A bad choice and a shortage of formula milk

Infant formula is the target of shoplifting rings. Its supply has been disrupted by Covid lockdowns. Its demand pattern has been disrupted by the pandemic-induced changes in baby retail and manufacturing. Add to that the fact that half of the US supply is consumed by welfare recipients, who are limited by regulations to a choice of three manufacturers. Add federal rules that make it difficult to relieve a national shortage by importing foreign-made supplies.

And yet, the shocking infant formula crisis of 2022 is no occasion for your perfect storm metaphors: the key factor that overwhelms all others is a government decision in February to force the closure of a factory and the product recall at an Abbott Labs facility in Michigan.

The four cases of Cronobacter sakazakii the infection in infants that the government cited could not be attributed to the factory’s products. No contaminated infant formula was found; Cronobacter was identified in the factory field, but had no genetic match to samples from affected infants. A thoughtful response might have been to keep the plant running and carefully check its output for contaminated formulas, but that is not the response the Food and Drug Administration has chosen and thus hangs a tale.

As one textbook puts it, Cronobacter is a “single product-population problem” – the product is powdered infant formula; the population consists of neonates, particularly low birth weight neonates.

An environmentally common and resilient bacterium with unusual resistance to arid conditions, Cronobacter generally causes disease only in the elderly and immunocompromised. The big exception is very young infants – 2 months or younger or with compromised immunity – who can develop life-threatening complications like sepsis and meningitis.

The natural reservoir of Cronobacter is uncertain, but the bacterium is easily found on plants, in soil, on meat, cheese, fruits and cereals, in sewage, in herbal teas, etc. A 2014 U.S. government study found specimens at premises in 38 of 55 United States. powdered milk manufacturing facilities, with 4.4% of 5,671 “swabs and sponges” testing positive. Although contamination from factory-sealed products was rarely seen, unlike more expensive liquid versions of infant formula, the powdered variety proved impractical to sterilize.

In the United States, contamination at home is clearly the big risk, “after opening the container”, as the Centers for Disease Control and Prevention put it. Cronobacter has been found on lids, spoons and bottles and in stored water. For parents of infants in vulnerable categories, the CDC recommends mixing powdered formula with water heated to 158 degrees Fahrenheit before serving the cooled solution to an infant.

To complicate matters, the incubation of Cronobacter is estimated to take at least four days and sometimes as long as 21, so a parent’s anecdotal hunch that a specific formula may be involved is not enough. Only one state, Minnesota, tracks Crononbacter infections. The CDC says it receives reports of two to four childhood cases per year, but has no idea of ​​the true incidence and points to recent evidence suggesting mild infection may not be uncommon in all age groups.

With this context in hand, particularly the lack of evidence that the plant was the culprit, it’s hard to resist one conclusion: in shutting down Abbott’s plant, the FDA acted with a zero-risk mentality in its own bailiwick: protecting infant formula. plant contamination, regardless of the costs and risks that would be someone else’s problem. These include a nightmare for parents and a risk of malnutrition for thousands of newborns, especially those who need doctor-prescribed formulas that only the Michigan plant produced.

When have we heard this story before? Almost daily during the Covid crisis, government agencies and politicians who have made blind decisions more in their own narrow interests than in the interests of the wider public. Remember the FDA’s self-protective perfectionism that delayed lab and later home testing for Covid long after other countries had them.

The media are often useless in this respect. “Following the science” can serve as a smokescreen to avoid often complex and uncertain science in favor of partisan stereotypes and tales of villains and heroes. In recent days, the FDA has continued to rationalize its behavior with a laborious and showy “rule” that will allow the Michigan plant to reopen; Because the Defense Production Act has become a “thing” for the media during the Covid crisis, the Biden administration on Tuesday invoked the DPA and sent military-affiliated air carriers to deliver infant formula from foreign origin.

Congress held hearings on Thursday. We may be witnessing only the beginning of the political circus stemming from a single act of questionable judgment by the FDA.

Wonder Land: Joe Biden prefers to talk about racism and weapons rather than confront the real problem. Images: AFP/Getty Images/Reuters/Shutterstock Composite: Mark Kelly

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