Howarth Bouis Founding Director, HarvestPlus November 6, 2016 Reducing Mineral and Vitamin Deficiences Through Biofortification: Progress Under HarvestPlus Howarth Bouis Founding Director, HarvestPlus November 6, 2016

Dietary Diversity Other approaches used when dietary diversity is out of the reach of the poor… Why are Mineral and Vitamin Deficiencies Such A Significant Public Health Problem? Copyright: Micronutrient Initiative

Percent Changes in Cereal and Pulse Production and in Population Between 1965 and 1999 50 100 150 200 250 India Pakistan Bangladesh Developing World Cereals Pulses Population

Cereal Price Indices for India, Three Year Averages

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

Severity of Micronutrient Deficiencies: Vitamin A, Iron, and Zinc Source: World Health Organization (WHO) children under 5 prevalence data

Consequences Mineral & Vitamin Deficiencies Vitamin A deficiency Supplements reduced child mortality by 23% 375,000 children go blind each year Iron deficiency Impaired cognitive abilities that cannot be reversed 82% of children < 2 years in India are anemic The Second Global Conference was held in Kigali earlier this year, during the first week of April. The first Conference, held in Washington in 2009, was a more scientific community-oriented event and was focused more on crop development and initial field tests. This second Conference was focused more on discussing the translational aspect – how to take these crops to scale and ensure they reached those most in need – the malnourished and hungry Over 300 leaders from around the world came together to discuss the challenges and opportunities around bringing biofortification to scale as well as develop a plan of action. - HERE YOU COULD BOTH RECOGNIZE THE FAO, IFAD AND WFP REPS WHO CAME (SOME SUCH AS BIBI IN THE AUDIENCE; OTHERS FROM IFAD AND FAO BASED IN AFRICA) AND MENTION THINGS LIKE THE FACT THAT FOR 3 AFRICAN COUNTRIES, THE MINISTERS OF BOTH HEALTH AND AG PARTICIPATED! - You could admit that there were fewer private sector reps than desired, and this might be a point for discussion when you open it up to the floor, i.e., to get ideas for how to take this strategy out to them Zinc deficiency increased incidence/severity diarrhea/pneumonia; stunting 2 billion people at risk; 450,000 deaths per year

Consequences of Zinc Deficiency Zinc essential for the function of many enzymes and metabolic processes Regular zinc supplements can greatly reduce common infant morbidities in developing countries (strength of evidence) Diarrhea  Pneumonia  Stunting ?

Risk of Zinc Deficiency Susceptibility to infections (diarrhea, malaria, pneumonia) Infant & child mortality

Biofortification – A Piece of the Puzzle Commercial Fortification Supplementation Biofortification is part of the puzzle, one strategy that together with others where appropriate can improve nutrition. While dietary diversity is the ideal solution to under/over nutrition, food systems often fail to provide adequate minerals and vitamins for vulnerable populations due to lack of infrastructure in remote rural locations, lower incomes, lack of access to markets, etc. My talk will focus (quickly) on why food systems have failed/are failing, and what new approaches we can use to address this – for improvement of both livelihoods and health. That’s what agriculture is/should be all about – making a living and eating for enjoyment and nourishment. Dietary Diversity Agricultural Interventions

75% of the poor 25% Let’s remember that most of the poor are in rural areas where they lack access to more nutritious foods. That is where our efforts are focused and other pieces of the puzzle do not work as well.

Empowering women farmers One of biofortification’s advantages is putting a nutrition intervention directly in the hands of farmers to employ and share with others. Many of these farmers are women. We commissioned a comprehensive gender assessment last year to ensure our field work is gender sensitive. Recommendations are now being implemented. Empowering women farmers

Cost-effective: central one time investment Photo: ICRISAT A one-time research investment to develop biofortified crops, low What struck CC was how cost-effective biofort can be..especially… Cost-effective: central one time investment

Incremental Changes in the Prevalence of Inadequate Zinc Intake, Bangladesh

Crops Released: Africa 2007 2007 2011 2012 2012 Sweet Potato Vitamin A Uganda Cassava Vitamin A Nigeria DR Congo Beans Iron (Zinc) Rwanda DR Congo Maize Vitamin A Nigeria Zambia While it took some number of years to develop the current line of primary crops, they are now being released (through official national regulatory channels) in a growing number of countries…both in Africa… BE SURE TO GET HOWDY TO NOTE THAT THESE ARE RELEASE ONLY IN HARVESTPLUS’ TARGET COUNTRIES – MANY OTHER COUNTRIES HAVE NOW TESTED/RELEASED! Crops are high-yielding & resistant to pests, disease, climate

Crops Released: Asia Pearl Millet Iron (Zinc) Rice Wheat India Zinc 2012 2013 2013 Pearl Millet Iron (Zinc) India Rice Zinc Bangladesh India Wheat Zinc India Pakistan(2016) And in Asia… Note again that all crops are competitive in terms of yield and other desirable agronomic traits, such as the drought tolerance of pearl millet – increasingly important given climate change… Crops are high-yielding & resistant to pests, disease, climate

