IBFAN Proposed amendments
EU-led Draft Resolution on Strengthening
WHO Preparedness and Response to Health Emergencies
74th session of the WHA, May 2021
IBFAN is grateful to the EU for giving Civil Society organisations the opportunity to contribute to draft Resolutions. Its much appreciated.
Recognising that Breastfeeding is lifesaving in emergencies and that babies are at greatest risk of water-related diseases – with diarrhoeal disease the second biggest killer of under-fives. That breastfeeding is resilient and provides food, care and immune support, and protection from the worst of emergency conditions.
Recognizing that epidemics and pandemics, such as HIV, ZIKA, Ebola and COVID-19 have had a profound impact on infant and young children’s feeding practices with interpretation of the same scientific data leading to differing guidance and both negative and positive impact on child survival.
Regretting the continuing commercial exploitation of emergencies with misleading claims that commercial ultra processed products for babies build immunity and are provided purely for humanitarian purposes.
INSERT:OP4.10 : Urges Member States to support and protect breastfeeding and appropriate infant and young child feeding from misleading marketing and inappropriate donations through the adoption, implementation and monitoring of regulations that fully implement the International Code of Marketing of Breastmilk Substitutes and subsequent relevant WHA Resolutions, and Infant and Young Child Feeding in Emergencies – Operational Guidance for Emergency Relief Staff and Programme Managers.
OP5.1 Strengthen [INSERT: appropriate] partnerships, global coordination and cooperation in response to infectious diseases based on lessons learned from COVID-19 and fostering a one health approach, including between WHO and relevant organizations and UN agencies, including through the Global Action Plan for healthy Lives and well-being for all INSERT: while safeguarding against Conflicts of Interest and ensuring that when needed, locally sourced and sustainably produced food assistance is prioritised.
OP6.19 ADD: Whilst ensuring adequate increases in the Assessed Contributions from Member States, increase efforts to broaden the donor base, [DELETE: including through increased the WHO Solidarity Fund and the WHO Foundation] ensuring full Member State oversight, transparency and accountability, and safeguards against conflicts of interest;
INSERT: OP6.20 Requests the Director General to prepare a framework to enable rapid understanding and response to emergent or epidemic infections and their implications for breastfeeding and infant feeding practices, survival and health, that will guide responses to future outbreaks for this particularly vulnerable group.
Rationale for above OP6.20 Framework:
In the past policies to move away from supporting breastfeeding in the HIV pandemic had a devastating impact on infant mortality in many middle- and low-income countries. More infants lost their lives through diarrhoea and pneumonia related to infant formula feeding compared to those who lost their lives through HIV infection. The aftermath of these recommendations had serious repercussions that lasted for more than a decade as the fear of HIV transmission and the normalisation of bottle feeding changed infant feeding practices. Though caused by a different virus, recommendations during the COVID-19 pandemic caused a similar risk as various countries initially steered away from breastfeeding of children by mothers with suspected or confirmed SARS-CoV-2 infection.
WHO is the best organization to formalize an objective (‘universal’) framework indicating the process on identifying when breastfeeding or human milk is no longer safe in an outbreak of a (novel) infectious disease. It should provide an outline of steps when is it justified to divert from the global WHO recommendations concerning breastfeeding and human milk taking into account transmission, detection of infective agent and/or disease, mortality and morbidity both on the short and long term.
The framework should identify steps to guide the process shaping the following policies (examples):
On consideration of a balance of risk, public health policy would be in favour of separation and avoiding breastfeeding among mothers with confirmed Viral Disease X there is evidence of: 1) Significant, immediate (infection fatality rate) and/or potential for long-term adverse health impacts of Viral Disease X in infants/young children, and; 2) Substantive Virus X transmission through breastfeeding and/or mother-infant contact; 3) being able to identify mothers with Virus X while infectious with or without symptoms.
Conversely, it would be expected that public health policy for mothers with confirmed Virus X infection would favour continued breastfeeding and mother-infant contact if there is evidence for: 1) Significant immediate infant or child mortality and/or long-term adverse effects associated with separation and non-breastfeeding for the infant/child or mother; 2) Low health impact of COVID-19 (infection fatality rate) among infants/young children; 3) Low Virus X transmission risk through breastfeeding and mother-infant contact.