Weak global trading standards and the climate crisis – why Codex must step up

Codex Alimentarius Commission (CAC45)  21-25th November 2022 – in Rome and on line.

Click here for the Codex agenda and papers and PAGE DOWN for comments.

IBFAN comment CAC45 Nov 2022

 CLICK HERE for IBFAN’s press releases about Codex back to 2006.

 

IBFAN, ENCA and ILCA will be attending the 45th CAC remotely and in person.   With the climate emergency and Cop 27 very much on our minds we are  urging all governments to speak out strongly about the global implications of weak Codex standards on the most vulnerable members of society, in particular the unrestricted global trade of unnecessary, ultra-processed, sweetened products targeting infants and young children, which, aside from the risks to  health, adds an unnecessary burden to the environment. (click here for our statement for Cop26)

“The most alarming finding in our research is a very large proportion of greenhouse gas emission impact is associated with the so-called growing up milks or toddler formula … In China, nearly half of the sales of milk formula is  toddler formula. For the UK alone, carbon emission savings gained by supporting mothers to breastfeed would equate to taking between 50,000 and 77,500 cars off the road each year”.  Dr. Julie Smith, Hon Ass Prof, Australian Centre for Economic Research on Health
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Why IBFAN attends Codex: IBFAN has been attending Codex since 1995/97 when the WTO was formed. While all governments have a sovereign right and duty to adopt effective health-protective laws to protect citizens,  weak Codex standards are used by the food industry and exporting nations to  introduce legal loopholes that allow harmful marketing to flourish.  Indeed between 1995 and 2019, there were 245 interventions made in the WTO concerning commercial milk formula marketing, labelling or safety testing regulations of another member state.(1) We consider it cruel to expect poorly-resourced countries to tackle cross-border marketing problems alone. Babies in these countries stand to suffer the most when breastfeeding is undermined, and the exporting nations that profit from the sales, take no responsibility. The corporations are never held financially responsible for the harm they cause and all the ‘costs’ are externalized to governments, families and babies. The financial cost of sub-optimal feeding is especially important at this time of global inflation following the pandemic.
Largely because of IBFAN’s consistent advocacy at Codex, the standards on foods for infants and young children adopted after 1995,  all refer in some way to the International Code, the Global Strategy and the subsequent WHA Resolutions on infant and young child feeding  and the Codex Code of Ethics for International Trade continues to require Member States to “…make sure that the international code of marketing of breast milk substitutes and relevant resolutions of the World Health Assembly (WHA) setting forth principles for the protection and promotion of breastfeeding be observed.”    These citings are critically important, and all the standards must refer to these texts in a meaningful way to offset the harm caused by global trade. 

Items on the CAC45 Agenda:

Click Here for what happened at CCFSNDU,CCFL and CAC last year

Ready to Use Therapeutic Food (RUTF) Agenda Item 4.2 Codex Committee on Nutrition and Foods for Special Dietary Uses (CCNFSDU) for adoption or approval by the Commission    (IBFAN 2021 comments) IBFAN comments on RUTF 2022

This Item is at Step 8 – so ready for adoption and unlikely to be opened up except for technical drafting reasons. The baby food companies (ISDI) are calling for the removal of references to the Code in the footnote to the Preamble. If the item is opened up,  Brazil, Colombia, and the Philippines are proposing similar strengthening text to us (IBFAN comments on RUTF 2022) about lowering sweetness, training on re-lactation to us etc.  Whatever happens we must not lose the safeguards agreed last year:  (the ban on health and nutrition claims, the ban on general retail sale and the recommendation that RUTF should be used in an “appropriately designed programme that promotes continuation of breastfeeding, appropriate transition to nutritious family food and psycho-social support for recovery.”  RUTF Comments from Member States and Observers are HERE   Page down for some excerpts

