Nutrition Industry Sponsorship of Healthcare Professional Associations

Last month, the World Health Organisation (WHO) published new resources to support Healthcare Professional Associations (HCPA) wishing to avoid conflicts of interest in relation to nutrition companies marketing foods for infants and young children. The new WHO resources include a model policy, suggestions for alternative funding sources and case studies of good practice [1]. The case studies include the Indian Academy of Paediatrics and examples from Africa, which are especially important given the harms associated with formula marketing in these regions [2]. The new resources underscore a long-standing WHO recommendation, made more explicit since 2016—that HCPA (and health workers) should not accept funding from companies that market foods for infants and young children, for either the general running of the HCPA or for supporting HCPA educational or scientific meetings such as an annual congress [3]. The scope of ‘foods’ that relevant companies might market is quite broad, including formula, ‘growing up’ drinks, specialised low-allergy formula, non-liquid foods and even bottles and teats sold for formula feeding. The scope of ‘infants and young children’ is from birth through to age 36 months, the period of time covered by the International Code of Marketing of Breastmilk Substitutes.

This WHO recommendation has met with significant resistance from HCPAs, including some allergy HCPAs [4]. Two key reasons cited for continuing to accept nutrition industry funding are access to scientific information about nutrition products, and difficulty funding educational and scientific activities without nutrition industry support [5]. Access to scientific information about nutrition products does not require a financial relationship, since companies already provide product information in the public domain and on request, without any exchange of funding. Finding alternative resources for educational and scientific activities is more challenging. So these new WHO resources aim to support HCPAs to address this challenge.

This month, the British Society for Allergy and Clinical Immunology (BSACI) hosted its first annual conference without sponsorship from any company that markets foods for infants and young children. It is 5 years since the society's announcement that it will no longer accept funding from commercial formula milk companies for its conference and educational activities. Culture change takes time, and reducing income sources is not something which organisations find easy. This is recognised by the WHO, hence the inclusion of case studies to help HCPAs understand that they are not alone in finding this difficult, and a journey is often required to transition away from nutrition industry funding. There are a number of other allergy societies which take a similar approach to BSACI of avoiding formula industry sponsorship. However, these are dwarfed by the major allergy HCPAs in Europe, Asia and the Americas which, together with the World Allergy Organisation, all continue to accept nutrition industry sponsorship. Allergy is an important growth area for the nutrition industry, and nutrition industry sponsorship often accounts for a significant proportion of total HCPA income.

Although the WHO guidance and these new resources focus on HCPAs and the nutrition industry, there are problematic relationships between a wide range of profit-making corporations and HCPAs, charities, regulators and key opinion leaders. These can have a negative impact on public health, healthcare and science. In a landmark report by the United States National Academies in 2009, an eminent panel noted that commercial influences may be jeopardising ‘the integrity of scientific investigations, the objectivity of medical education, the quality of patient care, and the public's trust in medicine’ [6]. Infant and young child nutrition industry conflicts of interest have a particular place in this story—due both to the devastating public health effects of formula industry marketing from the early 20th century onwards, which triggered the development of the WHO Code; and due to the current global child obesity crisis.

Organisations often question whether it is really necessary to make significant financial sacrifices by avoiding conflicts of interest which are seen by others to be problematic. HCPAs challenge the concept that conflicts of interest can cause harm, or are causing harm, in their particular area of healthcare. For allergy, there is evidence that conflicts of interest can drive overdiagnosis and unnecessary use of specialised formula products which carry health and nutrition risks (Table 1) [7].

It is this type of evidence, from multiple areas of healthcare, public health and biomedical science, which drives governmental and intergovernmental organisations to make recommendations such as those of the WHO.

The aims of the nutrition industry are often directly opposed to public health aims. For the nutrition industry, selling more formula often means aiming to prevent or shorten breastfeeding, whereas supporting the initiation and continuation of breastfeeding is an important public health goal. The impact of nutrition industry sponsorship of HCPAs over many years can be seen in the debate about the 2023 WHO infant and young child feeding guideline [8]. Recently, a group of nutrition industry-sponsored HCPAs, including the European Academy of Allergy and Clinical Immunology and World Allergy Organisation, criticised the WHO guideline and presented alternative proposals [9]. Every alternative proposal aimed to either shorten the recommended duration of exclusive or total breastfeeding, or to identify a role for earlier or more prolonged use of commercial milk formula—all of which are important nutrition industry marketing aims (Figure 1).

Allergy and nutrition HCPAs are likely to continue to attract criticism from the public health community, if they continue to accept nutrition industry funding. Allergy and nutrition HCPAs would be well advised to study these new WHO resources. Charities and other organisations that are trusted by the public to provide independent, credible information, advice and care related to infant and young child feeding may also find them helpful. The new resources illustrate that a culture change is possible, and that the missions of HCPAs can be successfully accomplished without nutrition industry sponsorship.

R.J.B.: wrote the first draft of the manuscript and submitted the final version. V.L.S.: edited the manuscript and approved the final version. C.v.T.: edited the manuscript and approved the final version.

R.J.B. is a member of BSACI, which in turn is a member society of the World Allergy Organization. R.J.B. is a member of the European Academy of Allergy and Clinical Immunology. V.L.S. and C.v.T. declare no conflicts of interest in relation to this article.