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What’s behind the US infant formula shortage – and how to make sure it doesn’t happen again

An infant nutrition expert explains what is behind the current formula shortage and what can be done to support hard-pressed parents.

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No easy formula. Stefani Reynolds/AFP via Getty Images

A baby formula shortage has added to the woes of American parents already confronted with the pressures of raising an infant during a pandemic in a country ranked low for family-friendly policies.

Media reports have highlighted the plight of mothers, fathers and caregivers across the U.S. who have scrambled to find scarce supplies, or driven long distances to buy formula.

But what is behind the shortage? And how can it be prevented from happening again? The Conversation asked Dr. Steven Abrams, a leading expert on pediatric health at the University of Texas who has advised both the formula industry and government on infant nutrition, these questions along with what advice he could give parents facing problems getting adequate supplies of infant formula.

1. Why there is a shortage of formula now?

There are really two factors that have driven the current shortage. First, we have the supply chain problem, which has affected all manner of goods since the onset of the pandemic. It eased off a little, but then at the beginning of 2022 it became worse.

Then in February a major baby formula manufacturing plant in U.S. went down. The FDA shut down Abbott Nutrition’s factory in Michigan. The closure came after Abbott’s nationwide recall of multiple brands of formula, including routine Similac cow milk-based formulas such as Similac Advance and several specialty formulas for allergic babies, including Similac Alimentum and and Similac EleCare.

Closing the factory had to be done amid an investigation into bacterial infections in connection to powdered formula produced at the plant, and the deaths of at least two babies. The problem is there just isn’t much redundancy in U.S. infant formula production. In other words, there aren’t enough other factories to pick up the slack when one goes down. The Michigan plant is the largest producer in the country, so when it goes down, it put added strain on the entire U.S. formula distribution system, especially for certain formulas for babies with high-risk allergic diseases and metabolic disorders.

Over the last couple of weeks the shortage has gotten worse. I can’t say for sure why this has happened. But I suspect there has been some hoarding going on as parents get anxious. Stores can limit the amount of formula that people can buy, but that doesn’t stop people going online to buy more.

On top of that, the shortage has gained wide publicity in newspapers, on TV and in political speeches. All that publicity feeds into public sense that the system is failing, prompting more panic buying and hoarding.

2. Who is the shortage affecting?

A majority of parents will feed babies with formula at some point to meet their nutritional needs, especially older infants. At birth and in days immediately after, around 80% of babies receive all their nutrition through breast milk. But by the age of 6 months, the majority of babies get at least some formula. The proportion of year-old babies receiving formula is even higher. This is largely the result of social dynamics and pressures - mothers going back to work after giving birth, but not receiving sufficient support to produce and store sufficient amounts of breast milk.

But the shortage will affect some parents more than others. Not surprisingly, the most affected parents are those on the lowest income. The federal food program for poorer women, infants and children, called WIC, provides formula for a majority of babies in low-income families. But costs have gone up and formula has become scarcer.

I’m hearing of some families driving two hours to find stores selling formula. Obviously that will be harder to do for poorer families as there are costs involved. Likewise, more affluent parents may be able to buy more expensive, so-called elite brand formulas.

The other thing to note is that the shortage is affecting both regular infant formula, and specialized versions. Regular or standard formula is the type most families are familiar with, and around 95% of formula-fed babies get the standard type. Specialized formula is for babies with unusual requirements, due to allergies, damaged intestines or special nutritional needs. Before the Michigan factory closed, it made most of the specialized infant formula used in the U.S. So it is an absolute crisis for families needing that type of formula.

3. What are the potential consequences of the shortage?

In the first six months, babies should only have breast milk or formula – anything else fed to them will be nutritionally incomplete. So there is a risk that a shortage will mean that babies will not be getting the nutrition they need to develop. That could lead to a range of health problems affecting their physical growth and brain development.

