Decision ‘noted’ at the 73rd World Health Assembly to end reporting on the International Code to the World Health Assembly after 2030 is causing alarm amongst the public health community. WHO’s Member States are invited to comment by 2nd December.  Please ask that the decision is recalled or amended (page further down or print the PDF for the full rationale)

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  1. On technical grounds due to the meeting being online. (see Point 1)
  2. The Code should be considered an exception as an important work in progress. (See Point 2)
  3. On legal grounds. The Code is in a ‘class of its own’ in terms of international human rights law and places obligations on Member States and the WHO to implement and enforce it and commercial companies to comply with it. (Point 3)
  4. The Code is not a time-defined goal like the MDGs or SDGs. WHO has a responsibility to alert its Member States to any threat to global health. This must include harmful commercial promotion on baby foods, tobacco, ultra-processed products etc. (Point 4)
  5. Reporting to the WHA on the Code should not end until there is convincing evidence that it is no longer needed (point 5)
  6. Governments and WHO have legal obligations under the WHO Constitution and the Code itself. Their removal will have serious consequences for maternal and child Health. (Point 6)
  7. ‘Sunsetting’ the Code will undermine the adoption of new Resolutions that keep pace with evolving marketing and help governments improve legislation. (Point 7)
  8. There is evidence that exploitation and misleading marketing of baby foods increases with pandemics such as the  COVID-19.
  9. There is no evidence that companies will abide by voluntary codes (Points 9 and 10)

IBFAN calls for reconsideration of harmful decision on baby food marketing

26th November 2020

The International Baby Food Action Network (IBFAN) [i] met WHO’s Assistant Director-General, Dr Yamamoto  and other senior staff this week to explain why there needs to be a reconsideration of a Decision (i) to end biennial reporting to the World Health Assembly on baby food marketing after 2030.

IBFAN pointed out that the obligations of WHO and Member States to report to the World Health Assembly are embedded in the International Code of Marketing of Breastmilk Substitutes (the Code) and  WHO’s Constitution and are one of its core strengths. The removal of these obligations will weaken the effectiveness of the Code and have harmful consequences for mothers and children. The Decision was ‘noted’ at the online 73rd World Health Assembly on 10th November and follows a streamlining decision (EB/146/21) intended to create more space on WHO’s packed agendas.

The Code is the first global consumer protection tool of its kind and is in a class of its own in terms of international human rights law. (Point 3) It was adopted in 1981 in response to evidence that 1.5 million babies were dying every year because they are not breastfed. Over 800,200 babies continue to die each year because they are not breastfed.[iii]  Harmful marketing,  driven by the US$ multi-billion baby food industry, [iv] is constantly evolving and remains a critical factor in the misleading of health workers and parents and the undermining of breastfeeding.  India was not present to read its statement during the debate but its statement on the WHO’s website that ‘biennial reporting should continue till more than 90% of Member States enact national laws and develop legal frameworks, which substantially align with the International Code and the relevant subsequent WHA resolutions.” Clearly strong, regularly updated legislation on the Code will remain vital long beyond 2030. [v]

Following the meeting, Dr Yamamoto’s gave an assurance of WHO’s strong commitment to the Code and the protection of breastfeeding and its wish to work together with IBFAN for the protection of child health.  She stated that if the unintended consequence of a broader governance issue is implied as a lack of WHO’s support for the Code, that needs to be corrected.