Biofortified crops released in 30 countries In-testing in another 25 countries Pearl Millet Rice Wheat Maize Sorghum Orange Sweetpotato Cassava Banana Plantain Potato Lentil Beans Cowpea

>150 Varieties Released Across 12 crops NOTE HERE THAT THERE IS A MUCH FULLER RANGE OF BIOFORTIFIED STAPLE FOODS, INCLUDING SORGHUM, COWPEA, LENTILS, AND MORE – AND THESE CROPS HELP FILL GAPS AS THE PRICE OF NON-STAPLES KEEPS MANY FAMILIES FROM GETTING THE NUTRIENTS THEY NEED. Nutritious crops released in 30 countries; in testing in another 25

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

Nutrition Impacts Efficacy trials with iron biofortified crops have also shown improved functional outcomes: Improved cognitive function Better work performance Biofortified crops, as consumed, provide an extra 40% of estimated average requirement each day – substituting one-for-one the biofortified variety for the existing non-biofortified variety.

Iron Pearl Millet Reverses Iron Deficiency Lack of iron impairs mental development and learning capacity, and increases weakness and fatigue. An efficacy trial conducted in India found that iron pearl millet was able to reverse iron deficiency in children aged 12-16 years in India within six months.

High Zinc Wheat Efficacy Trial Peri-urban areas near New Delhi, 6-month trial Center for Micronutrient Research, Subharti Medical College, Uttar Pradesh Center for Public Health Kinetics, Delhi 1,300+ children 4-6 years, 1,300+ mothers 15-49 years in each arm at endline. Intervention Subjects Children +1.2 mg Zn/day from high zinc wheat; baseline zinc intake of perhaps 7 mg Zn/day (+17%) Mothers +3.0 mg Zn/day from high zinc wheat; baseline zinc intake of perhaps 10 mg Zn/day (+30%)

Effect of High Zinc Wheat Intervention on Morbidity Indicators High Zinc Wheat Subjects Low Zinc Wheat Subjects Days of Sickness Averted For ~ 1300 Subjects Over 180 Days Difference Significant at 5% Level of Confidence? Children 4-6 Years Days With Pneumonia 203 244 41 YES Days With Vomiting 60 99 39 Women 15-49 Years Days With Fever 999 1092 93

Value of High Zinc Wheat Intervention Due To Morbidity Indicators Value Per Day of Sickness Averted Days of Sickness Averted Per Person Per Year Estimated Total Population (million) Potential Value Per Year at 100% Adoption ($million) Children 4-6 Years Days With Pneumonia 55 cents 0.06 82 $2.8 million Days With Vomiting 41 cents $2.0 million Women 15-49 Years Days With Fever 0.14 337 $26.6 million

Vitamin A OSP Reduces Diarrhea (Two Years After Extension Stopped) Diarrhea is one of the leading causes of death in children < 5 in developing countries. Eating orange sweet potato (OSP) reduces the incidence and duration of 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%.

What is the Way Forward? Mainstreaming Photo: Neil Palmer (CIAT) What is the Way Forward? Mainstreaming

Target Countries and Crops HERE IS WHERE WE ARE MAKING THESE NUTRIENT-RICH FOODS ACCESSIBLE TO FARMERS AND CONSUMERS; plans for Ethiopia. HarvestPlus is initially focusing on release and deployment of seven biofortified crops in nine target countries in Africa and Asia (NO NEED TO CITE THE CROPS – LET THEM READ) More than 2 million households have been reached in these countries, with crops that are high-yielding, disease and pest resistant, and also adapted for climate change. By 2018 that number will rise to at least 10 million households. The ‘plus’ is that biofortified crops are also high in essential nutrients, in keeping with specific dietary needs and existing consumption patterns of women and children. Several efficacy trials have established that biofortified crops do improve mineral and vitamin status among these populations. We commissioned a comprehensive gender assessment last year to ensure our field work is gender sensitive. Recommendations are now being implemented. More than four million farming households reached by HarvestPlus by end of 2016. Crops released are high-yielding with climate smart traits.

Rwanda: Location of combined activities in 2014

HarvestPlus in Bangadesh GO- 5 NGO- 25 PS- 2 associations (300 seed companies)

Additional Crop in Cropping Pattern Aman Sharna (155 days) Fallow (70 Days) Boro BRRI dhan28 (140 days) Before Now BRRI dhan62 (100 days) BRRI dhan64/ (135- 140 days) Mustard/ lentil/ vegetables (125-130 days)

HarvestPlus Delivery Goals Globally By 2030 One billion people will be benefitting from biofortified nutritious foods. Short-Term Goal By 2020 100 million people in farm households will be growing and consuming biofortified nutritious food crops By the End of 2016 20 million people in farm households

Mainstreaming Through Key Stakeholders Public agricultural research (CGIAR, NARS) Seed companies (Nirmal in India) International financial institutions (World Bank, IFAD) Multi-lateral agencies (World Food Program, Codex) National governments (Brazil, China, India) International NGOs (World Vision)