A day after Sten Vermund felt “kicked in the gut,” he found himself talking about a new opportunity to fight back.
The kick came from the news that the U.S. government used its influence to water down and almost completely derail a resolution by the World Health Assembly calling on countries to recognize that breast milk is the healthiest beverage for children and to limit misleading marketing of substitutes like infant formula. The Trump administration threatened trade sanctions and a cut in military aid to Ecuador, which then pulled out as the resolution’s sponsor; it took Russia to sponsor the resolution to get it to pass in some form. (Read about that here.)
A pediatrician and public health advocate, Vermund was involved at the beginning of a movement in the 1970s that led to an international boycott of infant formula manufacturer Nestle, a movement that eventually led to more honest marketing and better health for millions of newborns around the globe.
“When I read about this, I was literally sickened. I felt like I had a kick to the gut. I thought we were 35 years past this,” Vermund said during an interview on WNHH FM’s “Dateline New Haven” program.
These days Vermund is the dean of the Yale School of Public Health. In that role, he has already been working on training public health advocates to get their message across better. In the face of the latest setback on an issue he thought was already settled, he is returning to a revived movement to fight the promotion of formula over mother’s milk. On this issue, as on others like global warming, he sees the potential for an alliance with part of the right, especially religious conservatives.
An edited transcript of the conversation on “Dateline New Haven” follows:
Vermund: It was July 1977. I was starting my internship in pediatrics at Columbia Presbyterian Medical Center. That was the beginning of the INFACT [Infant Feeding Action Coalition] movement, which was a Nestle boycott.
Nestle had this bad habit of dressing up their saleswomen as if they were nurses and having them give free formula to new mothers in developing country hospitals.
The mothers who were encouraged not to breast feed would then become customers of the formula.
There were abundant vignettes of malnourished children. Mothers couldn’t afford the formula. So they would dilute it. Instead of putting a tablespoon they would put a teaspoon. Sometimes it was so bad they would color the water white to give it the impression it was milk.
WNHH: That’s evil.
It’s very evil.
We mobilized. The INFACT movement was very successful. By the time I had morphed from full time pediatrician to part time pediatrician to part time public health professional in 1983, there was an agreement with Nestle that they signed and voluntarily agreed to change their marketing practices. And the boycott was stopped.
In between, in 1981, there was a carefully negotiated breastfeeding and infant feeding agreement with the formula manufacturers. This had been carefully negotiated by the Carter administration. In the first months of the Reagan administration, the U.S. voted no.
So we’ve been through this before.
Is there any argument for letting companies make false claims?
There’ no legitimate argument. This was a pro-breastfeeding resolution that the World Health Assembly, the WCHO, would promulgate breastfeeding as the first choice, healthy…
Wasn’t it also calling on companies not to mislead people?
Correct. We’re simply rewinding the clock back to 37 years ago. We have yet another administration that has decided to advocate for formula rather than breast milk. We think it’s an important compelling issue for Americans too: We know that the breastfed baby is less likely to grow up to be obese than the formula fed baby, less likely to be overfed, which is a problem in this country.
In the lowest-income countries we need them breastfed so they don’t become undernourished. In the high-income countries we need them breastfed so they don’t become overnourished.
It’s best for everybody.
Isn’t there a problem with viral diseases? Is my understanding correct that having breastmilk makes it much less likely for a baby to be susceptible to those?
Yes. Breast milk is a miracle beverage. Breast milk has antibodies from the mothers that help protect the baby. It also has immunologic cells from the mother that help protect the baby. Our evidence is overwhelming from a decade, you could say 30 years of research in breast milk immunology, that not only is breast milk the perfectly balanced food for a baby — and that’s what the formula companies mimic. They mimic breast milk the best that they can.
And it has immunological properties that formula cannot produce.
Public Health Community’s Role
How do you feel as a public health professional? You’ve been at the beginning of this movement. You dedicate your life to have science and public health work help other people’s lives …
When I read about this I was literally sickened. I felt like I had a kick to the gut. I thought we were 35 years past this.
The formula manufacturers have been better corporate citizens in recent years. Why they should be encouraged to backslide by official U.S. government policy, to discourage the World Health Assembly and the World Health Organization from adopting a very thoughtful pro-breastfeeding policy, is an absolute mystery.
How much money is at stake?
Formula manufacturers had a leveling of their marketing and their sales.
I thought they were still looking at 3 percent growth in profits next year.
Yeah, but that’s considered a leveling in their business. They’d like to see 5 percent, 10 percent. They’d like to see better than population growth. And they’d like to expand their market. So there are forces within that industry, very few of them have my institutional memory on the issue, because they weren’t around 35 years ago. So they’re being reeducated how angry [people are] …
Russia saved the day yesterday …
Russia is not always the bad guy in public health. They’re the ones who produced in the 1950s to try to eradicate the world of smallpox. In the middle of the Cold War. The United States agreed. And we did succeed in eradicating smallpox.
