At-home vision assessments no replacement for in-office visits

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With COVID-19 keeping many of us at home, companies claiming to offer at-home vision tests are ramping up their marketing, despite the fact that there is no U.S. Food and Drug Administration-approved at-home device that people can use to self-conduct a vision assessment, let alone a full eye examination. These devices aren’t even proven to provide an accurate vision prescription. NCL has long recommended an annual, in-person eye exam as part of consumers’ annual health and wellness routines.

“Consumers need to be wary of products that mistakenly claim that their at-home devices can provide an eye exam or a vision prescription and should instead consult their eye doctors who are available to help provide safe solutions,” said NCL Associate Director of Health Policy Nissa Shaffi.

Sorting through bogus health claims

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Across the United States, people are rising to the historic health needs and challenges posed by coronavirus, with healthcare workers on the frontlines risking their lives, and businesses pivoting to manufacture much-needed medical and protective supplies.

But deep concerns about the health implications—what happens to people who contract the disease from a health and financial perspective—are top of mind for many of us. And a cynical minority has seized on the crisis to employ unscrupulous, and frankly dangerous, marketing tactics to promote bogus products claiming to protect users against the coronavirus or provide relief for those infected—as well as peddling downright phony coronavirus testing products.

“These false claims touting unproven medical benefits are nothing more than craven attempts to take advantage of fearful consumers,” said NCL Executive Director Sally Greenberg.

“Moreover, they spread misinformation among consumers anxiously seeking ways to stay safe and healthy amidst the coronavirus crisis.”

In an op-ed in The Hill published in May, Greenberg noted that a number of CBD manufacturers and stores are falsely promoting unproven medical benefits of CBD products.

A CBD store in Portland, OR, for example, was recently ordered by the office of the state’s attorney general to take down signs claiming that its products could boost immunity against COVID-19.

“False claims such as this are particularly dangerous as consumers anxiously attempt to stay safe and healthy amidst the coronavirus crisis,” said Greenberg. “The need for science-backed treatments is significant and we must ensure products are tested and regulated for safety.”

Contrary to claims being made by CBD marketers that products containing cannabidiol can help those suffering from coronavirus, recent studies have actually found potential harmful side effects of cannabis products on infected coronavirus patients. Aurelius Data cautions the public against the potential harmful side effects that can come from consuming cannabis products with Tetrahydrocannabinol (THC) if a patient is infected with COVID-19. And studies have shown that many unregulated CBD products have been found to contain THC, though the labels may not disclose this.

“In these uncertain times, we urge consumers to continue to take precautions,” said Greenberg. “We urge everyone to follow CDC guidelines for COVID-19, practice safe social distancing, and at the same time avoid THC products and all untested, unregulated CBD products to help keep your family, friends, and communities safe.”

The overlooked epidemic: COVID-19 and its relationship to opioids

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By NCL Health Policy intern Talia Zitner

The coronavirus pandemic isn’t the only major public health crisis plaguing America. As the country struggles to contain COVID-19, the pandemic has seen a corollary rise in incidents of opioid usage and overdose. A major disruption in the way people suffering from opioid addiction receive treatment may ultimately prove critical to understanding how the opioid epidemic is directly affected by the coronavirus.

When lawmakers passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act in March, opioid treatment centers were not eligible to receive any of the $50 billion in funding that was allocated for Medicare providers. As a result, these essential centers—often under-supported and understaffed—saw their workforce getting ill or leaving to care for loved ones. Additionally, job loss and illness have left those already at risk of opioid addiction more vulnerable to relapse and death.

A key problem is the patient’s ability to get a prescription for addiction-managing drugs. Many centers rightly offer only one pill a day to their patients, but as the pandemic has forced the need for physical distancing and lack of physical contact, it has become increasingly difficult for people to get their medication. Long lines and hours-long wait times dissuade patients from getting their daily dosage. Few patients qualify for more than one dose per day, and few doctors are authorized to prescribe larger amounts of opioid managing medication.

