WHA RESOLUTION
58.32
Infant
and young child nutrition
TThe
Fifty-eighth World Health Assembly,
Recalling
the adoption by the Health Assembly of the International
Code of Marketing of
Breast-milk Substitutes (resolution WHA34.22), resolutions
WHA39.28, WHA41.11,
WHA46.7, WHA47.5, WHA49.15, WHA54.2 on
infant and young child nutrition,
appropriate feeding practices
and related questions, and particularly WHA55.25,
which endorses the global strategy for infant and
young child feeding;
Having considered the report on infant and young-child
nutrition;
Aware
that the joint FAO/WHO expert meeting on Enterobacter
sakazakii and other
microorganisms in powdered infant formula held in 2004
concluded that intrinsic contamination of
powdered infant formula with E. sakazakii and Salmonella had been a cause of infection and illness,
including severe disease in infants, particularly preterm,
low birth-weight or immunocompromised
infants, and could lead to serious developmental sequelae
and death;(1-1)
Noting
that such severe outcomes are especially serious in preterm,
low birth-weight and
immunocompromised infants, and therefore are of concern
to all Member States;
Bearing
in mind that the Codex Alimentarius Commission is revising
its recommendations on
hygienic practices for the manufacture of foods
for infants and young children;
Recognizing
the need for parents and caregivers to be fully informed
of evidence-based public health
risks of intrinsic contamination of powdered
infant formula and the potential for introduced
contamination, and the need for safe preparation,
handling and storage of prepared infant formula;
Concerned
that nutrition and health claims may be used to promote
breast-milk substitutes
as
superior to breastfeeding;
Acknowledging
that the Codex Alimentarius Commission plays a pivotal
role in providing
guidance to Member States on the proper regulation
of foods, including foods for infants and
young
children;
Bearing
in mind that on several occasions the Health Assembly has
called upon the Commission
to give full consideration, within the framework of its operational
mandate, to evidence-based action
that it might take to improve the health standards of foods,
consistent with the aims and objectives of
relevant public health strategies, particularly WHO’s
global strategy for infant
and young-child
feeding (resolution WHA55.25)
and Global Strategy on Diet, Physical Activity and Health
(resolution
WHA57.17);
Recognizing
that such action requires a clear understanding of the
respective roles of the Health
Assembly and the Codex Alimentarius Commission, and that
of food regulation in the broader context
of public health policies;
Taking
into account resolution WHA56.23 on the joint FAO/WHO evaluation
of the work of
the Codex Alimentarius Commission, which endorsed WHO’s
increased direct involvement in the
Commission and requested the Director-General to strengthen
WHO’s role in complementing the
work of the Commission with other relevant WHO activities
in the areas of food safety and nutrition,
with special attention to issues mandated in Health
Assembly resolutions,
1. URGES Member
States:
(1)
to continue to protect, promote and support exclusive breastfeeding
for six months as a
global public health recommendation, taking into account
the findings of the WHO Expert
Consultation on optimal duration of exclusive breastfeeding,(2-1)
and to provide for continued
breastfeeding up to two years of age or beyond, by implementing
fully the WHO global strategy
on infant and young-child feeding that encourages the formulation
of a comprehensive national
policy, including where appropriate a legal framework to
promote maternity leave and a
supportive environment for six months’ exclusive breastfeeding,
a detailed plan of action to
implement, monitor and evaluate the policy, and allocation
of adequate resources for this
process;
(2)
to ensure that nutrition and health claims are not permitted
for breast-milk substitutes,
except where specifically provided for in national
legislation; (2-2)
(3)
to ensure that clinicians and other health-care personnel,
community health workers and
families, parents and other caregivers, particularly
of infants at high risk, are provided with
enough information and training by health-care providers,
in a timely manner on the
preparation, use and handling of powdered infant
formula in order to minimize health hazards;
are informed that powdered infant formula may contain
pathogenic microorganisms and must be
prepared and used appropriately; and, where applicable,
that this information is conveyed
through an explicit warning on packaging;
(4)
to ensure that financial support and other incentives for
programmes and health
professionals working in infant and young-child
health do not create conflicts of interest;
(5)
to ensure that research on infant and young-child feeding,
which may forms the basis for
public policies, always contains a declaration
relating to conflicts of interest and is subject
to
independent peer review;
(6) to work closely
with relevant entities, including manufacturers, to continue
to reduce the
concentration and prevalence of pathogens, including Enterobacter
sakazakii, in powdered
infant formula;
(7)
to continue to ensure that manufacturers adhere to Codex
Alimentarius or national food
standards and regulations;
(8)
to ensure policy coherence at national level by stimulating
collaboration between health
authorities, food regulators and food standard-setting
bodies;
(9)
to participate actively and constructively in the work
of the Codex Alimentarius
Commission;
(10)
to ensure that all national agencies involved in defining
national positions on public
health issues for use in all relevant international
forums, including the Codex Alimentarius
Commission, have a common and consistent understanding
of health policies adopted by the
Health Assembly, and to promote these policies;
2.
