway: “Norway appreciates the proposed preamble text provided by the New Zealand chairs. Although we would have preferred a more comprehensive wording [its] referral to key WHO and WHA documents, as well as a reference to subsequent WHA resolutions concerning infant and young child feeding ….provides context for understanding and implementing the standard. This will be of great importance for many countries in order to facilitate coherence with global policies to protect breastfeeding … WHO and UNICEF have documented how parents and pregnant women globally are exposed to aggressive marketing for baby formula milk and how marketing of formula milk influences decisions on infant feeding and undermines breastfeeding… The evidence is strong. Formula milk marketing, not the product itself, disrupts informed decision-making and undermines breastfeeding and child health.”
Notes:
(1) The 1987 Follow Up Formula Standard legitimised these problematic products, that were deliberately invented to get round the marketing recommendations of the World Health Assembly in 1981. The standard’s poor composition requirements and total lack of marketing safeguards (based on the claim that follow-up formulas are not breastmilk substitutes) boosted the growth of a $ multi-billion market for these unnecessary products. Its existence undermined laws to protect breastfeeding, fuelled the obesity epidemic and added to the environmental burden. One third of the world’s countries breastfeeding is a lifeline and the majority of children are breastfed in the 2nd year of life. When this new work was started in 2012/13, IBFAN proposed that the standard should be ‘sunsetted’ rather than updated.
(2) Reservations came from: Argentina Cuba, Vietnam, Panama, Guatemala, USA, Colombia, Costa Rica and Morocco. The Name of the Standard will be: Codex Standard for Follow-Up Formula for Older Infants and Product for Young Children*. *Other equivalent names for this product are drink for young children with added nutrients or product for young children with added nutrients or drink for young children.
(3) While the standard has improved its requirements for ingredients (the 1987 standard set no upper limits for sugar!) banned health and nutrition claims and included many other labelling restrictions, there are still unresolved problems including: the sodium levels; the sweetness; that the drinks can contain flavourings; the inadequate safeguards to stop misleading Cross Promotion; the nutrient claim in one of the proposed names ‘drink/product with added nutrients’ and the lack of reference to the fact that the products are not necessary.
(6) In the 2019 CCFSNDU meeting the critically important sentence: ‘Cross promotion between product categories is not permitted on the [label/labelling] of the product’, that was supported by many developing countries, was replaced by much weaker text that was falsely presented as having the same ‘intent’. Cross Promotion’ or ‘brand stretching’ is a deceptive marketing technique used to expand the sale of tobacco and other products with public health concerns. Cross Promotion of milks is especially harmful and increases the risk of infants not being breastfed or being fed with entirely inappropriate products.
(7) Text of new Preamble proposed by New Zealand and agreed: “This Standard is divided into two sections. Section A refers to Follow-up Formula for Older Infants, and Section B deals with Drink for Young Children with Added Nutrients, or Product for Young Children with Added, or Drink for Young Children, or Product for Young Children. The application of this Standard should be consistent with national/regional health and nutrition policies and relevant national/regional legislation and take into account the recommendations made in the International Code of Marketing of Breast-milk Substitutes, as per the national context. Relevant World Health Organization (WHO) guidelines and policies and World Health Assembly (WHA) resolutions were considered in the development of this Standard and may provide further guidance to countries.”
“I have had the pleasure of attending the 75th World Health Assembly in Geneva, Switzerland this week, along with other members of the global Infant Baby Food Action Network (IBFAN) team. I have learned so much from other Member States and delegates from all over the world. While there are many public health issues being addressed before the Assembly, our team is here to protect and promote breastfeeding, to strengthen the WHO Code on the Marketing of Breastmilk Substitutes by keeping policy setting free of commercial influence, and to prohibit the cross-promotion of products that function as breastmilk substitutes. Throughout our time here at the WHA, I have also had the opportunity to write a briefing on the contamination and infant formula product shortage occurring in the U.S., which we are now circulating among international delegates. I look forward to returning home and working hard on the establishment of INFACT USA and Code monitoring in the states.”
– Ellie MacGregor, Director of the Academy of Lactation Policy and Practice Program Coordinator of INFACT USA (Infant Feeding Action Coalition USA)
Report on IBFAN / INFACT Activities at the 27th World Health Assembly
Baby Milk Action’s Patti Rundall welcomes the increase in Assessed Contributions then asks WHO about its Conflict of Interest policy that only excludes arms and tobacco rather than all health harming industries. Dr Tedros Adhanom Ghebreyesus responds by saying ‘What she said is true by the way …”
The IBFAN team this year is small: Elisabeth Sterken (IBFAN Canada) Ellie MacGregor (IBFAN USA/ALPP) and Magdalena Whoolery (IBFAN Pakistan). Maryse Arendt will also join from ILCA. We are promoting the four new WHO reports and briefings (1) that all show that marketing in many countries is out of control and that strong safeguards are needed.