Sadly, the coronavirus pandemic has overshadowed the opioid epidemic that continues to haunt millions of Americans. During this difficult time, the government should focus on the risk of opioid abuse and overdose and put more money into treatment programs and centers. Without support, more people will succumb to opioid addiction, lack of access to treatment, and death, further burdening the health care system.

Talia is a Washington, DC native and a rising sophomore at Wesleyan University, where she is studying English. Beyond health policy, Talia’s interests are in journalism, law, and social justice.

Measures restaurants are taking during the pandemic to reopen

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By Nailah John, Linda Golodner Food Safety and Nutrition Fellow

As restaurants open across America, we all want to know what the ideal measures are to keep consumers safe. A few days ago, I went to a french restaurant in Old Town, Alexandria for brunch with my family. We weren’t allowed inside, but a hostess stood at the door with the names of customers waiting to be seated. We all practiced social distancing, every customer wore masks, and every restaurant staff member wore gloves.

We were eventually seated on the patio—six-feet apart—and a mobile menu was circulated to avoid person-to-person contact. My brunch experience during COVID-19 is similar to what states around the country are requiring as restaurants reopen.

According to Eater, all 44 states have allowed restaurants to reopen in some capacity. In each state, varying degrees of social distancing measures remain in place for businesses that want to reopen.

Forbes highlights what health experts say about reopening while also maintaining a safe environment for staff and patrons, including:

  • Implement shifts for employees and stick to them. This helps to make exposure clear and limited in case a staff member test positive for COVID-19;
  • place hand sanitizer on each table, at all entrances and exits, and in bathrooms;
  • regular disinfection of high touch surfaces is needed;
  • provide disposable menus or an online menu, touchless ordering through a mobile, app, text, or phone call;
  • and require all customers and employees to wear masks while waiting to be seated and when going to the restroom.

And here are other measures that restaurant industry experts recommend:

  • Implement available screening measures for employees before they start their shift, check their temperatures. If someone has a fever, send them home.
  • Train and communicate new protocols with your employees, it’s important they are briefed on new protocols or there would be a bit of chaos.
  • Buffets and salad bars should use sneeze guards- glass or plastic barriers that shield food- and utensils should be changed and washed frequently.
  • Install plexiglass dividers between booths and hostess stands.
  • Customers should make reservations as many restaurants have stopped serving walk-in customers.
  • Avoid reusable condiments on tables or self-serve stations and instead switch to single-serve packets for items like ketchup.

Restaurants are reopening and we are all eager to head out and socialize with friends and family, but it is paramount that we all adhere to safety protocols put in place by trusted experts to continue to not risk exposure to COVID-19. Please consumers, wear your mask, wash your hands, practice six-foot social distancing, and sanitize your hands. With your efforts, we can help to flatten the curve.

It’s time for U.S. tobacco companies to protect all child tobacco workers

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Reid Maki is the director of child labor advocacy at the National Consumers League and he coordinates the Child Labor Coalition.

In 2014, under pressure from advocacy groups like the Child Labor Coalition and Human Rights Watch (HRW), several tobacco companies operating in the United States announced they would only buy tobacco from growers who agree not to hire children under 16 to work in contact with tobacco plants.

The child rights and human rights groups had been pushing for a ban on all children—aged 17 and below—from harvesting tobacco because of health problems related to nicotine exposure. These negative health impacts were well-documented in Tobacco’s Hidden Children, a report from HRW published in May 2014.

“Children interviewed by Human Rights Watch in North Carolina, Kentucky, Tennessee, and Virginia frequently described feeling seriously, acutely sick, while working in tobacco farming,” noted HRW. “For example, Carla P., 16, works for hire on tobacco farms in Kentucky with her parents and her younger sister. She told Human Rights Watch she got sick while pulling the
tops off tobacco plants: ‘I didn’t feel well, but I still kept working. I started throwing up. I was throwing up for like 10 minutes, just what I ate. I took a break for a few hours, and then I went back to work.’