10 reasons why the ‘sunsetting’  decision should be reconsidered:

  1. Technical problems. The holding of such an important meeting online was a challenge for WHO and, as was mentioned during EB147, several Member States experienced technical and logistical problems. The sunsetting agenda item (15.2) was moved from Committee A to Committee B three days earlier than planned, with little more than an hour’s notice and the decision was taken without full Member State participation.  Indeed India was not present to read its statementSlovakia and India have called for reporting to continue beyond 2030.
  2. The Exception Clause should be used. The Governance documents (EB146/21)(EB146/32) (10.2020) that outline the rationale for sunsetting resolutions older than 6 years, describes criteria for possible exceptions, such as “ongoing efforts for the eradication of diseases…”  They should be read as granting the exception to the Code as an important work in progress. 
  3. The International Code of Marketing of Breastmilk Substitutes is a regulation sui generis (in a class by itself”, therefore “unique”) that Member States have an obligation to implement and enforce and commercial companies to comply with as an element of the international human rights law.[vi] [vii]
  4. The elimination of negative promotional practices is not a time-defined goal like the MDGs or SDGs. WHO must continue to keep a close watch on all commercial promotion that has the potential to harm health – whether on baby foods, tobacco, junk foods, alcohol or drugs.
  5. Reporting to the WHA on the Code should end only when there is convincing evidence that it is no longer needed, for example when there is evidence that effective and independently monitored legislation to eliminate harmful marketing has been adopted in all countries.
  6. Member States have legal obligations under Article 60, 61 and 62 of the WHO Constitution[viii] and Article 11.6 and 11.7 of the International Code to report to WHO on progress in implementing the Code. The WHO Director General has additional obligations to report to the World Health Assembly every two years. These obligations are embedded in the Code[ix] and are its core strength as they lead to subsequent Resolutions that clarify, strengthen and update the original Code.
  7. 19 Resolutions[x]have been adopted since 1981 that have helped governments counter baby food industry pressure to adopt weak voluntary measures. The resolutions have resulted in legislation forbidding marketing techniques such as health and nutrition claims, free and low-supplies of breastmilk substitutes and misleading marketing of baby foods. Eight resolutions have called for conflicts of interest safeguards, not only in health care but also in monitoring. This shows that the Code is far from a dead issue and explains why baby food companies have always wanted it taken off WHO’s agenda.
  8. Since the COVID-19 Pandemic, companies have exploited public fears increasing misleading marketing of baby foods.[xi]
  9. The sunsetting decision is closely linked to an initiative launched in June entitled, Breastmilk Substitutes Call to Action(CTA). The CTA called on companies to make voluntary commitments (by September 2020) explaining how they would abide by the International Code and Resolutions by 2030. IBFAN’s  Counter Call, which has been supported by many public health NGOs, including retired senior UN staff, highlights the risks and calls on WHO to distance itself from the CTA and its voluntary approach.
  10. With no evidence that baby food companies will abide by voluntary codes (indeed the companies contacted by the CTA failed to meet its minimum requirements) we need to place our mothers and children at the center of our policy efforts, protect them from potential commercial harm.[xii]Strong legislation and new Resolutions that keep pace with marketing developments are needed now  more than ever .

For more information: IBFAN’s Global Council and regional offices Co-Chair: Dr JP Dadhich,(India) jpdadhich@bpni.org, Co-Chair: Nomajoni Ntombela, (Africa), jonanantombela@gmail.com, Dr Marina Rea, (Brazil) marifrea@usp.br, Dr Marcus Arana (Mexico) observatoriosalud@gmail.com, Patti Rundall (UK) prundall@babymilkaction.org, +44 7786523493.  For online version of this statement see: www.babymilkaction.org/archives/27262

 IBFAN Sun-set Press Release Feb 2020.

Notes:

[i] The International Baby Food Action Network­­­­­­­ (IBFAN), the 40-year-old global network that protects breastfeeding and infant and young child health, has worked alongside WHO since the late 1970s. February IBFAN statement Feb 20, IBFAN statement WHA73 Nov 2020

[ii] Report by the Director General (A73/4 Add.2) on Maternal, infant and young child nutrition under the section:  Action by the Assembly:  ……   3. The Health Assembly is invited to consider adopting the following draft decision, containing the amendments to the text of decision EB146(20) agreed during the informal Member State discussions….(1) to streamline future reporting requirements on maternal, infant and young child nutrition, through biennial reports to the Health Assembly, through the Executive Board, until 2026 2030 (to be issued in 2022, 2024, 2026, 2028 and 2030, respectively);