Then there are concerns that parents may be using unsafe alternatives, like watering down their baby’s formula. People have been known to try and make their own by mixing powdered milk or vegan milk with vitamins. Not only are these alternatives not nutritionally complete, they may not be entirely sterile.

After the age of six months, things get a little better once the infant is able to start eating solid food. But even then, formula or breast milk remains the primary source of nutrition. So there may still be a risk of nutritional deficiencies, such as iron deficiencies.

4. Are there any viable alternatives?

Over the age of six months of age, for only reasonably short periods of time, parents can feed infants whole cow milk and look into iron supplements.

It isn’t ideal, and only applies for older babies. For those under six months old, cow milk is a real problem. It doesn’t have the right protein blend for babies and has next to no iron – risking anemia in very young babies. Cow milk also has a misbalance of minerals, especially for younger babies.

So what guidance is there for low-income parents?

It is challenging and I can’t provide a magic answer. But food banks and the WIC program have been a crucial lifeline. The WIC program in particular has proved itself to be very flexible during this shortage. When Abbott had to recall products and then couldn’t provide enough non-recalled formulas in states in which they were the WIC provider, WIC was able to change providers and reprogram EBT cards to allow low-income parents to buy different brands.

5. What can be done to prevent this situation happening again in the U.S.?

First we need to help families regain confidence in the formula production and supply system. This will prevent problems such as hoarding or making home brew formulas.

Then we need to look at how to make sure one plant going down doesn’t affect the whole system. The federal government can’t stockpile formula in the same way it might stockpile oil, as formula has a shelf life. But diversifying infant formula production is a possibility. This would involve making sure multiple factories and companies are making the formulas that this country needs. This doesn’t necessarily mean increased costs – competition could potentially drive down prices.

I believe America also needs to look at the country’s breast feeding support system. Don’t get me wrong, some parents will always need formula. But those who want to breast feed need everything possible done to support them. That includes better family leave policies, and help for low-income mothers who want to pump and store milk while they work.

Steven A. Abrams received funding from Perrigo Nutrition for research related to food insecurity in Austin during the COVID-19 pandemic and has given paid presentations on nutritional physiology to Abbott Nutrition's educational unit, ANHI.

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Tesla’s Situation In Shanghai Is An “Epic Disaster” For Its June Quarter, Wedbush’s Dan Ives Says

Tesla’s Situation In Shanghai Is An "Epic Disaster" For Its June Quarter, Wedbush’s Dan Ives Says

As Elon Musk continues to publicly melt…

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Tesla's Situation In Shanghai Is An "Epic Disaster" For Its June Quarter, Wedbush's Dan Ives Says

As Elon Musk continues to publicly melt down on Twitter about his proposed buyout offer and the left's "dirty tricks" and political attacks that he is expecting, Tesla stock has been plunging.

The automaker's stock came under pressure weeks ago, ostensibly after some investors started to do the math behind Musk's proposed buyout offer of Twitter.

This morning, it's under pressure again thanks to a price target cut by Wedbush's Dan Ives, who has cited Shanghai's lockdowns as his reasoning. 

Ives called the situation in China "an epic disaster" for Tesla's coming June quarter and said he expects to see "modest delivery softness", according to a Bloomberg note out Thursday morning.

Ives also said he is expecting a "slower growth trajectory" in China into the second half of the year and called the headwinds out of Asia "hard to ignore".

He also commented that the ongoing Twitter drama "may be a distraction" for Musk at a time when his attention should be focused on dealing with Tesla's issues. 

Recall, we noted days ago that "no vehicles were sold in Shanghai last month" as a result of the lockdown, according to an auto-seller association in the city. 

We also noted that Tesla's plans to restart Shanghai to its pre-pandemic production levels had been pushed back another week. Citing an internal memo, Reuters wrote just three days ago that Tesla is still planning on just one shift for its plant this week and a daily output of about 1,200 units.

Tesla is aiming for 2,600 units per day by May 23. 

