Interim policy on the importation and sale of infant formulas, human milk fortifiers and dietary products for the treatment of inborn errors of metabolism to mitigate shortages

March 10, 2022

Policy statement – Health Canada recognizes that the temporary closure of a large manufacturing plant in the United States will result in shortages of infant formulas, human milk fortifiers (HMF), and dietary products for the treatment of inborn errors of metabolism (herein referred to as metabolic products) for vulnerable populations in Canada, including infants and children.

Health Canada recommends that the Canadian Food Inspection Agency (CFIA) temporarily exercise enforcement discretion with respect to certain labelling and composition requirements on the importation and sale of products listed in Appendix A to prevent and mitigate shortages.

Purpose:

This document sets out Health Canada's recommendation to the CFIA with respect to the temporary importation and sale of infant formula, HMF, and metabolic products that may not fully meet Canadian regulatory requirements with respect to labelling and/or composition, but are manufactured to comparable standards, and that provide information that ensures the safe preparation and use of the foods. The purpose of the enforcement discretion recommendation is to help prevent and mitigate shortages of these products in Canada in relation to the temporary closure of a large manufacturing plant in the United States, while ensuring a safe supply of these products to the vulnerable Canadians that rely on them.

Scope:

The following policy applies only to the infant formulas, HMF, and metabolic products listed in Appendix A. Health Canada has conducted a safety assessment of each product prior to their inclusion in this list in order to support the CFIA in its food safety mandate and exercising its enforcement discretion.

It is recommended that the CFIA apply its enforcement discretion to foods listed in Appendix A, in respect of the provisions of Parts B and D of the Food and Drug Regulations (FDR). It is also recommended that the CFIA apply its enforcement discretion in respect of sections A.01.014, A.01.016, A.01.041 and A.01.044, to the extent necessary to give effect to the enforcement discretion.

Bilingual labelling provisions continue to apply with enforcement discretion recommended where there are reasonable alternative means of providing the required information in both official languages.

It is further recommended that the CFIA also apply its enforcement discretion, in respect of paragraphs 4(1)(a) and (d) of the Food and Drugs Act to foods listed in Appendix A, in relation to the use or presence of any of the following substances:

  1. a food additive;
  2. any nutritive material that is used as an ingredient of the food;
  3. vitamins, mineral nutrients and amino acids;
  4. agricultural chemicals;
  5. food packaging materials and components of those materials; and
  6. drugs recommended for administration to animals that may be consumed as food.

Roles and responsibilities:

Health Canada: federal authority responsible for establishing standards and regulations regarding, among other things, the labelling and compositional requirements of infant formula, HMF, and dietary products for inborn errors of metabolism sold in Canada, under the Food and Drugs Act

Canadian Food Inspection Agency: federal authority responsible for the compliance and enforcement of regulatory food requirements including those relating to the import, production and sale of infant formulas, HMF, and metabolic products under the Food and Drugs Act and the Safe Food for Canadians Act.

Manufacturers and Importers: responsible for ensuring that their food products comply with applicable food policies, standards, and legislation.

Background:

Protecting the health of Canadians is Health Canada's priority. Infant formulas and HMFs are regulated under Division 25 of the FDR, while metabolic products are regulated under Division 24 of the FDR. These provisions establish the regulatory requirements for the sale of these products in Canada, while Part A of the FDR establishes requirements applicable to the importation of these products. Part B of the FDR sets out additional applicable requirements, including with respect to labelling.

On February 17th, 2022, the CFIA issued a food recall warning in relation to certain powdered infant formula products produced in Abbott's Sturgis, Michigan manufacturing facility. Following this recall, the Sturgis facility was closed temporarily. This facility is a key supplier of infant formula, HMF, and metabolic products for the American and Canadian markets, as well as many countries.