[iii] Breastfeeding:  (Lancet 2016)

[iv]Revenue of the smallest of Fortune’s Global 500 companies (https://fortune.com/global500/2019/search/ )—approximately US$25 billion annually—exceeds the Gross National Income of the entire economies of each of 106 countries, https://unstats.un.org/unsd/snaama/Downloads  including 78 countries designated as low- and middle-income countries by the World Bank. https://blogs.worldbank.org/opendata/new-country-classifications-income-level-2018-2019

[v]2020 WHO/UNICEF/IBFAN report on the Code implementation. 70% of countries have some legislation based on the Code.

[iv] UN CRC General Comment no. 15 and 16 (2013) and UN ECOSOC General Comment no. 24 (2017) in combination with International Court of Justice Judgement of 30 November 2010 concerning Ahmadou Sadio Diallo (Republic of Guinea v. Democratic Republic of Congo). Also see Extraterritorial Obligations and the Code_Feb 2018 Discussion paper, February 2018 The Maastricht Principles on Extraterritorial Obligations of States in the Area of Economic, Social and Cultural Rights and the International Code of Marketing of Breastmilk Substitutes.

[vii] Shubber, S.: The WHO International Code of Marketing of Breast-Milk Substitutes: History and Analysis. Pinter & Martin Ltd. 2011. Dr. Shubber is formerly Senior Legal Officer, WHO. The book was endorsed by (the late) Sir Robert Jennings, former President and Judge of the International Court of Justice and Professor of International Law, Cambridge University and Chair of the Drafting Group of the 3rd and 4th (final) drafts of the Code. https://read.amazon.co.uk/?asin=B009YKJB6Q https://www.pinterandmartin.com/who-code-of-marketing-of-breast-milk-substitutes.html

[viii] WHO Constitution  

Article 60. (a) Decisions of the Health Assembly on important questions shall be made by a two-thirds majority of the Members present and voting. These questions shall include: the adoption of conventions or agreements; the approval of agreements bringing the Organization into relation with the United Nations and inter-governmental organizations and agencies in accordance with Articles 69, 70 and 72; amendments to this Constitution. (b) Decisions on other questions, including the determination of additional categories of questions to be decided by a two-thirds majority, shall be made by a majority of the Members present and voting. (c) Voting on analogous matters in the Board and in committees of the Organization shall be made in accordance with paragraphs (a) and (b) of this Article.

Article 61 states ‘Each Member shall report annually to the Organization on the action taken and progress achieved in improving the health of its people’

Article 62 states: “Each Member shall report annually on the action taken with respect to recommendations made to it by the Organization and with respect to conventions, agreements and regulations.”

[ixi] International Code of Marketing of Breastmilk Substitutes

Article 11.6 states “In accordance with Article 62 of the Constitution of the World Health Organization, Member states shall communicate annually to the Director-General on action taken to give effect to the principles and aim of the Code.” 

Article 11.7 states: “The Director-General shall report in even years to the World Health Assembly on the status of implementation of the Code; and shall, on request, provide technical support to Member States preparing national legislation or regulations, or taking other appropriate measures in implementation and furtherance of the principles and aim of this Code.”

[x] WHO Code and 19 Resolutions ICDC summary of key WHA resolutions.

xi] Marketing of breastmilk substitutes during the COVID-19 pandemic.  Lancet Volume 396, ISSUE 10259, e58, October 24, 2020.  Examples of how baby milk companies exploit COVID-19

[xii] Lancet 2016. And as proposed by the WHO-UNICEF-Lancet Commission in a report A future for the world’s children? published in The Lancet, VOLUME 395, ISSUE 10224, P605-658, FEBRUARY 22, 2020 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32540-1/fulltext

 

TEXT IN SPANISH:

IBFAN considera que debe revertirse la decisión perjudicial 

sobre la comercialización de alimentos para bebés

27 de noviembre de 2020

 

La Red Internacional de Grupos Pro Alimentación Infantil IBFAN ) [i] se reunió con la Subdirectora General de la OMS, Dra. Yamamoto y otro oficiales superiores para explicar más en detalle por qué es necesario reconsiderar su Decisión (i) de poner fin en el 2030 a la presentación de los informes que se dan cada dos años a la Asamblea Mundial de la Salud y que tratan la comercialización de alimentos infantiles.

