Parenting infant twins born prematurely was already a challenge before Cassandra Solberg faced a new, unexpected stressor: finding much-needed formula to feed her 3-month-old babies.

"Every store I would go to would only have one or two cans," she said. "After that then it started being non-existent. I started calling the stores … they started saying 'We don't know when we're going to get it in. We're having issues getting it in.'"

What began as a shortage of formula caused by supply chain and pandemic problems became an even scarier situation for caregivers when Abbott Laboratories recalled certain lots of its widely used Similac brand in February.

As local parents stare down near-empty shelves, some major retailers, including Target, are limiting how much formula consumers can buy each visit.

The scene hearkens back to the empty toilet paper shelves at the start of the pandemic — but with far more serious consequences. Formula is the only source of nutrition for many infants, especially those born prematurely or whose mothers are unable to breastfeed.

Solberg worked with the state's Women, Infants & Children (WIC) program to get the formula she needed. But it remains unclear when normal supply levels will return, and many parents and caregivers are running out of patience.

"Everywhere you ask, they don't know when this shortage is going to let up," said Solberg, who lives in Minnetrista. "No one has an answer."

Abbott's Similac brand is the only infant formula approved for Minnesota's WIC program. The state Department of Health has temporarily approved a long list of substitutes to help those who rely on the program pay for the essential product.

Recall recap

In mid-February, Abbott recalled several lots of Similac, Alimentum and EleCare powdered infant formulas that were produced at the company's facility in Sturgis, Mich. The company will not disclose how many total packages were recalled.

That factory remains closed while federal authorities investigate whether contaminated formula caused bacterial infections in four infants, two of whom died.

The first case last fall involved a baby in Minnesota's St. Louis County who was hospitalized for 22 days with a cronobacter infection. The baby recovered, but had the infection not occurred in Minnesota, other cases may have been missed.

"Minnesota is the only state in the country that has cronobacter as a reportable infection," said Seattle-based food safety lawyer Bill Marler. "They are the best in the country at figuring this out."

The stakes are high for cronobacter; infected infants typically have a 50% rate of survival.

But the investigation recently hit a snag: the bacterial strains discovered so far at Abbott's Michigan plant do not match those found in the infected infants.

Illinois-based Abbott is one of the nation's largest producers of infant formula in a tightly regulated market with few major competitors. The recall worsened an already-tight supply for the past two years when baby formula availability — for many brands — has been unreliable.

"We know the situation has further exacerbated industry-wide infant formula supply shortages," Abbott CEO Robert Ford said in a recent earnings call.

The company said it is importing formula made in Europe and expanding production at other U.S. facilities to boost supplies.

"We're working very closely with the FDA on corrective actions and enhancements so that we can restart operations at the [Michigan] facility," Ford said.

Marler said an inspection report from the U.S. Food and Drug Administration showed the plant was a "disaster."

"I think Abbott's got a real problem," he said. "I think they have exposure for criminal liability."

A whistleblower report revealed concerns about the plant that were brought to the FDA's attention last fall. The FDA didn't inspect the plant until late January.

"Why did the FDA not spring into action?" U.S. Rep. Rosa DeLauro, D-Conn., said at a hearing in April. "Why did it take four months to pull this formula off store shelves? How many infants were fed contaminated formula during this time, by parents who trusted that the formula they were buying was safe?"

Abbott is a health care giant that sells medical devices, diagnostic products and pharmaceuticals with a sizeable presence in Minnesota. In 2021, Abbott sold $4.3 billion of pediatric nutritionals globally — 10% of the company's total revenue.

Limited options

The FDA recently announced it would allow Abbott to release specialty and metabolic formulas — made at the Sturgis plant but not subject to the recall — directly to consumers on a case-by-case basis depending on the "severity of the individual's need."

"Those seeking access should consult with their health care provider in considering whether the benefit of consuming such product outweighs the potential risk of bacterial infection in the user's particular circumstances," the FDA said.

Food safety lawyer Jenny Schell at Marler Clark said the Similac recall came just as her daughter was transitioning off the formula — and before a May due date for her second child.

"Women have any reason to not breastfeed a child, be it choice or medical, and for me my daughter was born early and couldn't nurse," she said. "Now there's new pressure to keep our second off of formula."

Trust in powdered formula — which has a higher likelihood of carrying pathogens than liquid — has suffered.

"I've fielded several calls from families who all say 'Similac is supposedly the best, we want to do the best for our child, but what we thought was the best could actually be hurting them,'" she said. "I hope this is the only time my work comes this close to my personal life."

Correction: A previous version of this story incorrectly stated which baby formula would be released. Specialty and metabolic formula that was made at the Sturgis, Mich., plant but not subject to recall is being released.