Agenda Item 4.5  Committee on Contaminants in Food (CCCF).
Maximum level for lead in ready-to-eat meals for infants and young children. Proposed draft standards at Step 5,  if adopted, will be advanced to Step 6 for further comments and consideration by CCCF16.
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Agenda Item 4.8   Codex Committee on Residues of Veterinary Drugs in Foods: Zilpaterol:   This is a very controversial item about a steroid-like veterinary drug made by Merck for cattle, pigs, and poultry that promotes growth. (Bayer merged with Merck a few years back) It is currently banned in the UK, EU, Russia and China and these countries oppose the adoption of a Codex standard for Zilpaterol – so there will probably be a vote at CAC.  We hope the UK will  maintain its ban on the use of Zilpaterol, even if there is a Codex standard or following future trade deals, such as the UK Australia deal, and that any change is subject to full Parliamentary scrutiny.  
The use of drugs to promote growth in animals raises concerns that cut across health, veterinary medicine,  ecology, food systems and control of resources, not least antimicrobial resistance (AMR) Will resistant bacteria and resistance genes  emerge and spread from food animals to humans through the food chain? Untangling Antimicrobial Resistance (AMR) Report 2022  WHO’s Roundtable ONE HEALTH  meeting in Croatia 11/11/2022 attempted to address this. 
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Agenda Item 6. Other matters related to Codex Subsidiary Bodies
Possible new work: DISCUSSION PAPER ON GUIDANCE ON THE USE OF REMOTE AUDIT AND VERIFICATION IN REGULATORY FRAMEWORKS(Prepared by an EWG chaired by Australia, and co-chaired by Singapore and Canada)
Codex Trust Fund: activity report:  We always call for assurance that the CTF will not accept or seek funding from the Private Sector.  It is important that Member States are not subject to  Conflicts of Interest that might  affect their Human Rights obligations to protect their citizens.

Stronger Conflict of Interest and transparency safeguards would help ensure that Codex decisions are based on relevant, convincing and credible evidence rather than on political or commercial expedience.  In the 2019 CCNFSDU  meeting 44% (164) of the 370 delegates represented the food and related industries, who funding dinners, receptions and meetings, with 67 sitting government delegations. There were more industry than government delegates in the room. Because of this lack of attention to COI safeguards and scientific rigour, , the infant formula and follow-up formulas standards have three references to the meaningless term ‘history of safe use’ – a term that  industry has used for decades to establish trust in their products and new ingredients.   FAO’s partnership with the baby food company  Danone and  Croplife is an added challenge to Codex’ credibility.

Codex Committee on Food Labelling(CCFL) FOPNL Guidelines. HERE   The FOPNL Guidelines adopted at Step 8 at the last CCFL are fairly weak with minimal safeguards.  FOPNL schemes that do not include WARNINGs are  invariably promotional, so we are pleased that breastmilk substitutes are excluded. However  foods for infants and young children are not.  Bearing in mind the  2010 WHA Resolution 63.23 forbidding health and nutrition claims,  the Guidelines should at the very least have includes a statement – similar to that for alcohol – that FOPNL should not be promotional.    It is critical that FOPNL schemes are mandatory and  led by national governments and that the formation, implementation and monitoring of the schemes are free of commercial influence.  This study compares warnings to traffic light and GDA and shows the effectiveness of warnings.  Arrúa A, Machín L, Curutchet MR, Martínez J, Antúnez L, Alcaire F, et al. (2017). Warnings as a directive front-of pack nutrition labelling scheme: comparison with the Guideline Daily Amount and traffic-light systems. Public Health Nutr 2017; 20(13):2308-17. https://pubmed.ncbi.nlm.nih.gov/28625228/.
Sustainability labelling  To avoid greenwashing, sustainability schemes should be mandatory (government controlled) with warnings, independent monitoring and strong accountability safeguards.  Our comment on Sustainability labelling is here.IBFAN Sustanability CCFL 22.  
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Follow up Formulas (FUF)  and Drinks for Young Children:  This is not on the Agenda of CAC45 but there has just been a round of comments on the structure and whether there should be a preamble.   We are strongly opposed to the industry idea of two separate standards for Follow-Up Formula and Drinks for Young Children. A preamble  is needed to clarifiy that these products are covered by the International Code and Resolutions, are not necessary and should not be promoted. This is an essential l safeguard especially where breastfeeding into the second year is a lifeline. The  footnote in the description of section B  “That in some countries these products are regulated as breastmilk substitutes”  is important but far from adequate. 