Another child worker interviewed by HRW, Emilio R., a 16-year-old seasonal worker in eastern North Carolina, said he had headaches that sometimes lasted up to two days while working in tobacco: “With the headaches, it was hard to do anything at all. I didn’t want to move my head.”

Some children describe the flu-like symptoms of nicotine poisoning as “feeling like I was going to die.”

HRW researchers found that “many of the symptoms reported by child tobacco workers are consistent with acute nicotine poisoning, known as Green Tobacco Sickness, an occupational health risk specific to tobacco farming that occurs when workers absorb nicotine through their skin while having prolonged contact with tobacco plants.” Dizziness, headaches, nausea, and vomiting are the most common symptoms of acute nicotine poisoning. Three-quarters of the children interviewed by HRW in the report noted the onset of health symptoms when they began tobacco work, and many of those symptoms correlated with nicotine absorption.

U.S. child labor law is of no help in dealing with this problem. American law has exemptions for agriculture that allow children who are only 12 to work unlimited hours on farms as long as they are not missing school.

In 2014, the tobacco companies agreeing to protect the youngest child workers seemed like an important step forward. But six years later, we have concerns that the voluntary ban is not working.

Farmworker communities have proven particularly vulnerable to COVID-19. With schools closed for the summer and many parents sick, we fear that the number of children from desperately poor farmworker families who seek jobs on tobacco farms may increase.

Over the last six years, partner organizations in North Carolina have told us that younger children are still working in tobacco fields.

A recent health impacts study on child farmworkers in North Carolina (“Latinx child farmworkers in North Carolina: Study design and participant baseline characteristics” in the American Journal of Industrial Medicine, November 28, 2018) by researchers at Wake Forest School of Medicine reported data that suggests children under 16 continue to work in tobacco
fields.

In 2017, the first year Wake Forest researchers interviewed farmworker children—and three years after the tobacco companies’ voluntary age restriction, researchers interviewed 202 children and found 116 had worked tobacco in the week before the interview.

Yes, it’s just one study. But in the absence of federal and state data—which is notoriously poor when it comes to counting child farmworkers—it suggests that, in North Carolina, one of the four prime tobacco-growing states, nearly half of child tobacco workers are under 16. It confirms what we had been hearing anecdotally from farmworker groups in North Carolina: the
tobacco companies’ policy isn’t working.

Children in the United States are not allowed to perform work that has been labeled hazardous by the U.S. Department of Labor. You must be 18 to do dangerous work in all sectors except agriculture. This is an exemption that needs to end. Tobacco has not been labeled as dangerous work, even though everyone agrees that it is. That’s why the tobacco companies in
2014 said young children should not do it.

Children who are under 18 cannot buy cigarettes in a store, yet they are permitted to work 10 or 12 hour days in tobacco fields in stifling heat, breathing nicotine though the air, and absorbing it through their skin. Many children are so desperate to avoid contact with the plants that they work in black garbage backs with holes cut out for their arms and legs.

Efforts to pass federal legislation, the Children Don’t Belong on Tobacco Farms Act, could fix this problem with a total ban on child labor in U.S. tobacco. Unfortunately, versions of the bill, in both the U.S. House and Senate, are not expected to pass any time soon. Child farmworkers, often poor and Latino, are often at the end of congressional priority lists.

American tobacco companies have had six years to try a piecemeal approach that is not working. We need tobacco companies to step up and do the right thing by banning child work in tobacco.

Tips to reduce food waste during the pandemic and beyond

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By Nailah John, Linda Golodner Food Safety and Nutrition Fellow

The food waste epidemic in America has increased with each generation. Food has become cheaper than ever and we throw out millions of tons of food, while 37.2 million Americans are food insecure, according to the United States Department of Agriculture (USDA).

