In addition to the threat posed by COVID-19, the world faces “multiple famines of biblical proportions” that could result in 300,000 deaths per day – a “hunger pandemic,” World Food Programme (WFP) Executive Director David Beasley warned earlier this year.
An often forgotten dimension of this threat is a deepening malnutrition crisis also known as “hidden hunger,” as the pandemic and its socioeconomic effect make nutritious foods increasingly unaffordable and inaccessible to the world’s most vulnerable communities. The COVID-19 crisis is creating multiple shocks – disrupting livelihoods, food and health systems, social protection – all of which undermine nutrition.
Many of the world’s most vulnerable families have had to increase their reliance on staples like rice, wheat and maize that are energy rich but nutrient poor. Even before the pandemic, more than one-quarter of the world’s population could not afford a healthy diet that is rich in the nutrients needed to survive, thrive, and fight off infectious diseases. The pandemic threatens to deepen hidden hunger, negatively impacting child growth and development and human potential that will far outlast the COVID-19 crisis.
Take rice for example. Today, rice is the staple food for half of the world’s population. The minute but mighty grain is a rich source of energy. In developing countries it supplies up to 70 percent of the calories people consume every day. However, like other staples such as wheat and maize, it lacks vitamins and minerals that are essential to health and wellbeing. Fortifying the foods that people are already eating with the vitamins and minerals that they need to stay healthy is an efficient, cost-effective way to improve nutrition, especially during a pandemic.
Staple food fortification reaches vulnerable families where they are, strengthening the nutritional value of commodities like rice, maize, wheat flour, salt and cooking oil by adding vitamins and minerals during processing.
Although there is no silver bullet to solve the crisis of global malnutrition, food fortification can significantly improve nutrition across populations and generations, from unborn babies to the elderly. Food fortification has been utilised successfully around the world for over a century.
Salt iodisation is practiced in 160 countries – improving cognitive ability in infants and young children and reducing goitre, an indicator of iodine deficiency which causes significant swelling of the thyroid gland, by 74 percent. Fortifying staple foods with folic acid can prevent devastating birth defects even before an expectant mother knows that she is pregnant. Foods fortified with vitamin A fight against preventable blindness in children. Foods fortified with iron lower maternal mortality rates and ward off anaemia – a micronutrient deficiency that afflicts close to half the female population in many low and middle-income countries (LMICs). Fortification with zinc strengthens immune systems, decreases childhood diarrhoea and pneumonia and helps prevent childhood stunting.
By addressing malnutrition, food fortification supports healthy diets that improve the daily lives and futures of vulnerable populations, making children more alert and ready to learn and improving the health, energy, and productivity of their parents.
But the effect of the COVID-19 pandemic on supply chains and economies around the world has put national fortification programmes at risk in LMICs. Increased shipping costs and breakdowns in supply chains have made it difficult for producers of fortified staple foods to access raw materials and to get their products to consumers. The deprioritisation of nutrition by governments and donors in the face of the acute health and economic crises brought on by COVID-19, risks undermining staple food fortification programmes that took years to establish.
But every crisis contains seeds of hope, signs of our collective ability to fight and overcome the impacts of the pandemic. Despite the challenges that COVID-19 places on government priorities and budgets, many countries are determined to protect and even expand their fortification programmes. The Government of Madagascar has approved a pilot to introduce fortified rice in its school feeding programme, the Government of Egypt recently confirmed the restoration of its national wheat flour fortification programme after nearly 10 years, and the Government of Bangladesh has been undeterred in its effort to improve access to vitamin A fortified cooking oil for its people by the end of 2020.
Following their example, governments, donors, the private sector, and civil society can ensure that the production, distribution, and consumption of fortified foods continues, during and beyond the COVID-19 pandemic. Steps that can and should be taken include the following:
Use fortified foods and condiments in social protection programmes to mitigate against a rise in micronutrient deficiencies in vulnerable populations;
Maintain existing policies requiring fortification of staple foods and adapt monitoring and surveillance protocols to enable this work to continue safely throughout the pandemic;
Support the food industry to improve COVID-19-safe operating procedures, quality assurance systems and equipment maintenance, with well-trained personnel for sustained production and distribution of fortified foods;
Oppose trade barriers such as export bans and quotas by key grain exporting countries;
Ensure an uninterrupted national supply of premix in LMICs by classifying premix as an essential health commodity, exempting it from import taxes and maintaining a national stock of premix to ensure local availability.
Food fortification remains one of the most cost-effective nutrition interventions to support healthy diets and to help shield people from increased malnutrition due to COVID-19-related food system and economic challenges. We must not allow national fortification programmes to be derailed by the impact of COVID-19. Failing to protect these programmes now will mean loss of life, health and productivity that far outlast the current global pandemic.
(Allison Oman Lawi is Acting Director of Nutrition, World Food Programme and Penjani Mkambula is Head of programme, large scale food fortification, GAIN)