 

IBFAN señaló que la obligación de la OMS y de los Estados Miembros de presentar estos informes a la Asamblea Mundial de la Salud ya que son un mandato incluido en el Código Internacional de Comercialización de Sucedáneos de la Leche Materna (el Código) y en la Constitución de la OMS y son uno de sus principales puntos fuertes. La eliminación de estas obligaciones debilitará la eficacia del Código y tendrá consecuencias perjudiciales para las madres, niñas y niños.  Esta Decisión fue ‘anotada’ en la reunión en línea de la 73ª. Asamblea Mundial de la Salud el 10 de noviembre 2020 siguiendo una decisión del Comité ejecutivo de la OMS (EB / 146/21) que busca despejar las apretadas agendas de la OMS.

 

El Código es la primera herramienta global de protección al consumidor y es única en términos de derechos humanos en el tema. Fue adoptada en 1981 como respuesta a la evidencia de que 1,5 millones de bebés morían cada año porque no recibían lactancia materna. Hoy día, más de 800.200 bebés continúan muriendo cada año porque no son amamantados. [iii] El marketing perjudicial, impulsado por la industria multimillonaria de alimentos infantiles [iv ] está en constante evolución y sigue siendo un factor crítico para engañar a las madres y familias socavando la lactancia materna. En su declaración en el sitio web de la OMS, India dice que ‘la presentación de informes bienales debe continuar hasta que más del 90% de los Estados Miembros promulguen leyes nacionales y desarrollen marcos legales alineados sustancialmente con el Código Internacional y Resoluciones relevantes de la AMS “.  Claramente, la legislación fuerte y actualizada regularmente con el Código, seguirá siendo de vital importancia mucho más allá de 2030.[v]

 

En la reunión con IBFAN, la Dra. Yamamoto aseguró el firme compromiso de la OMS con el Código y la

protección de la lactancia materna y su deseo de trabajar junto con IBFAN para la protección de la salud infantil. Declaró que, si la consecuencia involuntaria de un problema de gobernanza más amplio implica falta de apoyo de la OMS al Código, deben tomarse medidas ya mismo para corregirse.

 

Diez razones por las que debería reconsiderarse la decisión de ‘extinguir’ los informes sobre el Código a la AMS:

  1. Problemas técnicos. La celebración de una reunión en línea tan importante fue un desafío para la OMS y, al igual que se mencionó durante la EB147, varios Estados Miembros experimentaron problemas técnicos y logísticos. El punto del orden del día (15.2) se trasladó del Comité A al Comité B tres días antes de lo previsto, y con solo una hora de antelación, y entonces la decisión se adoptó sin la participación plena de los Estados miembros. De hecho, India no estuvo presente para leer su declaración. (Eslovaquia e India piden que los informes continúen más allá de 2030).
  2. Se debe utilizar la cláusula de excepción. El documento de gobernanzaEB146 / 21 ) ( EB146 / 32 )

Resoluciones 16.10.2020) describe la justificación de la extinción de Resoluciones de más de 6 años, y plantea criterios para posibles excepciones, como por ej. “esfuerzos en curso para la erradicación de enfermedades…”, por tanto, debe interpretarse como el otorgamiento de excepción al Código ya que como un importante trabajo en curso.