The National Consumers League (NCL) has been an early leader in calling attention to this problem. In 2016, NCL and the Keystone Policy Center hosted a Food Waste Summit, which focused on Food Waste Landscape and how it impacts the consumer. The USDA estimates that we waste 30-40 percent of our food supply. In 2015, the USDA joined the U.S. Environment Protection Agency to set a goal to cut America’s food waste by 50 percent by the year 2030.

NCL helped to launch Further with Food: Center for Food Loss and Waste Solutions in 2017. NCL, along with 12 organizations, joined this online hub to exchange information and solutions towards the national goal of cutting food waste. The initiative focuses on best practices for preventing food loss and waste; providing educational materials; research results and information on existing government, business, and community.

Sadly, during the pandemic, some farmers have resorted to dumping milk and plowing crops under because schools, restaurants, and universities that usually purchase large quantities of food are closed. Dana Gunders, executive Director of ReFED- Rethink Food Waste, recently noted that “people are throwing out less food in their homes, but more food is going to waste throughout the supply chain.” Gunders was recently interviewed on NPR about COVID-19 and food waste.

Gunders offered a number of tips regarding food waste:

  • Consumers are making fewer trips to grocery stores during the pandemic, which makes it easy to adopt better practices that help reduce waste at home. Consumers are planning meals and thinking through what they want to eat and need to buy. Those who meal plan waste less food.
  • Households should do a better job storing food, which helps to reduce food waste. Putting items in correct packages, storing them properly, and freezing what you are not ready to use extends the life of many items. Fresh herbs and asparagus do great in a jar of water in the fridge, and avocados can be stored in the refrigerator once ripe. Fruit does best in a crisper drawer set to “low” or slightly cracked open.
  • “Use by” dates indicate the ideal time to consume the product, but as Dana says, “if you see the words ‘best by’ or ‘best if used by,’ those are foods you can eat well past the date as long as they look fine, taste fine, and smell fine.”

Civil Eats, a daily news source for critical thought about the American food system with a focus on sustainable agriculture, also highlights recommendations for reducing food waste:

  • Revive older food. Soak wilting veggies in ice water to re-crisp them. Un-stale bread, crackers, tortilla chips by toasting them in the oven for 1-2 minutes
  • Instead of throwing away leftovers, think about using them in a new recipe. For example, use your over-ripe bananas to make a tasty banana muffin, banana fritters, or smoothies with milk, ice, or other fruit.

The USDA recommends consumers consider donating food they can’t use to hunger relief organizations, shelters, etc. so that it can be used to feed people in need. And food that is inedible can be recycled into other products such as compost, worm castings, bioenergy, animal feed, bio plastics, and clothing.

USDA and EPA created the food recovery hierarchy (at right) to show the most effective ways to address food waste.

Food waste is always a challenge, but during Covid-19, we can employ some useful strategies. With so many Americans food insecure and people around the world facing dangerous food scarcity, it’s incumbent on all of us to treasure the food our farmers grow, honor it, and use it to feed our families.

NCL leads advocates in urging FDA to protect patient access to critical therapy for preterm birth

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By Sally Greenberg, NCL Executive Director

The National Consumers League and 14 leading health organizations and individual providers have collaborated in sending a letter to the Food and Drug Administration (FDA) as the agency considers whether to withdraw the only FDA-approved therapy that reduces the risk of preterm birth in women with a history of preterm birth.

Why did we and our fellow advocates decide to send this letter in the midst of the COVID-19 pandemic? Several important reasons.

First, preventing preterm birth is always a vital cause—during or without a pandemic. The leading cause of infant death in the United States, premature birth has devastating effects on families and is very costly to our health care system. For babies who do survive, short and long-term complications can accompany preterm birth. For mothers, a history of spontaneous preterm birth is a leading risk factor for recurrent preterm birth, yet providers have only one therapeutic option – hydroxyprogesterone caproate or “17P,” in one branded and five generic forms – to prevent recurrent preterm birth for these at-risk mothers.

