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Improving Nutrition through Agriculture: Cost-Effectiveness of Biofortification Dr. Howarth Bouis Director, HarvestPlus Chairs: Meera Shekar and Steven Jaffee October 6, 2015 Improving Nutrition through Agriculture: Cost-Effectiveness of

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Improving Nutrition through Agriculture: Cost-Effectiveness of Biofortification

  • Dr. Howarth Bouis

Director, HarvestPlus

Chairs: Meera Shekar and Steven Jaffee October 6, 2015

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HarvestPlus c/o IFPRI 2033 K Street, NW • Washington, DC 20006-1002 USA Tel: 202-862-5600 • Fax: 202-467-4439 HarvestPlus@cgiar.org • www.HarvestPlus.org

Improving Nutrition through Agriculture: Cost-Effectiveness of Biofortification

Howarth Bouis, PhD Director, HarvestPlus October 6, 2015

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Consequences Mineral & Vitamin Deficiencies

Vitamin A deficiency

  • Supplements reduced child mortality by 23%
  • 375,000 children go blind each year

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Zinc deficiency

  • increased incidence/severity diarrhea/pneumonia; stunting
  • 2 billion people at risk; 450,000 deaths per year

Iron deficiency

  • Impaired cognitive abilities that cannot be reversed
  • 82% of children < 2 years in India are anemic
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50 100 150 200 250 India Pakistan Bangladesh Developing India Pakistan Bangladesh Developing World Developing

Percent Changes in Cereal and Pulse Production and in Population Between 1965 and 1999

Cereals Pulses Population

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Indices of Inflation-adjusted Prices for Bangladesh 1973-75 = 100

25 50 75 100 125 150 175 200 1973-75 1979-81 1988-90 1994-96

Staple Non- Staple Plants Fish & Animal

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Share of Energy Source & Food Budget in Rural Bangladesh

Non-Staple plants Fish and Meat

Energy Source Food Budget

Staple foods

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Cereal Price Indices for India, Three Year Averages

100 110 120 130 140 150 160

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90 110 130 150 170 190 70-73 73-76 76-79 79-82 82-85 85-88 88-91 91-94 94-97 97-00 00-03 03-06 06-09 09-10 Eggs, Meat & Fish Pulses Vegetables Fruits

Non-Staple Food Prices in India Have Risen by 50% Over 30 Years

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After

50% Increase in All Food Prices

Animal

Staples

Non-Food Staples Non-Food

Before

Share of Total Expenditures

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After

Supply of Nutrients From Agriculture

Before

A Primary Role of Agriculture Is To Provide Nutrients for Healthy Populations

Nutrient Gap

Supplementation And Fortification Supplementation And Fortification

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Calcium Deficiency in Bangladesh

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Biofortification – A Piece of the Puzzle Supplementation Commercial Fortification Agricultural Interventions Dietary Diversity

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Cost-effective: central one time investment

Photo: ICRISAT

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Copenhagen Consensus (2008)

TOP FIVE SOLUTIONS CHALLENGE 1 Micronutrient supplements for children (vitamin A and zinc) Malnutrition 2 The Doha development agenda Trade 3 Micronutrient fortification (iron and salt iodization) Malnutrition 4 Expanded immunization coverage for children Diseases 5 Biofortification Malnutrition

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Portfolio of Micronutrient Interventions

  • Portfolio analysis by Keith Lividini and Jack Fiedler of

IFPRI/HarvestPlus, comparing biofortification and fortification

– Zambia (vitamin A) – Bangladesh (zinc) – Rajasthan (iron)

  • Methodology

– ex-ante simulation model – nationally representative food expenditure surveys, disaggregation by:

  • urban/rural,
  • farm/non-farm within rural, farm size
  • Income group

– planning horizon of 30 years to assess discounted costs per disability-adjusted life year saved (DALY)

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Provitamin A Maize is Competitive with Fortification in Zambia (Stand Alone)

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$4 $15 $18 $24 $34 $129

Vegetable Oil Child Health Weeks Sugar Biofortified VAM Wheat Flour Maize Meal Cost per DALY Saved

Cost per DALY Saved of 6 Vitamin A Interventions in Zambia, 2013-2042

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Combining nutrition interventions in Zambia?  Fortified oil with orange maize most effective

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Biofortification and Fortification: Complementarity/Overlap of Reach: Zambia

19 Total Maize Reach Sugar Reach Total Maize Reach Sugar Reach Additional Reach Maize Additional Reach Maize 92% 94%

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Zambia Number of DALYs Saved by Area

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High Zinc Rice is More Cost-Effective Than Wheat Flour Fortification

$264 $79 $165

$0 $50 $100 $150 $200 $250 $300

WF: Fortified Wheat Flour HZR: High Zinc Rice WF+HZR

Cost per DALY Saved

Portfolios

Cumulative, Discounted Cost per DALY Saved of Three Zinc Program Portfolios, 2013-2042

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Incremental Changes in the Prevalence of Inadequate Zinc Intake, Bangladesh