  1. El El Código Internacional de Comercialización de Sucedáneos de la Leche Maternaes un reglamento sui generis (único en su clase ”, por lo tanto, “único”) y los Estados Miembros tienen la obligación de implementarlo y de garantizar su cumplimiento; las empresas deben cumplir con el mismo ya que es un elemento del derecho internacional de los derechos humanos. [ vi ] [vii]
  2. La eliminación de las prácticas de promoción y mercadeo negativas no son un objetivo con un marco de tiempo definido como los Objetivos de Desarrollo del Milenio. La OMS debe continuar vigilando de cerca toda la promoción comercial que pueda dañar la salud, ya sean alimentos infantiles, tabaco, comida chatarra, alcohol o drogas.
  3. La presentación de informes sobre el Código a la AMS debe finalizar solo cuando haya pruebas convincentes de que ya no es necesaria la vigilancia permanente, es decir, cuando existan pruebas de que se cumple la legislación eficaz y supervisada de forma independiente y que se ha eliminado en todos los países la comercialización dañina.
  4. Los Estados Miembros tienen la obligación legal en virtud de la Constitución de la OMS.[viii]y del Código Internacional de informar a OMS sobre los avances en la implementación del Código. El Director General de la OMS tiene la obligación adicional de informar a la Asamblea Mundial de la Salud cada dos años sobre la situación de cada país. Estas obligaciones están incorporadas en el Código [ ix] y son su núcleo y fortaleza, ya que conducen a Resoluciones relevantes que aclaran, fortalecen y actualizan el Código original.
  5. Se han adoptado 19 resoluciones[ x] desde 1981 que han ayudado a los gobiernos a combatir la comercialización inescrupulosa de las compañías de alimentos infantiles y a la presión que ejercen con sus “medidas voluntarias” débiles. Las Resoluciones han dado lugar a legislación que prohíbe la comercialización y tácticas comerciales, las declaraciones de propiedades saludables y nutricionales, los suministros gratuitos o de bajo precio de sucedáneos de la leche materna y la comercialización engañosa de alimentos infantiles. Ocho resoluciones exigen salvaguardas para evitar los conflictos de intereses, no solo en los sistemas de salud sino también en el monitoreo del Código. Esto muestra que el Código está lejos de ser un tema muerto y explica por qué las empresas de alimentos infantiles siempre han querido eliminar el Código de la agenda de la OMS.
  6. Durante la pandemia de COVID-19, las empresas se han aprovechado de los temores del público aumentando la comercialización engañosa de productos y alimentos infantiles.[xi]
  7. La decisión de extinguir los informes sobre el Código está estrechamente relacionada con una iniciativa lanzada en junio titulada, Llamado a Acción sobre los sucedáneos de la leche materna(CTA). Este Llamado instó a las empresas a asumir compromisos voluntarios sobre cómo cumplirían con el Código Internacional y las Resoluciones relevantes en el 2030. Contra este Llamado, IBFAN se pronunció de inmediato con el apoyo de muchos aliados -incluido personal senior jubilado de las Naciones Unidas- dado el riesgo que significa Llamado, que lo que hace es dar permiso a las empresas para continuar violando el Código, siempre y cuando digan ¡que tomarán medidas para cumplirlo en el 2030! ¡Esto no puede ser! Hace 40 años se aprobó el Código y las empresas lo violan y violan cada vez más.  Por ello, IBFAN y muchos aliados piden a la OMS que se distancie

de semejante Llamado y de su enfoque de pedir medidas voluntarias a las empresas.

  1. Las empresas de alimentos infantiles no acatan ni sus propios códigos voluntarios (de hecho, las empresas contactadas en el Llamado no cumplen sus propios requisitos mínimos). Por ello, necesitamos colocar a nuestras madres y a sus hijos e hijas en el centro de nuestros esfuerzos de acción política, protegiéndoles de posibles daños comerciales.[xii] Se necesita con urgencia una legislación sólida y nuevas Resoluciones de la AMS que enfrenten la comercialización y el mercadeo inescrupuloso de las compañías de alimentos infantiles.  Esto es necesario hoy más que nunca.

Notas (en inglés) see above

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