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May 23, 2022

'It's a crisis': What's next in the baby formula shortage?

Daily Briefing

    Amid a nationwide shortage of infant formula, many families are struggling to feed their children, often traveling several hours or paying exorbitant prices for the products. To address this growing issue, the federal government recently implemented several new measures to increase production and supply.

    Cheat sheet: Infant health inequity

    A nationwide formula shortage

    Over the last few months, supply chain and staffing problems have contributed to a growing shortage of infant formula—a situation that was further exacerbated by a recall of several formulas produced by Abbott Nutrition, which makes up almost 50% of the market. According to the New York Times, the recall occurred after at least four infants developed bacterial infections and two died after consuming the formulas.

    Although Abbott recently reached an agreement with FDA to reopen its formula plant in Michigan after being cleared by an investigation, it will take several weeks before the products are available in stores. In the meantime, other manufacturers have had to fill the void and have largely been unable to ramp up their production quickly enough to meet surging demand.

    "Some industries are very good at ramping up and ramping down," said Rudi Leuschner, an associate professor of supply chain management at Rutgers Business School. "You flip a switch and they can produce 10 times as much. Baby formula is not that type of a product."

    According to research from Datasembly, the national out-of-stock rate for infant formula reached 43% the week ending May 8, up 10% from last month's average. In addition, some states, including Arizona, Nevada, Tennessee, and Texas, had even higher out-of-stock percentages at 50% or more. With supply continuing to dwindle, many retailers, including CVS, Kroger, and Walgreens, have limited purchases of formula.

    How the baby formula shortage is impacting families

    Families who rely on subsidies from the federal Women, Infants, and Children (WIC) program to purchase formula have been particularly affected by the shortage, the Wall Street Journal reports. Under the programs, recipients can only purchase formula from a state-contracted manufacturer, meaning that they cannot easily switch brands if the approved brand becomes available.

    "[U]nlike other food recalls, shortages in the infant formula supply affects a major — or even exclusive — source of nutrition for babies," said Brian Dittmeier, senior director of public policy at the National WIC Association, adding that insufficient nutrition "could have long-term health implications."

    Dittmeier also noted that the shortage is "particularly acute for infants who require specialty formulas to address allergies, gastrointestinal issues or metabolic disorders."

    Although pediatricians have attempted to find alternatives to specialty formulas for high-risk infants, they have not always been successful, leading their conditions to worsen. According to the Washington Post, two babies recently had to be hospitalized, and one newborn's discharge was delayed after they had trouble feeding with different brands.

    Furthermore, it is not only infants who have been negatively impacted by the formula shortage. Older children with certain health conditions who require special formula diets have also had difficulties finding suitable alternatives.

    For example, Mark Cokins, a pediatric gastroenterologist at Le Bonheur Children's Hospital, said he recently treated a toddler and a preschooler who were admitted for dehydration and other nutritional problems. The two children have short bowel syndrome, a condition that makes them unable to absorb nutrients properly, and could only consume an amino acid-based formula, which became unavailable amid the shortage.

    "It's a crisis," Corkins said. "This is not what we signed up to do. We're not giving the best care we can give."

    Currently, many parents are trying to stretch their dwindling formula supplies as long as possible as they search for more formula or test alternative options.

    Some parents are traveling hours to different stores to find formula, while others are paying significantly higher prices—sometimes double or triple the normal cost—to private, online sellers. And some have even turned to a "black market" to buy European infant formula, which is illegal to import into the United States.

    Some parents are also trying to make their own homemade formulas, although health experts recommend against this, saying these formulas often lack necessary nutrients or can lead to other dangers.

    "Homemade formula is dangerous for babies," said Katie Lockwood, an attending physician at Children’s Hospital of Philadelphia Primary Care. "Regular formula is F.D.A.-regulated and held to very high standards, the same way we treat medications. Making it at home is a lot riskier."

    The American Academy of Pediatrics (AAP) has also "strongly" advised against parents using homemade formulas for their children, the Times reports. "The nutrients in homemade formulas are inadequate in terms of the critical components babies need, especially protein and minerals," said Steven Abrams, an AAP spokesperson.

    How the government is working to address the shortage

    Since February, the U.S. Department of Agriculture (USDA) has worked with states to expand the formula options available under WIC programs, including alternative brands or different sizes and varieties that are not typically covered.

    "Over the last several months, the federal government has worked round the clock to address the production shortfall brought about by the recall…and offer maximum flexibility, information, and support to WIC participants," USDA officials said.

    In addition, the Senate on Thursday passed a bill by unanimous consent that would allow WIC recipients to purchase alternative formula brands and give USDA the ability to automatically waive restrictions limiting how much participants in a food nutrition program can spend on formula.

    Separately, lawmakers in House recently passed an emergency funding bill, allocating $28 million to FDA so the agency can hire additional staff to help inspect infant formula and to prepare for any potential shortages.

    On Wednesday, President Joe Biden invoked the Defense Production Act, which will require suppliers to "direct needed resources to infant formula manufacturers before any other customer who may have ordered that good."

    According to a White House fact sheet, "[d]irecting firms to prioritize and allocate the production of key infant formula inputs will help increase production and speed up in supply chains."

    In addition, the Biden administration is launching an effort called "Operation Fly Formula" that aims to transport Nestlé S.A infant formula from Switzerland to the United States. Currently, the Department of Defense plans to use commercial air cargo to import 1.5 million 8-ounce bottles of three different formulas that are currently in short supply in the United States.

    "Imports of baby formula will serve as a bridge to this ramped up production, therefore, I am requesting you take all appropriate measures available to get additional safe formula into the country immediately," Biden wrote in a letter instructing HHS and USDA to work with the Pentagon on the operation. (Gasparro/Kang, Wall Street Journal, 5/19; Sandoval et al., New York Times, 5/10; Medina, New York Times, 5/11; Moyer, New York Times, 5/11; Morris, New York Times, 5/17; Kennedy/Watts, USA Today, 5/18; Sellers, Washington Post, 5/18; Szalinski, The Atlantic, 5/19; Pearson, New York Times, 5/11; Martinez, Axios, 5/19; Chalfant, The Hill, 5/18)

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