The 55th World Health Assembly (WHA) adopted a new strengthened Resolution on Infant and Young Child Nutrition (WHA 55.25) in Geneva last Saturday.

A total of 38 countries spoke in the debate, and the majority of developing world speakers called for the draft text to be strengthened, and to mention the facts that exclusive breastfeeding for the first six months is critically important; and that infant feeding programmes do not involve the baby feeding industry (beyond the requirement to respect the International Code and subsequent relevant WHA Resolutions).

The Resolution endorses a new "Global Strategy for Infant and Young Child Feeding", the outcome of a four-year consultative process involving all member states.

The case of the five day old Belgian baby, who died of meningitis in March after being fed Nestlé Beba 1 dried infant formula from a batch which was contaminated with Enterobacter Sakazakii, was noted as raising consciousness of the need to do more to protect breastfeeding in all countries, not just in developing countries.

Two new monitoring reports from the US and Canada launched in Geneva at the time of the WHA also highlighted the flagrant violations of the International Code in industrialised countries and the failure to protect mothers' rights to make fully informed decisions about infant feeding.

Country's comments

During the WHA debate, notable interventions were made by several countries. The Indian delegation called for the removal of the term 'commercial' saying: "Commercial enterprises by definition are profit driven entities. It is neither appropriate nor realistic for the WHO to expect that commercial groups will work along with governments and other groups to protect, promote and support breastfeeding."

India also drew attention to WHA Resolution 49.15 which in 1996 urged member states to ensure that monitoring is carried out in a transparent independent manner, free from commercial influence and that financial support for professionals working in infant and young child health does not create conflict of interest.

These concerns were reinforced by a number of countries including Palau which appealed to WHO to "protect Member States from undue and unwanted influence by industries and manipulation by them".

Reinvigorate nutrition work

In addition to the intervention on the infant feeding debate, IBFAN and Consumers International made an intervention on the report on Diet, Nutrition and Physical Activity. IBFAN supported the opening address by the Director General Dr Gro Harlem Brundtland, in which she laid down a clear challenge to the trillion dollar food industry, referring to WHO's intention to "reinvigorate WHO's work on diet, food safety and human nutrition," and the problem of "excessive consumption of fatty, sugary and salty foods".

Dr Brundtland said that: "Getting loyalty to brand names is the key to influencing consumer behaviour - from the time children start to walk. Children currently influence 45% of household purchases in the US, and 65% in urban China.....Brand name promotions - whether for tobacco, alcohol or fast foods - are designed to take advantage of peoples subconscious... There is certainly a need for guidance: in some cases, like tobacco advertising and alcohol advertising aimed at the young, what we need is control. WHO will play its part."

Caution expressed on GAIN

IBFAN warmly welcomed this new initiative but expressed caution about the trend towards Public Private Partnerships. These concerns were echoed by many NGOs, such as the People's Health Assembly, INFACT and Health Action International. IBFAN called for an urgent review and change in WHO's checking procedures and guidelines on conflict of interest. Earlier in the infant feeding debate, several Member States had expressed concern about the new UN/Bill Gates backed Global Alliance for Improved Nutrition (GAIN) launched on 9 May. GAIN, ironically the name of an infant formula, involves companies known for pushing unhealthy brands of foods. WHO has in the past clearly indicated that it does not want to be involved in any 'partnership' or 'interaction' with the tobacco industry or any of its subsidiaries, but its guidelines on conflicts of interest are only in draft stage and are unclear. UNICEF by joining this initiative is also violating its own guidelines on the interaction with the private sector which exclude the tobacco as well as violators of International Code.

An article in the Wall St Journal on 9 May, stated that the companies involved in GAIN expect the UN system to intervene on their behalf to lobby for favourable tariffs and tax rates and a speedier regulatory review of new products in targeted countries. WHO staff denied that such promises had been made, but failed to give assurances about whether they would be involved in this venture.

In his answer on the Nutrition debate Dr Derek Yach, executive director of WHO's Non-communicable Diseases and Mental Health Cluster, said that this issue needs to be addressed from a life course perspective, including infant and young child nutrition. He went on to note: "the concern of Consumers International with regard to the possible adverse commercial influences on WHO's policy. And we certainly can assure you that as Dr Brundtland emphasised in her opening address, that we have a commitment to strengthen our protection of conflict and perceived conflict of interest. "

WHO was also asked for an affirmation that initiatives such as GAIN would not be used to undermine breastfeeding or the progress made on banning health claims on foods for infants and young children. At the Codex Alimentarius labelling meeting in Halifax, Nova Scotia, the week before the WHA, this moved one step further. IBFAN stressed that fortified junk foods would not be the answer to malnutrition and called for WHO to conduct independent research into the impact of marketing on the very poor.