Taking away these options—especially in the midst of a pandemic—would be concerning for pregnant women who are at high-risk for preterm birth, including those that reduce their risk of being admitted to the hospital for early delivery.

Secondly, as recent events surrounding both COVID-19 and continued fundamental rights injustices have reminded us, a profound and systemic inequity exists in the United States where institutional racism contributes to health disparities—including preterm birth and infant mortality. COVID-19 has disproportionally impacted African American women, the same population that is most likely to experience preterm birth. The preterm birth rate among U.S. black women is 49 percent higher than the rate among all other women, according to the March of Dimes.

Thirdly, 17P is the only FDA-approved therapy that reduces the risk of preterm birth and has been used for nearly a decade. We are concerned that removing access to the only FDA-approved therapy may deepen maternal and infant health inequities that exist within the U.S.

It is also troubling that if providers cannot access FDA-approved forms of 17P, this may expose pregnant women to compounded medications, which have no labeling to provide guidance on administration, contraindications, or potential side effects.

Removing 17P products in the absence of suitable alternatives would leave patients and providers significantly disadvantaged in the fight against prematurity. While we recognize the FDA is encountering tremendous challenges in addressing the COVID-19 pandemic, it is important to underscore the public health need for continued access to approved treatment options, and we trust that the agency will consider the patient impact as they evaluate this issue.

To add your voice to the letter to FDA, urging the agency to preserve patient access to the only FDA-approved therapy to reduce the risk of preterm birth, you can sign on here.

The impact of COVID-19 on child labor

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By Child Labor Coalition intern Ellie Murphy

Combatting child labor during a global pandemic is a staggering challenge. In countries like Ghana, the Ivory Coast, Bangladesh—and dozens more—school cancellations and lost family income may push children into the labor market. Once in, it may be hard for them to get out and return to school. In the face of this dire emergency, governments, the corporate world, and charitable institutions will need to support vulnerable families during this unprecedented time.

There is a strong correlation between access to education and preventing child labor. “Lack of access to education keeps the cycle of exploitation, illiteracy, and poverty going—limiting future options and forcing children to accept low-wage work as adults and to raise their own children in poverty,” noted the children’s advocacy group, Their World.

With nine in 10 children across the globe prevented from attending school in person, Human Rights Watch notes that interrupting formal education will have a huge impact on children and jeopardize their opportunity for better employment opportunities in the future: “For many children, the COVID-19 crisis will mean limited or no education, or falling further behind their peers.”

Poverty is the single greatest cause of child labor. Because many parents have lost or will lose their jobs, children are facing increased pressure to supplement family incomes. “Children work because their survival and that of their families depend on it, and in many cases because unscrupulous adults take advantage of their vulnerability,” notes the International Labour Organization.

Countries are being impacted by COVID-19 differently, but developing countries are expected to feel more negative consequences than developed countries, according to a report from WorldAtlas.com. Tourism and trade helps fuel many of these economies and the COVID pandemic has devastated both sectors.

Developing countries—primarily in Africa and Asia—already house 90 percent of working children, according to the International Journal of Health Sciences. Economic pressure from the pandemic will likely drive even more children into the workforce.

Before the pandemic, child labor in West Africa was widespread. 2.1 million child laborers were employed by cocoa farms in the Ivory Coast and 900,000 children on cocoa farms in Ghana, according to researchers from Tulane University. Ghana and the Ivory Coast produce about 60 percent of the world’s cocoa—a critical ingredient in chocolate. A recent Voice of America (VOA) article included predications that “there will be increased economic pressures on farming families, and ongoing school closures in Ghana [meaning] children are more likely to accompany their parents to their farms and be exposed to hazardous activities.”