Other FUF  issues that will be difficult to resolve: Cross promotion:  this is a harmful far-reaching loophole that undermines healthy eating messages and leads to newborn babies being fed inappropriate products. Click here for more about cross promotion in Brazil.  Flavours: The EU, WHO, UNICEF IBFAN and others were strongly opposed to allowing fruit extracts and vanilla flavourings that promote products and mislead parents and carers – especially if packages are idealised with images of  fresh fruits – that act as a health claim. However the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) – who  support so many industry positions at Codex – successfully argued against this prohibition.We know theseproducts pose many risks for young children in that they are highly processed, sweetened and displace breastfeeding, other fresh milks or other healthier family foods. Sweetness: CCMAS admitted that it is not possible to measure the sweetness of formulas. GM ingredients – our call to keep baby foods GM free was supported by Ecuador – but was not taken up.
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RUTF Excerpts from  Member States comments HERE  (our italics) 

Brazil :  Brazil acknowledges the consensus reached by CCNFSDU on the revised and simplified text to clearly take into account concepts such as: the promotion of continuation of breastfeeding, transition to nutritious family food; psycho-social support for recovery; the use of locally based foods; RUTF is not for general retail sale.  We understand that the text covers the main issues of concern raised by members. Nevertheless, we would like to emphasize that an appropriately designed programme should support continuation of breastfeeding, training re-lactation and appropriate transition to nutritious family food and psycho-social support for recovery. Furthermore, the use of RUTF should not preclude other more culturally appropriate dietary options including the use of nutrient dense, family-based local foods.

Carbohydrates. Brazil would like to recall the discussion that took place at the 39a session of CCNFSDU (2017) when the Representative of WHO mentioned that there were clear recommendations to reduce the consumption of sugars and understanding that it may be possible to further reduce the content of sugars with future technological advances, clearer relevant language could be included in the guideline to address this issue. … Brazil is aware of the issues raised by UNICEF regarding the challenges to limit the addition of free sugars to less than 20% of the energy in the product. On the other hand, reducing the quantity of free sugars used in RUTF at the minimum level possible shall be a goal to be achieved. Considering that further efforts were being made by the suppliers of RUTF to explore the possibilities of lowering the contents of free sugars, Brazil is of the opinion that free sugars should be limited and should not exceed 10% of total energy.

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Colombia: stresses the importance of continued breastfeeding and relaxation training.  Preamble …within an appropriately designed program for the promotion, protection, support of breastfeeding, and relactation training and appropriate transition to home-prepared nutritious foods and psychosocial support for recovery… The changes highlight the importance of the practice of breastfeeding and highlight the need to preserve or reestablish it, as the best option for the treatment of malnutrition.
-12.4 The following additional stateme nts must appear on the RUTF label: • The consumption of this product must be accompanied by adequate complementary food and drinking water. It is proposed to include the text for the product’s label.

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The Philippines: The Preamble and additional labeling requirements highlighted the need to promote continuation of breastfeeding and recommend exclusive breast feeding for the first six months and its continuation up to two years old and beyond. These are safeguard measures to ensure that RUTF is used in conjuction with breastfeeding.  We firmly believe that these guidelines should be complemented by national nutrition policies highlighting the use of local foods and that RUTF should be used in specific situations such as insufficient local food production, food insecurity or under emergency situations.

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ISDI reply to Circular Letter (CL 2021/31-NFSDU) ISDI-reply-to-CL-2021-31-OCS-NFSDU-2021-08-20-final.   ISDI calls for the removal of references to the International Code in the footnote. Here are some excerpts: “ISDI notes that RUTF is not a breastmilk substitute, therefore, ISDI questions the reference to guidelines included as part of Footnote 1: 1981. International code of marketing of breast-milk substitutes, Geneva: World Health Organization and subsequent relevant WHA Resolutions on infant and young child feeding. ISDI notes this information is not specific to the Guidelines for Ready to Use Foods and considers this sentence should be deleted.  ISDI also questions the following reference in Footnote 1: World Health Organisation. 2003. Global Strategy for Infant and Young Child Feeding, Geneva: World Health Organization. This reference does not provide specific guidance relevant to the purpose of the RUTF. Finally, ISDI proposes to update the date of publication of the Code of Ethics for International Trade in Food including Concessional and Food Aid Transactions (CXC 20-1979); Food and Agriculture Organisation and World Health Organisation. A new version of this report was published in 2021 and this should be reflected.:

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IBFAN and ENCA comments:

