Need baby formula? You’re on your own

Babies and their well-being have never been much of a priority in the United States. But an alarming shortage of infant formula— and the lack of a national mobilization to keep babies fed—provides a new measure of how deeply that indifference runs.

Formula has been in short supply since the early days of the covid-19 pandemic. Back then, customers who could afford it stockpiled formula to limit their trips outside. A manufacturing and delivery cycle that takes between 12 and 16 weeks from start to finish didn’t keep pace.

Freight delays held up crucial ingredients. Like many other industries, formula manufacturers struggled with labor shortages. And as 2021 turned into 2022, a spate of severe winter storms slowed deliveries of products to store shelves.

The worst blow came in February when Abbott Nutrition recalled formula made in its Sturgis, Mich., plant. Two babies who drank formula from the plant died of bacterial infections, and others were hospitalized. Although bacteria wasn’t found in the samples they drank, Abbott announced the recall as a precaution.

For Abbott to face such a shutdown is significant, given the role it plays in the highly concentrated U.S. formula market. In 2008, three companies made 98 percent of the formula Americans bought; Abbott alone accounted for 43 percent of the market.

On Feb. 28, Abbott widened its voluntary recall. Supply problems have worsened since then.

According to the retail analysis firm Datasembly, starting the week of April 24, the amount of formula available on shelves was 40 percent below normal inventory levels, up from 31 percent three weeks prior and 11 percent in November.

In several states, there is half as much formula on shelves as customers would normally expect. Other analyses are less dire, but still point to a substantial shortage.

To add insult to the injury being done to babies and their frantic parents, news came in late April that a whistle-blower had contacted the Food and Drug Administration with concerns about Abbott’s Sturgis plant in October 2021, and that the FDA hadn’t interviewed the whistle-blower until December, or inspected the plant until January.

This isn’t a matter of families being unable to find their preferred brand of pureed peas. The Centers for Disease Control and Prevention reports that 84 percent of babies are breastfed at some point in their lives. But almost three-quarters of U.S. infants will eat some formula by the time they’re six months old. Even babies who breastfeed successfully might need extra help in the beginning: 19 percent of these babies eat formula in their first two days of life as their mothers’ milk comes in.

For families with unfussy little eaters, a shortage of one product might be a mere annoyance. But for those who receive aid from the federal Special Supplemental Nutrition Program for Women, Infants and Children— which limits recipients to a few brands of formula and for which Abbott is a major contract-holder—the situation is considerably more difficult.

Circumstances are even more dire for babies (and older children and adults with feeding tubes) whose life-threatening allergies or metabolic issues mean they can tolerate only certain formulas.

Brian Dittmeier, senior director of public policy at the National WIC Association, said he has heard of families starting solids earlier than they would prefer, turning to risky recipes for homemade formula, or diluting formula to make it last longer even though it might not provide the nutrition babies need.

Some parents, he said, are feeding recalled formula to their children despite the risks, because it’s the only age-appropriate food they have available. It’s a disgrace that parents have been forced to make these wrenching choices. When we spoke in early May, Dittmeier said he hoped more formula would be available within weeks. But in the interim, it’s shocking how few suggestions formula manufacturers and government agencies have offered to help desperate families.

Rep. Rosa L. DeLauro (D-Conn.), chair of the House Appropriations Committee who revealed the whistle-blower report, sounded a note of fury when I asked her what should be done.

“Parents shouldn’t have to pay a price because Abbott has a contaminated product,” DeLauro said, adding that there had to be a way to induce other formula manufacturers to get products onto shelves more rapidly.

She also invoked the possibility of using the Defense Production Act to get more formula in the pipeline: “If there was a shortage, why weren’t we in the business of making sure that wasn’t happening? What did we do in times of crisis in the Second World War, and so forth? We produced what we needed to produce.”

A spokeswoman from Abbott Nutrition declined to answer questions about what might help the company increase production dramatically and quickly, as did a spokeswoman for Danone, which makes formula brands including Neocate, one of the products for babies with severe allergies.

Robert Rankin, executive director of the Infant Nutrition Council of America, the trade association of formula manufacturers including Abbott, said his member companies were “increasing production at individual facilities; making use of global manufacturing networks; and identifying alternative methods for shipping product, including airfreight, to help mitigate shipping delays.”

He did not say whether or how the government could help.

That’s a shame. If ever there was a moment for private companies to ask federal agencies for immediate assistance, this is it.

When I floated the idea, DeLauro said she’d be willing to look into whether infant formula should be included in the Strategic National Stockpile. She plans to work with the Appropriations Committee’s agriculture subcommittee to hold hearings on the formula shortage.

Both she and Dittmeier said that in the long term, it would be worth revisiting the policies that leave families who receive public assistance reliant on certain brands, although Dittmeier pointed out that it might be hard to get manufacturers to bid on contracts without the promise that they would become the sole supplier for an entire state.

Another potential solution to avoid future shortages, suggested by the office of Sen. Sherrod Brown (D-Ohio) whose constituents include the families of the two babies who died, would be for the FDA to adopt the sort of monitoring system for formula that an agency task force recommended in 2019 to forestall prescription drug shortages.

Federal data collection about supply-chain issues, whether a lack of aluminum for packaging or spiking prices of ingredients such as vegetable oil, could theoretically be used to get ahead of shortages before they kick in. The FDA asked for the authority to do this in its fiscal 2022 budget request, released in March.

None of this will help parents who need to feed their children now, and who are spending days driving to multiple stores or obsessively monitoring online stock alerts.

“The manufacturers aggressively pursued this market,” Dittmeier said. “They’re in the hospitals, they’re in the maternity wards, they’re sending samples. They built a customer base. But what happens when they can’t provide the supply?”

We’re on the verge of finding out. The consequences could be awful for babies and terrifying for parents, who are getting a clear message from this crisis: You’re on your own.