The VOA cited research by the International Cocoa Initiative that analyzed the impacts of income loss on child labor rates in the Ivory Coast and found that a 10 percent drop in income for families in the cocoa industry is expected to produce a 5 percent increase in child labor.

Bangladesh, which had a reported 1.2 million children trapped in the worst forms of child labor in 2015, according to the ILO, is also at risk of seeing child labor increase. Most Bangladeshi workers—87 percent—earn money in the informal economy performing daily labor, unpaid work for their family, or piece-rate work. COVID-19 impacts have left families struggling with a severe drop in income of around 70 percent in many cases. Many adults and children who work making parts of products like garments have seen their income disappear entirely. “Those who depend on daily wages, for example, day labourers, rickshaw pullers, construction workers, street vendors, workers at small informal factories have lost their incomes with the hit of the pandemic,” noted researchers with the Institute for Development Studies. With this dramatic loss of income, it is expected that families will turn to their children to earn more money to buy basic necessities for survival.

In an effort to combat the potential increase in child labor, human rights organizations have urged governments to support families during this crisis—including the use of cash transfer programs. This entails direct cash payments to destitute families. Sometimes there are strings attached to the payments. Families that accept the money must promise to keep children in school and not allow them to enter the labor market. Cash transfers, often involving small amounts of money, have proven effective, in varying degrees, in reducing child labor in many countries.

In the COVID-19 pandemic, even small amounts of money might prevent starvation—or keep children out of the labor market. Save the Children argues that cash transfers help reduce the rate of child mortality, increase access to education, and reduce child abuse. Researchers Jacobus DeHoop and Eric Edmonds recently noted that 133 countries were working on social protection responses that provide financial support to vulnerable families in an effort to combat an increase in child labor during this time. Human Rights Watch has a series of recommendations for governments, including cash transfer payments.

Government efforts alone may not be enough. Companies that employ vulnerable demographics must also respond. Verité, an organization that works to eliminate abusive labor and empower workers, issued a series of recommendations to help companies address COVID impacts. Among the recommendations was a call for companies that work in areas with high rates of child labor to monitor “hot spots” for exploitation and intervene when necessary. Additionally, Verite urged companies to provide benefits for families who experience a loss of a parent due to the pandemic, make work remote when possible, and provide longer sick leaves for employees.

The COVID-19 crisis calls for innovative efforts to protect vulnerable families and children. As Jo Becker, the children’s rights advocacy director at Human Rights Watch, notes “the choices governments make now are crucial, not only to mitigate the worst harm of the pandemic, but also to benefit children over the long term.” By providing families with desperately needed resources during this unprecedented time, it may be possible to help curtail the increase of child labor worldwide.

In the last two decades, the world has seen the number of child laborers drop by nearly 100 million. “We do not want to see those hard-won gains reversed,” said Reid Maki, director of child labor advocacy for the National Consumers League and the coordinator of the Child Labor Coalition. “Concerted and robust action is required.” The actions that those in power take today will have long-lasting impacts that go far beyond COVID-19.

Ellie Murphy is a rising junior at Tufts University, majoring in International Relations and Sociology.

Vaccine hesitancy and the unique challenge of COVID-19

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headshot of NCL Health Policy intern Talia

By NCL Health Policy intern Talia Zitner

Around the globe, researchers and scientists are racing to find a vaccine for the COVID-19 virus. Developing a safe, effective, and affordable vaccine is already a challenging feat, but vaccine hesitancy presents another unique challenge to scientists, government researchers, and community leaders.

“Vaccine hesitancy” refers to the reluctance or refusal to be vaccinated or have one’s children vaccinated against a disease, even if a vaccine is proven to be safe and effective. Vaccine hesitancy poses dangers to both the individual and their community, since exposure to a contagious disease puts the person at risk, and they are far more likely to spread the disease to others if they won’t get vaccinated. Ironically, these communities may be the most vulnerable to COVID-19, and a serious effort must be made to create a sense of comfort around the COVID-19 vaccine once it’s available to the public.