Russia can be enlightened on public health issues when it chooses to be. I think in this case Russia must have something on our president. Because this president capitulates on every turn to Russia.
You were sickened about the news yesterday. What do you do about it? We depend on people like you …
Well, I sent a letter to The New York Times.
That’s step one.
I’m revitalizing my attention to this issue. Because there is an incipient and expanding boycott movement again. It’s spearheaded by a consortium led by a group in Great Britain. I’m looking into that to see if I should join again. I thought we were done with this. I thought the formula manufacturers had woken up and smelled the coffee and recognized that unethical practices are not the way to sell their product. There’s a plenty big market for formula.
What can a public health advocate or researcher or dean do? You talked about writing a letter to the Times. You talked about joining a movement. Is it about producing credible research? Is that the main role?
On this particular topic, the research is overwhelming. On this particular topic, we have such compelling clinical, biological, immunological evidence of the benefits of breast milk.
Certainly there is more research to be done. But the fundamental question is answered:
Breast milk is a superior product to feed a newborn child. It has to do with advocacy and communication.
We have been working with a Yale alumnus out in San Francisco who is interested in supporting a competition at our school. At the Yale School of Public Health, we’re going to launch in the fall a 1 to 2-minute video competition, in which students are going to make a brief video about a compelling public health issue in our time.
The goal will be to either target the lay public as their audience or target policymakers, politicians. We don’t care which group they target. We want to target both, and see if we can communicate sometimes complex public health challenges in ways that lay audiences and policymakers can understand.
It is one of our great failings. We are not effectively communicating. Why are so many parents rejecting vaccines for their children? Why is there so much support for environmental degradation? Why are there not more sentiments in favor of alternative energy sources and battling global warming.
The fact that we don’t have 70, 80 percent of the public in favor of protecting our environment, in favor of reducing the risks to our children from global warming, in favor of protecting our children from suboptimal nutrition, in the case of breastfeeding or avoiding vaccination ... We’re failing. We’re not reaching out to the public in an effective way. We need to redouble our efforts.
Right-wing media outlets are convincing people that it’s experts versus people like them. That people like you, Dean Vermund, are not like them, and you want to take away their jobs and tell them how to live their life through fake science. Those same [funders] can pay for studies that say it’s great to drink formula. Any thoughts on that?
There are a host of conservative activists who have a book that liberals rarely read anymore, by Saul Alinksy: Rules for Radicals. It was a book written in the early ‘60s by a left-wing labor and community organizer that was all about community organization. This is required reading in a number of conservative circles because of how effectively it argues the need for community mobilization. How to do it.
Community mobilization and public education strategies that were used by the left in the ‘60s are now used by the right in the 2000s. These are effective strategies. You can mobilize communities for effective community action.
We who are public health advocates looking to talk up social needs and improve people’s ability to get jobs and improve people’s ability to get housed, to cope with their demons, be it mental health or drug use — if we could forge a grand alliance with a subset of conservatives, who actually agree with us.
This breast milk argument, if I wanted to put my old Norwegian Lutheran hat on, I could argue that breast milk is God’s creation, is God’s gift to children. The Judeo-Christran traditions, Hinduism, Islam, all of them would see breast milk as a creation of God. One could forge an alliance around the importance of healthy feeding of newborns. That doesn’t have to be a political issue. Climate change does not have to be a political issue. Do we reallly want more contamination of our streams and our air? Is this conservatism? Is conservatism trying to preserve Mother Earth?
We have to improve our vocabulary. There is an interesting program that the Bill & Melinda Gates Foundation has spearheaded. They have done surveys. They found that conservative groups … equate family planning with abortion. If on the other hand, you talk with conservative groups about contraception, there is a positive response. …
Sometimes it’s our vocabulary and our ability to communicate what we mean. ... Engaging traditional conservatives, not Trump conservatives …
What can our listeners and readers do today or tomorrow on this breast milk issue?
The sentiment of the Connecticut Congressional delegation is overwhelmingly in favor of what you, Paul, and I have been saying. I think this is an opportunity to tap into other ties.
Let’s say that you have a cousin in Oklahoma. You send a not to the Oklahoma legislator in Congress citing that your cousin’s district is this district. I will send notes to Tennessee politicians because I lived there for the last 12 years before moving to New Haven. I think we want to reach out to a broader constituency. I think that letting the White House know that this is seen as an unacceptable situation. A letter to a local newspaper, a letter to a local blog … It’s an important and compelling issue not to let our government get away with an anti-breastfeeding stand at the World Health Assembly.
(The Federalist Society, a conservative publication, published this critique of the New York Times account of the Trump administration’s actions.)
Click on the above audio file or the Facebook Live video for the full interview with Dean Sten Vermund on WNHH FM’s “Dateline New Haven” program. Other topics discussed included obesity.