We will be making several statements including on Maternal, Infant and Young Child Nutrition (MIYCN) and Food Safety (Agenda item 18, FRIDAY 27th May), Non Communicable Diseases (Agenda Item 14.1) and Emergencies (Agenda Item 16.3)
Maternal, Infant and Young Child Nutrition (MIYCN) and Food Safety (Agenda item 18, FRIDAY 27th May)
The International Code, and its 20 Resolutions, is a landmark document that protects breastfeeding’s crucial role in child survival as a safe, renewable natural food resource that contributes to food and water security. All Member States have an obligation to implement it and commercial companies must comply with it.
While 144 countries have implemented the Code to some degree, WHO’s recent reports expose many loopholes that allow digital and other forms of predatory marketing to flourish (1).
The Decision EB150 (7) at present, only requests the DG to provide Guidance to MSs on digital marketing and to report back in 2024. This year WHO has published four new reports and briefings that all show the importance of strong marketing safeguards. (1)
The Director General can be asked to:
(1) Assist MS in ensuring that trading and export standards, guidelines and regulations support full implementation of the International Code of Marketing of Breast-milk Substitutes (i.e. “the Code) and subsequent WHA Resolutions. (2) Rationale: This would help MS hold companies’ accountable for marketing practices in importing countries.
(2) Assist MS to prohibit the promotion of cross branded products that function as breastmilk substitutes within The Codex Alimentarius revision of the draft standard for Follow-up Formula. (2) Rationale: these products are unnecessary, ultra-processed, sweet-tasting and flavoured.
(3) Assist MS in adopting legal frameworks that cover all foods for infants and young children and related products, including commercial milk formulas for pregnant and lactating mothers. (A useful example is the WHO Model Law for Europe)
(4) Assist MS in keeping policy setting free from commercial influence by consistently adopting and applying conflict of interest and transparency safeguards. Rationale: With the pressure to work in Multi-Stakeholder environments WHO must consistently warn and encourage Member States to adopt and apply such safeguards.
(5) Assist MS in ensuring effective independent food safety regulations and standardized monitoring and enforcement for all feeding products for infants and young children.
On Emergencies we will call for increased protection and support for breastfeeding, skin-to-skin contact and relactation; ensure that micronutrient and other interventions during emergencies are culturally appropriate and not commercially promoted, to support sustainable food production, food security and biodiversity. We will also promote the UNICEF led Ukraine statement that is now endorsed by WHO, UNHCR and many others.
[2] The 1992 Export Directive (92/52/EEC) and Council Resolution called for Code compliance by EU Based companies when marketing in ‘third countries’ along with monitoring and reporting and accountability proposals. The Codex CODE OF ETHICS FOR INTERNATIONAL TRADE IN FOOD requires Member States to “…make sure that the international code of marketing of breast milk substitutes and relevant resolutions of the World Health Assembly (WHA) setting forth principles for the protection and promotion of breastfeeding be observed.”
CLICK HERE for IBFAN interventions made at the 150th Executive Board Meeting. Click here for the IBFAN Blog on the run up to the EB.
IBFAN STATEMENTS FOR WHA 75
Maternal Infant and Young Child Nutrition and Food Safety Agenda Item 18.1 read by Elisabeth Sterken
Over 800,000 babies die every year because of unsafe feeding, and many more do not reach their full potential because they are not breastfed. This year four WHO reports show that too many of the 144 countries with Code legislation have serious loopholes allowing predatory marketing to flourish.
It’s time that exporting nations take responsibility for the marketing activities of their companies. WHO, the parent of Codex, must defend Assembly decisions, as amended by Bangladesh, against challenges by those pushing unnecessary, sweetened, flavoured ultra-processed products. The forthcoming decisions at Codex will fundamentally affect child health and survival
The undermining of breastfeeding using digital marketing, deceptive claims and cross promotion must be eliminated. Mandatory paid maternity leave, effective and independent food safety systems and baby-friendly birthing practices are essential to reduce illness and death associated with formula feeding
NCDs and Humanitarian emergencies. Agenda item 14.1. A75/10 Add 2, Annex 4 read by Patti Rundall
Recommendations on how to strengthen the design and implementation of policies, including those for resilient health systems and health services and infrastructure, to treat people living with noncommunicable diseases and to prevent and control their risk factors in humanitarian emergencies
The recommendations on NCD risk factors in humanitarian emergencies rightly calls for strengthened policies and services but also calls for partnerships with the private sector – with NO mention of the need for conflicts of interest safeguards – nor any mention of the protection of breastfeeding – a resilient practice that protects children from the worst of emergency conditions.