Some important safeguards were added to the text of the Guidelines last year and it is important that these are not lost

DRAFT GUIDELINES FOR READY TO USE THERAPEUTIC FOODS (RUTF) (For adoption at Step 8)

PREAMBLE Children affected by severe acute malnutrition (SAM) need efficacious and timely intervention including safe, palatable foods with a high energy content and adequate amounts of vitamins, minerals and other nutrients within an appropriately designed programme that promotes supports continuation of breastfeeding, training in re-lactation and appropriate transition to nutritious family food and psycho-social support for recovery. In accordance with the Joint Statement by the World Health Organization (WHO), the World Food Programme (WFP), the United Nations System Standing Committee on Nutrition (UNSCN) and the United Nations Children’s Fund (UNICEF) (2007) and taking note of other relevant documents by WHO and FAO, Ready-to-Use Therapeutic Food (RUTF) is a WHO recommended option for the dietary management of children aged 6 to 59 months with SAM without medical complications. However, this does not preclude other more culturally appropriate dietary options including the use of nutrient dense, family-based local foods. RUTF is not for general retail sale.

5.2.1 Carbohydrates Carbohydrates are used to achieve energy requirements in balance with proteins and lipids. Plant starch, lactose, maltodextrin and sucrose are the preferred carbohydrates in RUTF.  Free sugars should be limited and should not exceed 20% of total energy. Only precooked and/or gelatinized starches may be added. Glucose and fructose should not be used. Carbohydrates must adhere to the relevant Codex Alimentarius texts. Honey should not be used in RUTF due to the risk of infant botulism from Clostridium botulinum. The total CHO can be 20% of total energy and since the peanut pastes use sucrose and maltodextrin to make them palatable, this creates a high level of sweetness as well as the use of a non-nutritive CHO as 20% of total energy.

IBFAN recommends that sucrose and maltodextrin be no more than 10% of the total CHO of the product.

12.4 The following additional statements shall appear on the label of RUTF:

• The product is not to be used for Nasogastric Tube (NG tube) administration.

• The product should be used in conjunction with breastfeeding.

• Exclusive breastfeeding is recommended for the first 6 months of life, and continued breastfeeding is recommended for up to two years or beyond. 12.5 Instructions for use

• The label should indicate clearly from which age the product is recommended for use. This age shall not be less than six months for any product.

• Feeding instructions shall be given; preferably accompanied by graphical presentations.

• Feeding instructions must include the availability of potable water needed to address thirst conditions when consuming RUTF.

• The time within which the product should be consumed after opening should be clearly indicated.

References:

(1)  Russ K, Baker P, Byrd M, et al. What you don’t know about the Codex can hurt you: how trade policy trumps global health governance in infant and young child nutrition. International Journal of Health Policy and Management 2021; 10(12): 983-97.  Baker et al. Globalization and Health (2021) 17:58. Advocacy at Work During the Codex Committee on Food Labelling Meeting

Risks of UPFs

UPFs form 50% of Britons’ calorie intake

Nelson et al Premature Deaths Attributable to the Consumption of Ultraprocessed Foods in Brazil  American Journal of Preventive Medicine   10.1016/j.amepre.2022.08.013 2022) https://www.eurekalert.org/news-releases/970082. Review article

Angel et al.  Ultraprocessed Foods and Public Health: A Need for Education. Mayo Clinic Proceedings, Volume 94, Issue 11, November 2019, Pages 2156-2157

Wang et al. Trends in Consumption of Ultraprocessed Foods Among US Youths Aged 2-19 Years, 1999-2018. JAMA. 2021;326(6):519-530. doi:10.1001/jama.2021.10238

Neri et al. Ultraprocessed food consumption and dietary nutrient profiles associated with obesity: A multicountry study of children and adolescents. Obes Rev 2022 Jan;23 Suppl 1:e13387.do10.1111/obr.13387. Epub 2021 Dec 9.

Nelson et al. Premature Deaths Attributable to the Consumption of Ultraprocessed Foods in Brazil. https://doi.org/10.1016/j.amepre.2022.08.013

The increased proliferation, consumption and global trade in ultra-processed products baby feeding products (Euromonitor 2019).

FAO. Ultra-processed foods, diet quality, and health using the NOVA classification system Monteiro et al.

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