No one-size-fits-all solution: Irresponsible of WHO to expect adherence to its guidelines over local laws – Australia’s Infant Nutrition Council

The INC takes issue with “an egregious point” that has been repeatedly raised to the Australian government, namely that WHO guidelines should take precedence.

“WHO stated that if there is a conflict between its guidance and national law, we should follow WHO guidance. Now, think about what that implies – private companies are being told by the WHO secretariat to ignore national laws or regulations when they conflict with WHO guidelines,”​ said CEO of the INC Jonathan Chew, who called this move by the WHO “irresponsible”.

These comments come in the wake of recent publications that criticised private companies for not adhering to WHO guidelines.

For example, a recent paper looked at infant and toddler food in Australia’s supermarkets​. It found that every infant and toddler food in Australian supermarkets failed WHO standards. Researchers argued that regulations are needed to improve the nutritional profile of products and prevent deceptive labelling.

There is also an ongoing debate on complementary feeding and the credibility of infant formula products in Australia.

The INC does not object to the WHO making recommendations, which, in its view, are only guidance notes until a national government decides how to apply those guidelines.

Another point of contention has to do with the ban on all forms of marketing for infant formula products.

Is there a need to ban all forms of digital marketing?​

Australia is aligned with the WHO in terms of not marketing infant formula to parents due to a common goal of protecting and promoting breastfeeding.

The country has a voluntary self-regulated code – the Marketing in Australia of Infant Formulas (MAIF) Agreement – which prohibits all forms of marketing for infant formula products. This includes traditional broadcasting and modern methods via social media or influencers.

But it permits certain aspects of digital marketing.

For example, parents may use digital means to contact an infant formula brand to seek clarifications on stock availability, ingredients, and preparation methods. Brands may interact with parents in such instances to provide answers.

However, such interactions are apparently not permitted according to the WHO.

“The WHO guidance went much further than the Australian position in saying that all digital communication had to be prohibited, without acknowledging the need for exemptions based on sound policy,”​ said Chew.

In Australia, infant formula is promoted such that it is consistent with the national government’s requirements. 

“Unfortunately, there are some academics who believe that anything industry does is self-serving and evil,” said​ Chew, referencing the recent school of thought called “the commercial determinants of health” – an academic theory suggesting that private companies in the food and beverage industry are solely focused on maximising profits and, as a result, cannot be trusted to prioritise the quality of their products.

But this perspective overlooks the fact that it is in no one’s interest to intentionally ignore the wellbeing of consumers just to increase profits, said Chew.

Firstly, it can damage a company’s reputation, leading to loss of consumer trust and declining sales over time. In addition, companies in highly regulated industries like infant formula must comply with strict health and safety standards. Failing to meet these standards can result in legal penalties, product recalls, or being removed from the market altogether.

Long-term profitability and brand success depend on consumer confidence in the safety and nutritional value of the products they buy, so prioritising health and quality are in a company’s best financial interest.

All these raise concerns about the credibility of the authors behind the WHO guidelines, and it is important to scrutinise such guidance especially when it conflicts with well established local regulations, said Chew.

“The WHO has a halo around it, like it is an infallible source of information. But it's just another bureaucratic body. So its publications, often co-authored by those who might have political agendas, should be approached with the same scepticism as any other,”​ said Chew.

This also raises the important question of WHO’s role in ensuring access to health and wellbeing.

What is the WHO’s role?​

In response to the suggestion that the WHO sees itself as an international watchdog for the member states, Chew questioned the necessity of WHO’s involvement in countries like Australia, where comprehensive systems are already in place to regulate infant formula.

“Australia has a robust Food Standards Code, regulators that actively monitor and enforce it, and governments with the resources to ensure compliance with the manufacturing and marketing of infant formula. So why does a country like Australia need the WHO to step in and dictate how things should be done domestically when the national government is fully capable?”​ questioned Chew.

Chew acknowledges that the WHO can play a role in countries that lack resources or expertise, but ultimately, it serves member states, not its own interests.

A differentiated approach​

As national governments are responsible for determining what’s best suited to their own populations, Chew’s concern is that the WHO does not always consult thoroughly before issuing guidance. This can lead to recommendations that, while perhaps well-intentioned, may be unsuitable or even dangerous at a local level when they contradict national guidance.

When asked if the WHO should take a differentiated approach in recommending guidelines since each country has unique needs, Chew agrees that this could be one solution.

For example, Australian guidelines advise parents to boil water and let it cool before adding infant formula powder for mixing.

The WHO, in contrast, says the water should be at a temperature of no less than 70°C, and does not specify that the water should be boiled. This overlooks the capabilities and access to clean water in different countries.

In Australia, most parents have access to clean water and sanitation, allowing them to follow the national government's guidelines, which are also observed by formula manufacturers.

“It would be helpful for WHO publications to note that different member states often have variation in local advice due to differing national contexts. This would mean that where countries like Australia develop national guidelines, these guidelines are recognised as more relevant than WHO advice,” ​said Chew.