Additionally, it was reported Monday that Tesla would be recalling over 100,000 vehicles in China. 107,293 vehicles in China will be recalled "due to safety risks", according to the China People's Daily

The recall, which relates to a defect in the central touchscreen during fast charging, "involves Model 3 and Model Y vehicles produced in the country between Oct 19, 2021, and April 26, 2022," the report says. 

Tyler Durden Thu, 05/19/2022 - 08:26

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Joined up thinking needed for joined up data plans

Joined up data could transform the pharmaceutical industry and help create a healthier Europe for decades to come
The post Joined up thinking needed for…

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Joined up data could transform the pharmaceutical industry and help create a healthier Europe for decades to come – but the route to change is far from smooth sailing.

Without careful consideration and full stakeholder input, the EU’s plans for a connected data system could end up being counterproductive.

That’s the view of the European Federation of Pharmaceutical Industries and Associations (EFPIA), which has published a list of recommendations aimed at helping the sector get the most of out of the data it holds.

“If the European Health Data Space (EHDS) and the rules surrounding access to the data are not carefully thought through, with the involvement of all stakeholders, there could be unintended consequences that limit the utility of the data for developing innovative medicines,” said the organisation.

Huge potential

The EFPIA Recommendations on a Connected Data System in Europe, published at the end of April, welcomes the proposals, which are part of the European Strategy for Data, to create common data spaces.

Said the authors: “A connected health data ecosystem has the potential to empower more effective and efficient research and development of new treatments and diagnostics. It would also ensure better planning and delivery of patient-centred care through personalised medicine.

“This, combined with value-based healthcare, can result in better allocation of resources and more sustainable healthcare systems.”

The value of this approach, which places real-world data in the hands of the right people at the right time, was demonstrated in abundance over the last few years, they went on.

It was, they explained, stakeholders from across the healthcare ecosystem coming together to share insights, whether from clinic, research, or genomics, that changed the course of the COVID-19 pandemic.

Applying the same ethos to healthcare in general, then, could give the drug development sector all the information it needs to contribute to a fitter, healthier Europe.

“For the research-based industry, access to data is critical at every step. From accelerating drug discovery to understanding patients’ behaviours and the outcome of treatment, the availability of data is essential to testing hypotheses, identifying trends and assessing proposed treatments,” they said, adding that improved access to, and transmission of, health data could “transform the pharmaceutical industry”.

“A connected health data ecosystem has the potential to empower more effective and efficient research and development of new treatments and diagnostics. It would also ensure better planning and delivery of patient-centred care through personalised medicine.”

 

Significant challenges

While EHDS is a lofty ambition, bringing it to fruition will not be without its challenges, both practical and regulatory.

As the EFPIA paper points out, health data is currently held in a wide range of repositories, from clinical notes and electronic health records to insurance claims, patient registries, patient-reported outcomes records, and continuous patient monitoring data from apps and wearables.

Unlocking their value, then, requires a high level of interoperability between different IT systems, providers, data sources, and software, all based in different countries with different levels of infrastructure maturity.

“Healthcare system information must be better connected. This will allow stakeholders to use this data for optimising and improving health outcomes,” said the paper, adding that interoperability was a “critical enabler of the digital transformation of healthcare in Europe”.

Conflicting national laws could be another important barrier to data access and use. Varying interpretations of the General Data Protection Regulation (GDPR), for example, present challenges for clinical development of innovative medicines, said the authors.

“Conflicting interpretations of Article 9 of the GDPR, and the additional limitations on processing of health and genomic data that member states have enacted under this article, cause significant delays in study start-up and patient enrolment.

“Some member states take the position that the only lawful basis for processing health data is when individuals have given their consent for its collection and use. Others… take the position that processing this health data, when necessary for scientific research, is lawful.”

EU Data Protection Supervisors, the paper recommends, must reach a common understanding of key GDPR terms if citizens are to enjoy the same rights across the EU.

Practical solutions

The EFPIA paper makes a number of recommendations on how the EU could embrace the full potential of the proposed EHDS.

