As most everyone now knows, the United States is in the grip of an unprecedented crisis, the formulas that so many of our infants depend on to live are suddenly in very short supply.  Right now across the nation, stores are reporting that the availability is down 43%.  Many parents in many states are reporting they simply cannot find formula to feed their baby.  And our babies must be fed.

The urgency of course has led many families to try to buy extra in case supplies really dry up, which only pushes the supply to dry up faster.

How did this come to be?  What can be done?

What is Formula

Formula is an unusual food.  It is not grown, and it is not raised.  Over 100 years ago, the composition of human breast milk was described enough to have a template to create a food that could mimic it closely enough to help those babies not able to nurse to live.  That formula is very strictly defined, and includes settings like having to contain exactly 20 calories per ounce.   Every infant formula sold, with the sole exception of speciality formulas to promote faster growth in premature or gut challenged infants, has this exact calorie count.  The same uniformity defines how many grams of protein, fat, and carbohydrate are in an infant formula, and the ratio of calcium and phosphorus, and the level of vitamins and minerals.

That is why it’s called formula- there really is only one formula to manufacture infant formula.   Most variations in formula sold across the nation have nothing to do with these formulas of nutrition, but rather reflect the food that is the base of the formula, and if the protein is pre-digested or not.  The two dominant sources of food from which formula is manufactured are milk (from cows and other mammals) and soybeans.   With regard to any protein in a formula, it is a fact that every protein in any form of life is a long, long chain of amino acids.  Take thousands of amino acids, link them in a chain, and it will automatically fold into a unique protein.  From a nutritional point of view you can take a pound of protein, each of which is 1,000 amino acids long; or, take a pound of the same protein and separate each of the 1,000 amino acids in each protein molecule yielding a pound of the same amino acids, just no longer attached to each other- and you have exactly the same nutritional value.  But from an allergy point of view the formula whose proteins are separated into amino acids can no longer cause allergy, which always happens when a baby’s immune system recognizes the protein and reacts to it.  Almost no one can react to a sole amino acid.

It is now clear that formula is manufactured.  There are home recipes, but they are risky, you get the actual formula wrong and you can impair your infant’s growing.

How We Came Up Short

I wonder how many of our readers know who is the largest purchaser of infant formula in the US?  Is it first time mothers, grandparents, mothers in the Southeast US or in California?  Each of these answers would be quite wrong.  The correct answer does not involve anyone purchasing it as a mother, only for caregivers.  And that is a US Federal agency called WIC.  WIC is the agency that provides nutrition to families who cannot afford to feed their babies.  Now in the United States, fully 50% of all infants are born into poverty, and therefore, depend on WIC to feed their babies.  With fully half of all formula purchased by one entity, WIC has a determining influence on the marketplace.  And with that power, WIC has elected to only purchase formula from essentially three companies:  Abbott (which makes Similac), Mead Johnson (which makes Enfamil) and Nestle  (which in the US makes Good Start through Gerber).

#1  Only 3 companies make nearly all the formula in the United States

So the first step in the this crisis being formed is the concentration of manufacture of formula largely in the hands of 3 companies.  By the way, it is essentially only these companies that make all the formula that stores put their labels own, like Walmart, CVS, Walgreen’s formula brands, etc.

#2  Formula is a product that is caught up in our recent trade wars

The next step has to do with picking fights with our trading partners, including Europe and Canada which began in earnest under our last administration.  Right now if the US knows a can of formula is imported it can face tariffs that will raise its cost 17%.

#3  Europe makes formula with sometimes slightly different ingredients

Our FDA sets very tight rules for what the “formula” to make infant formula is, down to the source of the sugar.  It requires more of our infant formula be made with corn syrup than European formulas which use more lactose as the sweetener.  The result is that our FDA does not approve of many formulas manufactured in the US.

#4  Massive swings in demand.

When COVID first struck in 2020, people hoarded not only paper towels and toilet paper, but formula, so much of the US supply was purchased.

Then in 2021, the number of babies born plummeted, 500,000 fewer!  So demand dropped, and manufacturers dropped the amount of formula made.

Now in 2022, an unusual drop in breastfeeding is happening, sharply increasing the demand for formula, just after a year of depleting our reserves, and a year of making less of it.

#5  Put it all together, and add a major plant shutdown.

The topping that plunged so many into trouble right now came at the hands of a bacteria called Cornobacter skazakii or C.s. for short.  C.s. is not a common bacteria, and in adults tends to cause little or no harm. But if it gets into the gut of an infant it can be deadly and damaging.  It can get into the baby’s body and infect the brain causing meningitis, or the bloodstream causing sepsis.  Tragically C.s. found its way into the manufacturing plants of Abbott in Michigan where a lot of Similac was made.  That fact was discovered by infants getting C.s. infection, 4 ended up hospitalized and at least one has died.   As soon as Abbott heard, it shut down the Similac plant, recalled all lots that could have contained the germ.

Abbott recently announced it will take over 10 weeks to reopen the plant.  The problem is that the sudden drop in formula manufacture right now sinks the market.  There are only 2 dometic manufacturers who could fill the gap, and they can’t given the sequence of depleted reserves, a drop in demand, and now a surge of demand- before the Abbott plant closure.

And we can’t make up the different internationally, the FDA has not approved of enough foreign manufacturers to allow the gap to be filled, and there are stiff tariffs on them as well.

What To Do?

The first piece of good news is that our national community is taking this very real crisis very, very seriously.  Just this week the President of the United States announced formally this crisis is recognized and the full power of the US government is now behind making sure all our babies can be fed and well.

The VERY BEST guidance has been provided by the great American Academy of Pediatrics.

Here is their advice: https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/What-should-I-know-about-the-infant-formula-recall.aspx#:~:text=Some%20of%20the%20recalled%20formulas,and%20Similac%20PM%2060%2F40.

The most important thing you can do for your baby if you face any threat of a shortage of formula, is to go to this guidance.

It is detailed, well-written and covers the ground very, very well.

Bottom Lines:

1. A series of realities have combined in a rare moment causing the US supply of infant formula to be severely depleted.  The national stockpile is down 43%!
2. Infant formula is not so easy to make.  The actual composition is very, very carefully defined to match that of breast milk, very precisely.  If someone makes a formula not matching these specifications, harm can be caused.
3. A combination of pandemic swings in demand and depletion of stores, along with a tragic contamination of a major Abbott plant that makes Similac has plunged us into this crisis.
4. The good news is that the US government has weighed in, I have no doubt that formula will be flowing again, hopefully very soon.

In the meantime, be careful, read these guidelines carefully to ensure your baby, if he or she needs formula, can have it provided safely and thoughfully:

https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/What-should-I-know-about-the-infant-formula-recall.aspx#:~:text=Some%20of%20the%20recalled%20formulas,and%20Similac%20PM%2060%2F40.

To your health,
Dr. Arthur Lavin