Not to be confused with the vaccine-hesitant, “anti-vaxxers” represent a movement of people who dispute the safety of vaccinations and challenge laws that mandate vaccinations. This is a more insidious movement funded by dubious sources (reportedly, one New York couple has donated millions of dollars to the movement) that deceptively politicize public health measures under the guise of protecting personal liberties.

Public health agencies are trying to get vaccination levels to 95 percent to guarantee herd immunity. Some concerns that are top of mind for consumers include knowing the timeframe for a vaccine, who will have access to it, what it will cost consumers, if anything, and how states will determine methods of enforcing vaccination. The possibility of a COVID-19 vaccine also begs the question of whether vaccination will be mandatory for public schools and government workers.

Perhaps one of the most important projects right now surrounding vaccine hesitancy is the Vaccine Confidence Project (VCP), which is dedicated to “conducting a global study to track public sentiment and emotions around current and potential measures to contain and treat COVID-19.” Using a mix of population surveys and social media tracking, VCP “will investigate perception and sentiment of COVID-19 social distancing measures and potential medical tools globally.” This project will be essential moving forward, as it will continue to inform understanding on how the global population perceives the eventual vaccine.

As of now, VCP reports that only 25 percent of African Americans—a population that has been disproportionately hit by the virus—plan to get the COVID-19 vaccine. Why is this the case? Due to lack of access to hospitals, pharmacies, doctors and clinics in Black communities, failure to expand Medicaid, and other root causes; the COVID-19 pandemic has laid bare the disparities in our health care system.

To ensure herd immunity—which is somewhere north of 90 percent immunity—much work needs to be done, especially with the Black community, to increase confidence when a COVID-19 vaccine is released. At this time, Black leaders such as former U.S. Surgeon General, Dr. Regina Benjamin, and current U.S. Surgeon General Dr. Jerome Adams, are among those leading the charge to encourage public health efforts such as advocating for face-mask usage and collaborating with the National Newspaper Publishers Association (NNPA) Coronavirus Task Force and Resource Center, which provides expertise on the virus and its impact on the Black community.

Another community that will be crucial to prioritize surrounding vaccine hesitancy is the older Americans. The New York Times reported that of the “241 interventional COVID-19 studies undertaken in the United States and listed on clinicaltrials.gov…37 of these trials—testing drugs, vaccines and devices—set specific age limits and would not enroll participants older than 75, 80 or 85 years old. A few even excluded those over 65.” Why would older Americans trust a vaccine not tested for their age groups? Clinical trials will need to include people across all ages, otherwise, this will only increase vaccine hesitation. The vaccine must be safe and effective, and ample outreach must be conducted to ensure vaccine confidence across all demographics.

There are many questions left to be addressed. As we continue to navigate preventive measures for COVID-19, independent researchers and organizations will become increasingly more important to guiding decision making before and after a vaccine is developed.

Vaccine hesitancy is a global problem that will only be compounded by the COVID-19 pandemic. Fostering vaccine confidence will be imperative when the second wave of the virus sweeps the globe, as it inevitably will.

Talia is a Washington, D.C. native, and a rising sophomore at Wesleyan University, where she majors in English. Beyond health, Talia’s interests are in journalism, law, and social justice.

Sweetened with what? Lack of transparency and misleading claims make reducing added sugars confusing

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Many of us are probably trying to heed the advice of the U.S. Food and Drug Administration (FDA) to reduce our consumption of added sugars. FDA has made “Added Sugars” content per serving a mandatory line on the Nutrition Facts label and has established a Daily Value of 50g of added sugars based on a 2,000 calorie a day diet. FDA’s actions, however, have had some unintended consequences.