First, it says that developing a shared understanding of the relevant requirements in digital health is essential, and calls for an EU-wide approach to how data is accessed, pooled, compared and used, while also protecting privacy.

In terms of possible solutions, it points to the use of Federated Data Networks (FDN), in which separate networks share mutual RWD resources.

“In an FDN, data is not moved from its host source, though hybrid models can exist with local and central data hosting. The research question or query moves to where the data is originally hosted, with results aggregated centrally or delivered to the researcher,” said the authors.

This, they went on, could unlock the power of data in primary or secondary care settings, in clinical care decision-making, and in research, whilst preserving the privacy of the RWD at a local level.

Common data models (CDM), which standardise the logical infrastructure of software systems to enable interoperability, are also required.

“CDM is essentially a construct, a means to an end to help organise RWD into a common structure, formats, and terminologies across diverse, heterogeneous, and multiple source datasets,” said the paper.

“It addresses a central need to be able to curate data for analysis on a contemporaneous and continuous basis (not on a per study basis) or for largescale, geographically diverse, network studies of multiple data sources.”

 Joined up approach to joined up data

Ultimately, building a usable EU-wide health data system requires input from all stakeholders, and decisions on FDNs and CDMs should be taken internationally, as a sector.

Because, as the EFPIA says, we all have one goal: using the power of data to improve the health of the citizens of Europe.

About the author

Amanda Barrell is a freelance health and medical education journalist, editor, and copywriter. She has worked on projects for pharma, charities and agencies, and has written extensively for patients, HCPs and the public.

The post Joined up thinking needed for joined up data plans appeared first on .

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Weekly investment update – The soft underbelly of hard inflation data

Warnings by the US and Chinese authorities have underscored the dilemma of conflicting inflation and growth data, with energy and tight labour markets…

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Warnings by the US and Chinese authorities have underscored the dilemma of conflicting inflation and growth data, with energy and tight labour markets pushing up producer and consumer prices amid creeping signs of softening growth. This has put global monetary policy, and markets in risky assets, in a bind.

The Dow Jones Industrial Average fell for the seventh consecutive week last week, while the benchmark US Treasury 10-year yield hovered around 3.0% (almost double the 1.6% of a year ago). Commodity prices came under selling pressure as risk aversion among investors mounted. Safe-haven flows pushed up the US dollar, driving its trade-weighted index to near two-decade highs (see Exhibit 1).

Policy warnings…

China fanned market worries early last week, with Premier Li Keqiang warning that the domestic jobs situation was getting ‘complicated and grave’. The country’s zero-Covid policy is taking a heavy toll on the local economy with negative spillover effects globally. While Shanghai’s lockdown may be wound down soon, other major cities (including Beijing) are facing renewed restrictions.

US Federal Reserve Chair Jerome Powell issued a warning mid-week: The Fed could not guarantee a ‘soft landing’ as it looked to get runaway inflation back to its 2% target amid a tight US labour market. The US Senate nonetheless overwhelmingly confirmed Powell for a second term, signalling monetary policy continuity.

Earlier in the week, former Fed Chair Ben Bernanke warned about the risk of stagflation in an interview with The New York Times.

Aggravated by hard inflation data…

US consumer price inflation was 8.3% YoY in April, down slightly from 8.5% in March. However, core inflation (which excludes food and energy prices), rose on the month from 0.3% to 0.6%, a level still too high for the Fed’s comfort.

Services inflation was particularly strong, rising by 0.7% MoM in April, marking the biggest monthly gain since August 1990. Underscoring continued robust consumer demand, retail sales rose by 0.9% vs the prior month, though this marks the third month in a row that the growth rate has decelerated. 

The prospects for inflation to fall back to the Fed’s 2% target anytime soon may not be good: High wage growth – hourly earnings rose at around 5% YoY – could continue to fuel inflation in the near term. We note that services inflation tends to be much stickier than other index components.

From the Fed’s perspective, these price pressures could in turn drive inflation expectations higher.

