In May, MedPage Today reported on the national infant formula recall and resulting shortage. In this report, we follow up on what has happened since the worst of the shortages, as well as what experts say should happen to prevent future shortages of infant formula.
At the height of the infant formula shortage, Jules McCarthy took the 140-mile trip from her home in Oshtemo, Michigan, to Chicago with her husband, building in stops along the way to find formula for their baby. Local stores were out of the Happy Baby Organic powdered formula she preferred, and her nearby health food stores had raised the prices by $10 per tub.
“That was just like a huge slap in the face,” the mother of two told MedPage Today. “It was just kind of really a bummer.”
But even in October, with more formula on the shelves as she transitioned her youngest son to solid foods, McCarthy still had to visit multiple stores to find it.
Since the February 2022 recall by Abbott Nutrition and the resulting infant formula shortage that left new parents scrambling to feed their children safely, it’s become easier to find most formula on shelves. But the national supply still hasn’t stabilized, and experts say the country still has a ways to go before families can easily get what they need, let alone trust government and industry to prevent another crisis.
“It’s not like how we choose foods as adults. [Infants] are reliant on caregivers, and they trust, obviously, whoever that is to keep them safe,” said Cecília Tomori, PhD, of the Johns Hopkins School of Nursing in Baltimore. “And in this case, Abbott didn’t.”
She continued, “In terms of the order of priority, all of the FDA needs reforming. But this issue requires special attention, more than what it’s been given so far.”
The Initial Crisis
Months after an outbreak of a rare bacteria, Cronobacter sakazakii, sickened five infants and killed two in late 2021, it was traced to formula from a Michigan plant owned by Abbott Nutrition, one of the nation’s largest infant formula makers.
A belated FDA inspection revealed the presence of strains of the bacteria in multiple areas in the plant, along with other safety problems, and noted that the firm itself had found 20 instances of Cronobacter species in production areas in February alone. The plant closed, and Abbott recalled a number of powdered formulas in February.
The plant closure set off a national shortage that left shelves empty and parents panicked. Families of infants and even older children who needed specialty formulas, especially those in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program were left with few options but to fend for themselves.
Out-of-stock rates for baby formula were under 18% in early December, according to some reports; by comparison, grocery and retail data purveyor Datasembly reported that rate had been an alarming 43% in May.
“The situation is undeniably better than it was in April, May, June, July. No question about that,” said Steven Abrams, MD, a spokesperson for the American Academy of Pediatrics and a professor of pediatrics at the University of Texas at Austin. Even now, though, he said, “there are a couple of specific sore spots.”
According to the most recent data available from the Census Bureau’s Household Pulse Survey, even as late as mid-November, 33.86% of people living with infants under age 1 reported difficulty obtaining infant formula. And rural-urban disparities deepened, Abrams said, as those with access to big-box retailers more easily found formulas.
Meanwhile, Facebook groups for exchanging or selling infant formula remain active, and parents are still airing their frustration online. In comments on a since-deleted Reddit post from December 6, parents described problems finding both Similac brands from Abbott and Enfamil brands from Reckitt Benckiser, especially hypoallergenic and specialty formulas.
One user whose 2-month old son is allergic to milk wrote that the hypoallergenic formula is expensive, and “it is IMPOSSIBLE to find,” even after trying multiple stores and brands. “So here we are, yet again, trying desperately to make breastfeeding work, despite the toll it takes on me mentally and physically. … We’ve been totally forgotten about.”
As of press time, multiple brands of powder in various sizes — including Similac’s hypoallergenic Alimentum, Enfamil’s equivalent Nutramigen, Similac 360 Total Care, Similac Advance, Enfamil NeuroPro — were out of stock at Target, Walgreens, Walmart, and on the formula company sites.
On Enfamil’s website, a note read, in part, “Since the recall by another manufacturer, resources have been added to address the need but unfortunately, the wave of online orders is significant.” A vice president at Enfamil-maker Reckitt told Reuters that the shortage is expected to extend into the spring of 2023.
“It’s kind of mind blowing that this isn’t a state of emergency,” another Reddit user recently wrote. “[I]t’s been this long and the problem hasn’t been fixed.”
In August, the USDA announced it would extend a series of waivers granted to state WIC agencies to allow families to substitute sizes, forms, and brands of formulas until December 31, 2022. The recall made it clear that WIC customers, who account for more than half of all U.S. infant formula use, were limited to purchasing only limited brands that contract with the program and could not easily switch. Also, they were unable to order formula online with their WIC benefits.
A law passed in May called the Access to Baby Formula Act would compel formula manufacturers with WIC contracts to plan for potential supply disruptions and grant the Secretary of Agriculture other emergency powers to waive red tape in case of such disruptions.
The FDA published an evaluation of its formula response, which offered recommendations to modernize data systems, improve emergency responses, provide specialized training to investigators and expand their foods workforce, improve industry accountability, and build better regulation around preventing Cronobacter contamination specifically.
An FDA official, in an email to MedPage Today, highlighted additional FDA efforts since the recall and shortage, including retraining investigators on infant formula inspections, using what is known as “enforcement discretion” to allow nine manufacturers to sell their products on U.S. shelves with certain flexibilities around FDA-mandated labelling and other requirements, and working with the CDC to implement a national reporting system for Cronobacter infections.
An external review of the FDA foods program by the Reagan-Udall Foundation went even further, calling for the FDA to require formula manufacturers to share their product testing records and to use its mandatory recall authority “more frequently.”
Beyond the Shelves
But experts say the federal government and formula companies have yet to address some of the underlying problems that made the country so vulnerable to a meltdown: a few big companies dominating the formula market and WIC contracts, a lack of basic support for women who can breastfeed, and a long history of predatory formula marketing toward low income families and people of color that Tomori says misleads families and discourages breastfeeding.
Abrams says an industry where 80% of the market is dominated by two companies needs to expand. To that end, “I think we need to be cautious about reimposing tariffs on imported formulas,” Abrams said. The milk industry is lobbying to keep tariffs on imported infant formulas as Congress decides whether to let its temporary tariff removal on baby formulas expire on December 31.
Experts agreed that new parents need paid leave in order to care for their infants, education about breastfeeding, and safe spaces to pump milk in the workplace – basics that would give more parents a choice to use formula instead of a mandate. “Imagine the mom is working and … trying to pump for her baby while she’s working at any of the retail chains,” said Abrams. “It’s not easy to do.”
“We need to look at a much deeper kind of examination of how we got here, and what we can do to improve this at all levels: obviously increasing safety at the plants themselves,” said Tomori, “but also really investing in protecting, promoting, and supporting breastfeeding and holding society accountable for that support — not individual families.”
What Should Parents Do?
In the short term, pediatricians urged parents to avoid using formula workarounds. Abrams stressed the importance of avoiding homemade formulas, despite a history of the practice, because these can throw off the balance of nutrients an infant needs and aren’t sterile.
“There’s a reason why formula was developed. It was no secret to the medical literature [of the] ’50s and ’60s that homemade formulas worked for some and not for all,” Abrams said, citing high rates of anemia.
Doctors also stressed that parents should not dilute formulas to stretch their supplies, as this can also harm an infant’s growth and development.
For parents who still can’t find specialty formulas, “it’s important to talk to the pediatrician and [have them] tell you one brand name, and say, ‘If I can’t find that, what else is identical?'” said Abrams. He also encouraged parents to be “a little bit patient” when making substitutions, for which there are lists on state WIC websites.
Abbott Nutrition did not respond to requests for comment in time for publication.