The agency’s decision to include “Added Sugars” on the Nutrition Facts label has created a marketing incentive for food and beverage manufacturers to replace added sugars with alternative or substitute sweeteners.  Leading brand name products bear prominent claims such as “No Added Sugars,” “Zero Sugar,” and “Reduced Sugars,” implying that the new product is healthier than the original without disclosing how the sugar has been reduced. As detailed in a recent Center for Science in the Public Interest (CSPI) letter and an industry citizen’s petition filed with the FDA (Docket No. FDA-2020-P-1478), consumers have little idea that when they purchase a no/reduced sugar product, they may be buying a food that contains alternative sweeteners, highly processed, or artificial substances.

Most of us following the FDA’s advice aren’t looking to load up on combinations of new-fangled sweetening agents, sugar alcohols and other synthetic substances. CSPI’s January 9, 2020 letter asks that FDA enforce standards for nutrient content claims related to added or reduced sugar. We support that request.

The petition was filed by the Sugar Association, whose members are clearly concerned about competition from alternative sweeteners. But their complaint to the FDA makes a strong case for transparency by citing products that make no/reduced added sugars on the front label, but fail to disclose that sugars have been replaced by other sweeteners—many unfamiliar, some artificial, and some with known glycemic index effects. For example:

  • Rebel Ice Cream claims “No Sugar Added” but is sweetened with Erythritol, Chicory Root Fiber, Vegetable Glycerin, and Monk Fruit;
  • Kool-Aid Jammers claim “Zero Sugar” but are sweetened with Sucralose and Acesulfame Potassium;
  • Oikos Greek Yogurt claims “No Added Sugar and No Artificial Sweeteners” but contains Stevia and Chicory Root Fiber;
  • Quest Nutrition’s Hero Blueberry Cobbler Bar claims “1g” of sugar but is sweetened with Allulose, Erythritol, Sucralose, and Steviol Glycosides (Stevia);
  • Snack Pack Juicy Gels claim “Sugar Free” but are sweetened with Sucralose;
  • ONE Maple Glazed Doughnut Bar claims “1g” of sugar but is sweetened with Maltitol, Vegetable Glycerin, and Sucralose;
  • Snack Pack Chocolate Pudding Cups claim “Sugar Free” but are sweetened with Sorbitol, Maltitol, Sucralose, and Acesulfame Potassium;
  • Welch’s Fruit Snacks claim “Reduced Sugar” but are sweetened with Chicory Root Fiber and Maltitol Syrup;

The petition, among other steps, urges FDA to require that such substances be clearly disclosed as a “sweetener” in the ingredient list. That step seems reasonable to insure transparency and ensure that consumers know what they are purchasing.

The petition also calls for action against outright misleading claims regarding sugar content. The CSPI letter and industry petition blows the whistle on deceptive claims like these:

  • The reduced sugar version of Skippy peanut butter has 1/3 less sugar than its traditional counterpart but has more calories and fat per serving than the regular version. Despite having 1g less added sugars, the reformulated product provides 20 more calories per 2 tablespoon serving. The claim on the front label is misleading because it implies that the reformulated version is healthier due to the reduction in added sugars when the reformulated version is higher in calories.
  • Welch’s Fruit Snacks Reduced Sugar version claims 25 percent less sugar than the original version. The claim is predicated upon a reduction in the serving size of the reformulated version of the product. The original version has a serving size of 25.5g while the Reduced Sugar version has decreased to 22.7g.
  • Oikos Triple Zero blended Greek Yogurt makes a “0 Added Sugar” claim but has more calories per serving than the company’s regular Greek yogurt. The zero added sugars product, which is sweetened with Stevia Leaf Extract, has 120 calories per serving while the company’s original version has 110 calories per serving.

Statements like these turn the supermarket aisle into a minefield of misleading claims that are not good for consumers who are trying to sort out health values. We urge the FDA to prohibit misleading labeling of alternative sweeteners in processed foods and beverages and to grant the citizens’ petition for greater transparency in food labeling when it comes to these artificial sweeteners.