REQUESTS the Codex Alimentarius Commission:
(1)
to continue to give full consideration, when elaborating
standards, guidelines and
recommendations, to those resolutions of the Health Assembly
that are relevant in the
framework of its operational mandate;
(2)
to establish standards, guidelines and recommendations
on foods for infants and young
children formulated in a manner that ensures the development
of safe and appropriately labelled
products that meet their known nutritional and safety needs,
thus reflecting WHO policy, in
particular the WHO global strategy for infant and young
child feeding and the International
Code of Marketing of Breast-milk Substitutes and other
relevant resolutions of the Health
Assembly;
(3)
urgently to complete work currently under way on addressing
the risk of microbiological
contamination of powdered infant formula and establish
appropriate microbiological criteria or
standards related to E. sakazakii and other relevant
microorganisms in powdered infant formula;
and to provide guidance on safe handling and on warning
messages on product packaging;
3. REQUESTS the
Director-General:
(1) in collaboration
with FAO, and taking into account the work undertaken by
the Codex
Alimentarius Commission, to develop guidelines for clinicians
and other health-care providers,
community health workers and family, parents and other caregivers
on the preparation, use,
handling and storage of infant formula so as to minimize
risk, and to address the particular
needs of Member States in establishing effective measures
to minimize risk in situations where
infants cannot be, or are not, fed breast milk;
(2)
to take the lead in supporting independently reviewed research,
including by collecting
evidence from different parts of the world, in order to
get a better understanding of the ecology,
taxonomy, virulence and other characteristics of E. sakazakii,
in line with the recommendations
of the FAO/WHO Expert Meeting on E. Sakazakii and other
Microorganisms in Powdered
Infant Formula, and to explore means of reducing its level
in reconstituted powdered infant
formula;
(3) to provide
information in order to promote and facilitate the contribution
of the Codex
Alimentarius Commission, within the framework of its operational
mandate, to full
implementation of international public health policies;
(4)
to report to the Health Assembly each even year, along
with the report on the status of
implementation of the International Code of Marketing of
Breast-milk Substitutes and the
relevant resolutions of the Health Assembly, on progress
in the consideration of matters referred
to the Codex Alimentarius Commission for its action.
Ninth plenary meeting, 25 May 2005
A58/VR/9
1-1
FAO/WHO Expert Meeting on E. sakazakii and other Microorganisms
in Powdered Infant Formula: Meeting
Report. Microbiological Risk Assessment Series No. 6, 2004,
p. 37.
2-1
As formulated in the conclusions and recommendations of the
Expert Consultation (Geneva, 28-30 March 2001)
that completed the systematic review of the optimal duration
of exclusive breastfeeding (see document A54/INF.DOC./4).
2-2 The
reference to national legislation also applies to regional
economic integration organizations.
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