Inside the scramble to help low-income infants during formula recall

The prospect of tainted infant formula in U.S. stores has made life frightening and difficult for some parents since the federal government issued a safety warning on Feb. 17.

But the burden falling on parents in poverty has proven to be even greater — especially those in Pennsylvania’s WIC program, which serves low-income pregnant women, new mothers, and children under the age of 5.

Almost 10 days ago, the U.S. Food and Drug Administration issued a caution to consumers saying that bacterial infections found in four hospitalized babies in Texas, Ohio, and Minnesota — one of whom died — may be connected to certain batches of Similac, Alimentum, or EleCare powdered infant formulas, manufactured by Abbott Nutrition in Sturgis, Mich.

Federal officials say one infection was linked to Salmonella and three to Cronobacter, an extremely rare and potentially deadly bacterium that can cause blood infections and meningitis.

Soon after, Abbott issued a recall of the products. Meanwhile, the FDA has been advising Americans to avoid any containers of Abbott powdered infant formulas that display all three of the following elements: stamped codes whose first two digits run from 22 through 37; codes including the alphanumeric combinations of K8, SH, or Z2; and expiration dates of April 1, 2022, or later.

Over the years, Abbott has contracted with Pennsylvania and other states to use Similac in their WIC programs in exchange for formula rebates. That agreement precludes the mothers of 37,000 infants in the Pennsylvania WIC program from using any formula other than Similac, WIC agency leaders said.

As a result, the recall created an imbalance: Higher-income parents had the opportunity to hunt for alternatives to Abbott products; WIC mothers did not.

“People have no idea this occurs,” said Filomena Ahlefeld, the Delaware County WIC program director at the Foundation for Delaware County, headquartered in Media. “Even our clients want to know why they can’t get what they want.”

The story was the same across the state. “Parents have been scrambling and desperate,” said Melissa Bishop, director of WIC for the Family Health Council, which runs WIC programs in 11 counties in central Pennsylvania. “We’ve been receiving phone calls from moms saying, ‘I don’t know how to feed my baby.’ ”

Mothers in the WIC program are issued monthly benefits on EBT cards, which allow them to buy certain foods. The types and amounts of food covered by the cards are as specific as prescriptions, and substitutions aren’t normally allowed.

Aware of the constraints in the wake of the Abbott recall, the federal government stepped in to instruct states to bend the rules.

The USDA declared that it was issuing nationwide waivers through March 31 that allow parents to exchange any recalled products for other brands, or to use their WIC benefits to purchase non-Similac products.

“The waivers put the WIC moms on a more even basis with the non-WIC moms,” Bishop said. “I’m honestly surprised the USDA did it, and so quickly.”

Cindy Long, administrator of the USDA’s Food and Nutrition Service, said in a statement, “We are committed to providing WIC participants with access to a variety of safe and healthy foods, including infant formula.”

Some parents are concerned that switching formula could be a problem, but Joannie Yeh, a pediatric professor at Jefferson University, said not to worry: “You can switch formulas just like that, and most times babies don’t care. They just want something to eat.”

Yeh, who fed her children Costco formula, added that brands such as Similac aren’t any better than cheaper store brands. For comparison, 35 ounces of Target brand formula is $20, while 30.8 ounces of Similac is $37.

Still, while the USDA has loosened rules, problems persist.

Before the product recall, there were periodic shortages of formula because of worldwide supply-chain disruptions, said Brian Dittmeier, senior director for public policy at the National WIC Association in Washington.

Now, with the recall, ”there’s not enough Abbott product available,” he said. “And with an increased demand for non-Abbott product, it’s not clear competitors will ramp up production enough to meet that demand.”

In a statement, Abbott said that all products are tested for pathogens before being released. The statement went on to say, “We value the trust parents place in us for high quality and safe nutrition and we’ll do whatever it takes to keep that trust and resolve this situation. It’s important to note that no distributed product from our Sturgis, Mich., facility has tested positive for the presence of either Cronobacter sakazakii or Salmonella. Additionally, retained samples related to the three complaints for Cronobacter sakazakii tested negative for Cronobacter sakazakii. And the retained sample related to the complaint for Salmonella tested negative for Salmonella.” As part of Abbott’s quality processes, all infant formula products are tested for Cronobacter sakazakii, Salmonella and other pathogens, and they must test negative before any product is released.”

Without exact data, the extent of formula shortages is not known. While some customers are reporting a dearth of product in stores, Alex Baloga, president and CEO of the Pennsylvania Food Merchants Association, representing 4,000 to 5,000 grocery and convenience stores, said he was not aware of any shortages. And FMI, the national food industry association in Arlington, Va., said in a statement that there is "product available to meet consumers’ needs.”

In some cases, stores don’t yet understand that WIC parents are allowed to use their benefits to purchase non-Similac product, Ahlefeld said.

“My local store is having a problem with this,” said Chantay Swiggett, 41, a caregiver in Brookhaven with an 11-month-old daughter. She declined to name the store, an independent grocer, adding, “I told them WIC is letting us switch off Similac, but they didn’t believe me.” Swiggett eventually got her local WIC office to vouch for her, and the store relented.

During a call late last week among numerous WIC agencies, advocates, and the state Department of Health, advocates suggested that the DOH create a contingency plan that would get emergency supplies of formula to clients should a recall happen again, according to a person on the call who was not authorized to speak.

At St. Christopher’s Hospital for Children, which serves North Philadelphia, the staff is fielding a broad spectrum of complaints related to the formula recall.

“Parents are terrified,” said pediatrician Dan Taylor. “We’re inundated with calls. First, we’ve seen a lot of distrust of medicine around the COVID vaccine. And now a multimillion-dollar company is recalling formula.

“People are coming into the ER with kids with normal stomach viruses, saying they consumed formula with recalled lot numbers. Parents worry their babies are contaminated, but I assure them that diarrhea and vomiting aren’t symptoms connected to this very rare bacteria.”

It’s so uncommon, in fact, that the Centers for Disease Control and Prevention say fewer than 10 Cronobacter cases are reported throughout the United States in a year.

In some special cases, the recall is creating huge problems.

Alisha Mooney, 24, of Landsdowne, who does COVID-19 contract tracing for the state, has a four-month old boy named Dominic Amoroso with a milk allergy. She was feeding him Abbott’s EleCare, but much of it was recalled..

While the slackening of WIC rules allows her to search for alternatives, there is only one, Neocate by Nutricia, that works for Dominic. But these days, it’s extremely hard to find, and a case of eight 14.1-ounce cans costs $300, Mooney said.

“We’re taking it one bottle at a time,” she said. “If I didn’t, I’d go absolutely insane.”