Interim Policy:

Health Canada has determined that a shortage of infant formulas, HMF, and metabolic products in Canada related to the closure of the Abbott facility may be detrimental to the health of vulnerable Canadians. Therefore, Health Canada recommends that the CFIA apply its enforcement discretion to the importation and sale of certain infant formula, HMF, and metabolic products. This discretionary enforcement is limited to only those products that are included in the list in Appendix A. These products have been approved by a foreign regulatory authority or are allowed to be sold in foreign jurisdictions that have high quality and manufacturing standards similar to Canada. However, they may not fully meet Canadian labelling and/or composition requirements set out in Part B, in particular, Division 24 and 25, and Part D of the FDR.

In the event that food safety issues arise with the products covered by this notice, licenced importers of these products must notify Health Canada and the CFIA immediately. In such case, appropriate action will be taken.

Health Canada is recommending that the CFIA exercise this enforcement discretion until June 30, 2022. If an extension is required, Health Canada will consider other options to mitigate the risk of shortages.

Appendix A

This list will be updated regularly.

Last updated: May 9, 2022

List of products eligible for enforcement discretion
Product category or name

Product description and use

Manufacturer

Country of manufacture

Date

Nestlé®Good Start®Plus Infant Formula

Infant formula

Nestle®Canada Inc.

United States

March 10, 2022

Nestlé®Good Start®Soothe Infant Formula

Infant formula

Nestle®Canada Inc.

United States

March 10, 2022

Similac®Advance®with 2'-FL Step 1

Infant formula

Abbott®Canada Inc.

Ireland

March 10, 2022

Similac®Advance®with 2'-FL Step 2

Infant formula

Abbott®

Ireland

March 10, 2022

WND 1

UCD*

RB®/Mead Johnson®

United States

March 10, 2022

WND 2

UCD*

RB®/Mead Johnson®

United States

March 24, 2022

MMA/PA Anamix®Early Years

MMA/PA*

Nutricia®

United Kingdom

March 10, 2022

OA 1

MMA/PA*

RB®/Mead Johnson®

United States

March 10, 2022

OA 2

MMA/PA*

RB®/Mead Johnson®

United States

March 24, 2022

IVA Anamix®Early Years

IVA*

Nutricia®

United Kingdom

March 10, 2022

LMD

IVA*

RB®/Mead Johnson®

United States

March 10, 2022

HCY 1

Homocystinuria

RB®/Mead Johnson®

United States

March 10, 2022

HCU Anamix®Early Years

Homocystinuria

Nutricia®

United Kingdom

March 10, 2022

GA 1

GA*

RB®/Mead Johnson®

United States

March 10, 2022

GA 1 Anamix®Early Years

GA*

Nutricia®

United Kingdom

March 10, 2022

MSUD Anamix®Early Years

MSUD*

Nutricia®

United Kingdom

March 10, 2022

TYR Anamix®Early Years

Tyrosinemia

Nutricia®

United Kingdom

March 24, 2022

Locasol®

Hypercalcemia

Nutricia®

Germany

March 10, 2022

Similac® Alimentum® with 2'-FL, 946 ml

Infant formula

Abbott®

United States

April 28, 2022

Enfamil®Nutramigen®, liquid concentrate, 384 ml Infant formula RB®/Mead Johnson® United States May 09, 2022

*WND: waste nitrogen disorder, UCD: urea cycle disorder, MMA/PA: methylmalonic or propionic acidemia, OA: organic acidemias, LMD: leucine metabolism disorders, IVA: isovaleric aciduria, HCY/HCU: homocystinuria (or hypermethioninemia), GA: glutaric aciduria type 1, MSUD: maple syrup urine disease.

Manufacturers or importers of infant formula, HMF, or metabolic products wishing to add products to the list in Appendix A may contact the Bureau of Nutritional Sciences, Food Directorate via email at: bns-bsn@hc-sc.gc.ca.

Note that all other applicable Canadian laws and regulations remain in force, including those related to import (e.g. licensing) and food safety (evidence of meeting Canadian food safety controls).

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