The market perceives the latest inflation report as sealing a 50bp rate rise at the June and July meetings of Fed policymakers. It also boosts the chances of the Fed persisting in its aggressive tightening stance at later meetings. A key question is the extent to which – and when – higher interest rates will hit real incomes and crimp demand growth, slowing the economy overall. 

The high services inflation data also suggests labour market tightness would have to ease significantly to bring wage growth back to levels that are acceptable to the Fed. We believe something will have to give. If not, the Fed may have to tap harder on the brakes down the line.

The ECB continues to move closer towards a hawkish policy, with the market now expecting its asset purchasing programme (APP) to end in July, to be followed by a 25bp rate rise soon after. Underpinning the ECB’s policy tightening stance is strong inflation, which rose by 7.4% YoY in April (same as in March), and falling unemployment (the jobless rate hit a record low of 6.8% in March).

The war in Ukraine has added to the upside risks to inflation via food and energy price increases and supply bottlenecks. In addition to higher inflation, the ECB also appears to be concerned about the spillover effects from wage increases. An increasing number of policymakers has spoken out recently in favour of an initial rate rise as soon as July.

And creeping signs of slower growth

Indications of weakening growth momentum have appeared, most noticeably in the UK where GDP growth contracted unexpectedly by 0.1% MoM in March.

In the eurozone, industrial production shrank by 1.8% MoM in March and manufacturing output was down by 1.6%. The main culprit was disruption caused by the war in Ukraine. The weakness was concentrated in Germany, whose supply chains are more integrated with eastern Europe. Its car sector is missing components produced in Ukraine.

Even in the US, recent data showed signs of slowing growth. Jobless claims filings showed an increase in initial claims; the May Senior Loan Officer Opinion survey recorded a drop in demand for mortgages; the University of Michigan consumer sentiment May index hit its lowest level since the start of the pandemic; and the May Empire State Manufacturing survey plunged.

China also released weak data, with industrial output, fixed-asset investment and retail sales all showing year-on-year declines. The property market’s woes deepened, with new home sales and starts falling precipitously.

Investment implications

Mr. Bernanke’s warning of stagflation underscores the dilemma facing policymakers and financial markets: Inflation and growth data are sending conflicting signals. Parts of the US yield curve are inverted, pointing to some risk of an economic recession.

The slowdown concerns are linked to inflation forcing the Fed to tighten policy into restrictive territory and turning weaker growth into a contraction.

The situation is similar in the eurozone: inflation is at its highest ever and could lead the ECB to take stronger measures, exacerbating headwinds from weak Chinese activity and a Russia-induced energy supply shock.

Against the backdrop of the continuing Ukrainian conflict and prolonged supply-chain disruptions, we do not favour sovereign bonds and European equities at this point. We prefer commodities, Japanese and emerging market equities, including Chinese stocks.


Disclaimer

Please note that articles may contain technical language. For this reason, they may not be suitable for readers without professional investment experience.

Any views expressed here are those of the author as of the date of publication, are based on available information, and are subject to change without notice. Individual portfolio management teams may hold different views and may take different investment decisions for different clients. The views expressed in this podcast do not in any way constitute investment advice.

The value of investments and the income they generate may go down as well as up and it is possible that investors will not recover their initial outlay. Past performance is no guarantee for future returns.

Investing in emerging markets, or specialised or restricted sectors is likely to be subject to a higher-than-average volatility due to a high degree of concentration, greater uncertainty because less information is available, there is less liquidity or due to greater sensitivity to changes in market conditions (social, political and economic conditions). Some emerging markets offer less security than the majority of international developed markets. For this reason, services for portfolio transactions, liquidation and conservation on behalf of funds invested in emerging markets may carry greater risk.

Writen by Chi Lo. The post Weekly investment update – The soft underbelly of hard inflation data appeared first on Investors' Corner - The official blog of BNP Paribas Asset Management, the sustainable investor for a changing world.

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