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Changing Effectiveness with Increasing Levels of Farmers Adoption

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Comparison of Annual Biofortification and Fortification Costs, Bangladesh

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Combining Biofortification and Fortification to Address Different Micronutrient Deficiencies

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HIB is less cost-effective than Iron- Fortified Atta Wheat Flour, Rajasthan

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$9 $7 $8 $7 $56

PDS- Accessed PDS- Eligible Open Market Sales-2% Open Market Sales-10% High Iron Bajra

Cost per DALY Saved

Cost per DALY Saved of High Iron Bajra and 4 Atta Flour Fortification Scenarios, Rajasthan 2014-2043

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But Becomes the most cost-effective Annually Beginning in 10 years

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Cassava Vitamin A Nigeria & DRC Beans Iron Rwanda & DRC Maize Vitamin A Zambia

Release Dates for Crops for Africa & Asia

2007 2007

Sweetpotato Vitamin A Uganda Pearl Millet Iron India Rice Zinc Bangladesh Wheat Zinc India | Pakistan 2015

2013 2013 2012 2012 2013 2013 2012 2012 2011 2011 2013 2013 2012 2012

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Biofortified crops released in 27 countries 18 in Africa, 4 in Asia, 5 in LAC In-testing in 43 countries 26 in Africa, 8 in Asia, 9 in LAC 4 Vita-A , 5 Iron , 4 Zinc Crops Sorghum Banana Plantain Cowpea Potato Lentil

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Present Reach of Biofortification

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Human Nutrition Efficacy Trials

Fourteen Efficacy Trials either completed or in process

–High iron crops +

  • Meta-analysis completed for beans and pearl millet

–High pro-vitamin A crops 

  • Multiple efficacy trials completed for sweetpotato,

maize, and cassava

–High zinc crops

  • Bioavailability studies positive, efficacy trials in the field
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  • Lack of iron impairs mental

development and learning capacity, and increases weakness and fatigue.

  • A new study found that iron

pearl millet was able to reverse iron deficiency in children aged 12-16 years in India within six months.

Iron Pearl Millet Reverses Iron Deficiency

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Orange Sweet Potato

  • Vitamin A-rich orange sweet potato

(OSP) was released to 24,000 households in Mozambique and Uganda from 2007-2009

  • Findings from the project have shown

high rates of adoption and consumption, resulting in increased vitamin A intakes among women and children

  • Distribution of OSP has been scaled-

up in Uganda by HarvestPlus to reach 225,000 households by 2016

Photo: HarvestPlus

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Impact on vitamin A intakes

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Vitamin A OSP Reduces Diarrhea (Two Years After Extension Stopped)

  • Diarrhea is one of the leading causes
  • f death in children < 5 in developing

countries.

  • Eating orange sweet potato (OSP)

reduces the incidence and duration

  • f diarrhea in children.

– For children < 3 likelihood of developing diarrhea was reduced by more than 50% and duration of diarrhea reduced by more than 25%. – For children < 5 likelihood of developing diarrhea was reduced by more than 40% and duration of diarrhea reduced by more than 10%.

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Ten Bean Varieties Released in Rwanda

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Rwanda: Location of combined activities in 2014

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What is the Way Forward? Mainstreaming

Photo: Neil Palmer (CIAT)

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  • Seed companies (Nirmal in India)
  • International financial institutions (World

Bank, IFAD)

  • Multi-lateral agencies (World Food Program,

Codex)

  • National governments (Brazil, China, India)
  • Regional frameworks (African Union)
  • International NGOs (World Vision)

Mainstreaming Through Key Stakeholders

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Challenges for Phase 3 (2014-18)

Mainstream Breeding

  • Make breeding for minerals and vitamins

“core” breeding objectives at CGIAR Centers and NARS

– Develop markers – Lower costs of breeding – All elite breeding lines should have the relevant genes that convey the high mineral and vitamin traits; any cross will contain these genes

Additional Efficacy Evidence

  • 1,000 Days – mothers pre-pregnancy and infants
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Challenges for Phase 3 (2014-18)

Scale up Delivery in Target Countries

  • 9 target countries (adding Ethiopia)
  • Develop specific deployment strategies
  • Establish in-country staff/office
  • Establish networks of collaborators and

stakeholders

  • New releases from breeding pipeline
  • Measure cost-effective impact
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Endorsements for the Kigali Declaration

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Recognition of Evidence and Impact Potential

“We can see that after years of scientific research we are just at the point where the research is no longer being argued or debated, but we are at that tipping point where we can start taking the product

  • f all of that work and push it out into the world at

scale.” Rachel Kyte, Vice President and Special Envoy for Climate Change, World Bank

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SHARE – DISCUSS - LEARN

Agrilinks.org

Top Take-aways

  • 1. Biofortification and fortification are

complimentary in that they reach different populations and complement each other to provide near universal reach

  • 3. The next challenge is

taking this proven intervention to scale.

  • 2. Global leaders

recognize that biofortification works – the evidence is no longer in question.

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Questions and Answers

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Continue the conversation

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