Safeguards must be consistently integrated into ALL policies to ensure that partnerships are appropriate and that policy setting is not commercially influenced.
When talking about health harming industries terms such as ‘partnership’ ’trust’ ‘shared aims’ and ‘values’ is naive. It blurs identities and responsibilities. Corporations have no democratic accountability and public health policy decisions should be free of their influence.
In times of crisis, companies mislead and exploit public fears, donating inappropriate products that claim to build immunity – good that WHO supports the statement warning of the risks of formula donations in Ukraine.
Public Health Emergencies. Agenda Item 16.3 Read by Dr Magdalena Whoolery
Breastfeeding is a resilient practice that provides food, care, immune support and protection from the worst of emergency conditions while protecting against malnutrition in all its forms. Breastfeeding and conflict of interest safeguards must be consistently integrated into all Emergency Prevention & Management policies.
As poverty rates, economic disparity, conflicts and hunger are rising, short term treatment models that rely on market-led approaches and fail to recognise how companies undermine health and the environment pose serious risks to child health. Ready to Use Therapeutic Foods should not be on retail sale and should be used only in programmes that promote skin-to-skin, re-lactation and continuation of breastfeeding with appropriate transition to nutritious family food and psycho-social support. Micronutrient interventions should be culturally appropriate and not undermine sustainable food production, food security and biodiversity.
We are pleased that WHO endorsed the joint statement on Ukraine led by UNICEF and UNHC warning of the risks of donations of baby feeding products.
Non State Actors in Official Relations (such as IBFAN) can listen and intervene on some of these meetings. On the Working Group on Emergency Preparedness (WGPR Intersessional Informal Meeting (Systems and Tools / Finance) on 24th March, I made the following intervention:
IBFAN – like all public interest civil society – supports the call from Germany for a long overdue increase in Member States contributions to WHO. This is important for so many reasons, but essential if WHO is to continue to lead in emergency preparedness and response. Without such secure income and in the absence of strong safeguards on COI there are huge risks. IBFAN is especially concerned about the need to protect infant and young child feeding and of course breastfeeding – a lifeline in emergencies. We see now that appeals and funds are being attracted to the WHO Foundation and we’re very, very concerned about this and feel that its policy must be strengthened and donors carefully screened. The Foundation has recently dropped an exclusion criteria from its initial guidance guidelines that would have forced it to reject funding from companies that do not contribute to “a healthy diet.” And its messages have failed to follow WHO policy and alert the public to the risks of donations of feeding products.
Report issued by a team around Jonathan Glennie based on research funded by the BMGF, adapting Glennie’s “global public investment” proposal (The Future of Aid: Global Public Investment) narrative to the field of financing pandemic preparedness and response
South Centre Research Paper No. 147 (28 February 2022): Can Negotiations at the World Health Organization Lead to a Just Framework for the Prevention, Preparedness and Response to Pandemics as Global Public Goods?
By Viviana Muñoz Tellez This paper advances that WHO Member States, having agreed to the objectives of advancing equity and solidarity for future pandemic prevention, preparedness and response, now must operationalize these. The paper offers suggestions for the ongoing WHO processes of: 1) review of recommendations under examination by the Working Group on Strengthening WHO Preparedness and Response to Health Emergencies, 2) consideration of potential amendments to the International Health Regulations (IHR) 2005, and 3) elaboration of a draft text for an international instrument on pandemic preparedness and response.
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The politics of a WHO pandemic treaty in a disenchanted world G2H2 research and advocacy project 2021. Members of the Geneva Global Health Hub are currently exploring a follow-up action Report: https://g2h2.org/posts/whypandemictreaty/
Von: HMP <HMP@who.int> Gesendet: Mittwoch, 23. März 2022 10:28 An: HMP <HMP@who.int> Betreff: Informal WHA75 pre-meetings during 11 April to 6 May
Dear non-State actors in official relations,
Please find attached the draft concept note for the” Informal WHA75 pre-meetings for Member States, non-State actors in official relations and the Secretariat” to take place over 4 days during the period from 11 April to 6 May 2022. The informal meeting is organized as per the decision of the Executive Board at its 150th meeting. In developing the concept note, the comments and input from non-State actors who attended the planning meeting on 28 February on the concept and content for the meeting , have been considered.
