Unprecedented regional coordination in SE Asia mandates ‘stronger regulation of infant formula’

Unprecedented regional coordination in SE Asia mandates ‘stronger regulation of infant formula’

In July 2020, complaints surfaced on social media after seventeen infants and young children were hospitalized in Cambodia due to severe anemia. With the support of partner organizations including Alive and Thrive, the Cambodian government conducted independent investigations, and traced the problem back to Nutrilatt infant formula, a breastmilk substitute (BMS) produced in Singapore. The lab work showed that iron was nearly non-existent, with less than 5% of the amount that was stated on the label. The concentration of zinc, which boosts the immune system and metabolism, was only half of what was claimed.

In response, the Royal Government of Cambodia issued an order to stop the import and distribution of Nutrilatt BMS products. “The Cambodia Ministry of Commerce took swift action, even while the company disputed the charges,” commented Rachel Pickel, United Nations Children's Fund (UNICEF) East Asia and Pacific Regional Legal Consultant. Soon after, information about the substandard product was shared in the region with Viet Nam and Myanmar, who set the wheels in motion in their own countries to test and regulate the product.

The rapid response among Cambodia, Myanmar, and Viet Nam sets a precedent for South-South coordination in the region. “This is the first time that information spread this fast and Food and Drug Administrations (FDAs) in all three countries reacted quickly,” Rachel added.

In compliance with The International Code of Marketing of Breast-milk Substitutes and subsequent World Health Assembly (WHA) resolutions, the Myanmar FDA advised the public not to use Nutrilatt formula and to report to FDA if such products were seen in the market. 

Myanmar photo - UNICEF/Minzayar Ooyar Oo

Dr. Kyaw Win Sein, Nutrition Specialist for UNICEF, recalled the sequence of events. “As a focal person for the enforcement of BMS code, after receiving the information from the UNICEF East Asia and Pacific Regional Office and local non-profit Alive & Thrive, I provided information to discuss with government counterparts including the FDA to take immediate action from Myanmar.”

The issue was tabled in Myanmar’s Nutrition Emergency Strategic Advisory Group, a coordination mechanism that includes civil society organizations active in the SUN Civil Society Network (CSN) and the Scaling Up Nutrition (SUN) United Nations Network (UNN) in Myanmar, which includes FAO, UNFPA, UNICEF, UNOPS, UN WOMEN, WFP and WHO. It was decided that the UN should respond as well as the FDA. “Normally, coordination is quite [slow]; you don’t receive responses from everyone. But amazingly, this was the first time we’ve received feedback from 100 percent of all the agencies involved,” observed Soe Nyinyi, UNN-REACH [1] Facilitator. 

On 7 October 2020, a joint statement was issued by Myanmar’s UN Network: Stronger regulation of Infant Formula and Formulated Foods required to ensure proper child nutrition. In the two-page document, the public is warned about the dangers of Nutrilatt formula due to the lack of iron and zinc. The importance of exclusive breastfeeding for the first six months of life is emphasized to support optimal infant development as well as to mitigate the likelihood of becoming overweight or obese and the onset of non-communicable diseases such as diabetes later in life. Likewise, the “Order of Marketing of Formulated Foods for Infants and Young Children” is cited as the standard for safety.

Further on, the statement makes recommendations for stronger regulation of infant formula in the future. To this end, UNICEF is coordinating with the FDA to check compliance of the formula companies every six months, when formula companies are required to send a sample for testing. Finally, the statement urges companies to refrain from misleading marketing and promotion practices, that ‘unethically engage health care professionals, celebrities and social influencers to promote follow-on or growing-up milk formula.’ [2] According to Soe, these tactics have led to the product’s popularity.

The joint statement was posted on government, SUN and UN websites as well as social media platforms such as Facebook, where parents were counseled to make informed choices. “After it was agreed that the SUN UN Network would issue a joint statement, UNICEF Myanmar Country Office communicated to SUN CSA that both SUN Networks ‒ SUN UN Network and SUN CSA ‒ had a collective mandate to support the Government of Myanmar in encouraging optimal IYCF practices and ensuring implementation and enforcement of the Order of Marketing on Breast-milk Substitutes,” Rachel recalled. Based on SUN CSA’s past activities on monitoring the implementation of ‘the Code’, including submitting numerous reports of Code violations and breeches in the Order of Marketing to the Government, the SUN CSA decided to issue its own statement of appreciation for the swift action taken by the FDA to protect children.

Sanjay Kumar Das, a nutrition specialist with UNICEF, is pleased with the collective action taken on this issue. “When we got this message from Cambodia, immediately we coordinated with UN agencies and CSN to explore the situation in the context of Myanmar. With the support of FDA, we quickly got the message that one product was used by local people. We thought it would be better to have a joint statement, with UNICEF as the lead and chair of SUN [UNN], will be more effective in highlighting the importance of the issues. We are together. We have the same voice and the same stand.”

Footnotes:

[1] REACH stands for the Renewed Efforts Against Child Hunger and undernutrition initiative, which is the intensive support arm of the UNN’s multi-sectoral technical assistance facility.

[2] https://www.unicef.org/myanmar/press-releases/stronger-regulation-infant-formula-and-formulated-foods-required-ensure-proper-child 

Photo credit @ UNICEF/Minzayar Ooyar Oo