The proposed dates and the agenda for the informal WHA75 premeeting are:
Monday 11 April 2022 at 10:00-13:00 CEST
Pillar 1: One billion more people benefitting from universal health coverage
13.1 Follow-up to the political declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases:
(a) Draft implementation road map 2023–2030 for the global action plan for the prevention and control of noncommunicable diseases 2013–2030
(d) Draft recommendations on how to strengthen the design and implementation of policies, including those for resilient health systems and health services and infrastructure, to treat people living with noncommunicable diseases and to prevent and control their risk factors in humanitarian emergencies
(h) Draft action plan (2022–2030) to effectively implement the global strategy to reduce the harmful use of alcohol as a public health priority
21 April 2022 at 15:30-18:30 CEST
Pillar 1: One billion more people benefitting from universal health coverage Human resources for health
Pillar 3: One billion more people enjoying better health and well-being 17.1 Maternal, infant and young child nutrition
3rd item TBD
28 April 2022 at 15:00-18:00 CEST
Pillar 2: Public health emergencies: preparedness and response 15.2 Strengthening WHO preparedness for and response to health emergencies
15.4 WHO’s work in health emergencies
Pillar 4: More effective and efficient WHO providing better support to countries
Sustainable Financing
Thursday 6.5. at 10.00-11:00 CEST
Engagement modalities
Feedback on the meeting
Constituency statements
The duration of each session is 3 hours, with 3 agenda items for discussion, and with expected participation as panel members from Member States, WHO Secretariat including regional offices and non-State actors in official relations. We would propose that non-State actor representative will moderate the sessions like last time. It is expected that panel members will be respond to questions from the audience and discuss with other panel members on the agenda item. The fourth session on 6 May is dedicated for a discussion on engagement modalities for non-State actors, and to a dialogue between non-State actors and the Director-General as well as giving a space for non-State actors to prepare for the Seventy-fifth World Health Assembly (22 – 28 May 2022). Should you have any suggestions for the format or agenda items of the meeting or comments, especially for the 3rd agenda item on 21 April, please contact hmp@who.int.
We are calling for expressions of interest from non-State actors to be members of the panels as well as moderators of the panels in this meeting. Kindly indicate your interest to Taina Nakari at hmp@who.int by 27 March 2022. Please also let us know which session you are interested in to moderate or to be a panel member. Once all the proposals have been received, we will contact the panel members and moderators to finalize arrangements. Looking forward to working with you to shape the sessions.
Connection details and other practical arrangements will be sent ahead of the meeting.
Thanking in advance for your participation.
Best regards, Dr Gaudenz Silberschmidt Director Health and Multilateral Partnerships External Relations
Elisabeth Sterken is Director of INFACT (Infant Feeding Action Coalition) Canada/IBFAN (International Baby Food Action Network) North America, past chair of the IBFAN Global Council, coordinates the IBFAN Codex Alimentarius Program, and represents IBFAN on the UNICEF/WHO the Global Breastfeeding Collective.
Linda J. Smith is the owner and director of Bright Future Lactation Resource Centre, author of 4 breastfeeding textbooks, and created the International Code Committees of ILCA and La Leche League International. She is a consultant to INFACT Canada/IBFAN North America.
Karin Cadwell is a faculty member of the Healthy Children Project and is serving as convenor of the new organization, Infant Feeding Action Coalition USA.
Kimarie Bugg is President and CEO of Reaching Our Sisters Everywhere (ROSE), adjunct faculty for Morehouse School of Medicine/Pediatrics, and faculty at Union Institute and University.
David Clark is an international public health and human rights lawyer who spent 25 years as the Legal Specialist with the Nutrition Section, UNICEF, New York.
Constance Ching currently provides technical support in Code advocacy and implementation for Alive & Thrive in the ASEAN region. Prior to that, she worked for IBFAN-ICDC, was involved in capacity building with governments, UN agencies and NGOs on Code implementation and monitoring.
Leah Margulies is a lawyer, founder of Corporate Accountability International (formerly Infact), and the International Nestle Boycott. She set up the legal office of the Baby-Friendly Hospital Initiative, UNICEF and was legal staff at the Environment Unit of the UN Centre on Transnational Corporations.
Jacqueline H. Wolf is professor of the history of medicine in the Department of Social Medicine at Ohio University. She specializes in the history of birth and breastfeeding practices in the United States.
