Alexander J. Stein

Plant breeding to control zinc deficiency in India : How cost-effective is biofortification?

OBJECTIVE To estimate the potential impact of zinc biofortification of rice and wheat on public health in India and to evaluate its cost-effectiveness compared with alternative interventions and international standards. DESIGN The burden of zinc deficiency (ZnD) in India was expressed in disability-adjusted life years (DALYs) lost. Current zinc intakes were derived from a nationally representative household food consumption survey (30-day recall) and attributed to household members based on adult equivalent weights. Using a dose-response function, projected increased zinc intakes from biofortified rice and wheat were translated into potential health improvements for pessimistic and optimistic scenarios. After estimating the costs of developing and disseminating the new varieties, the cost-effectiveness of zinc biofortification was calculated for both scenarios and compared with alternative micronutrient interventions and international reference standards. SETTING India. SUBJECTS Representative household survey (n = 119 554). RESULTS The calculated annual burden of ZnD in India is 2.8 million DALYs lost. Zinc biofortification of rice and wheat may reduce this burden by 20-51% and save 0.6-1.4 million DALYs each year, depending on the scenario. The cost for saving one DALY amounts to

Potential impact and cost-effectiveness of Golden Rice.

US 0.73-7.31, which is very cost-effective by standards of the World Bank and the World Health Organization, and is lower than that of most other micronutrient interventions. CONCLUSIONS Not only may zinc biofortification save lives and prevent morbidity among millions of people, it may also help accommodate the need to economise and to allocate resources more efficiently. Further research is needed to corroborate these findings.

Potential impacts of iron biofortification in India

Genetic engineering (GE) in agriculture is a controversial topic in science and society at large. While some oppose genetically modified crops as proxy of an agricultural system they consider unsustainable and inequitable, the question remains whether GE can benefit the poor within the existing system and what needs to be done to deliver these benefits? Golden Rice has been genetically engineered to produce provitamin A. The technology is still in the testing phase, but, once released, it is expected to address one consequence of poverty – vitamin A deficiency (VAD) – and its health implications. Current interventions to combat VAD rely mainly on pharmaceutical supplementation, which is costly in the long run and only partially successful. We develop a methodology for ex-ante evaluation, taking into account the whole sequence of effects between the cultivation of the crop and its ultimate health impacts. In doing so we build on a comprehensive, nationally representative data set of household food consumption in India. Using a refined disability-adjusted life year (DALY) framework and detailed health data, this study shows for India that under optimistic assumptions this country’s annual burden of VAD of 2.3 million DALYs lost can be reduced by 59.4% hence 1.4 million healthy life years could be saved each year if Golden Rice would be consumed widely. In a low impact scenario, where Golden Rice is consumed less frequently and produces less provitamin A, the burden of VAD could be reduced by 8.8%. However, in both scenarios the cost per DALY saved through Golden Rice (US

International trade and the global pipeline of new GM crops

3.06-19.40) is lower than the cost of current supplementation efforts, and it outperforms international cost-effectiveness thresholds. Golden Rice should therefore be considered seriously as a complementary intervention to fight VAD in rice-eating populations in the medium term. JEL classifications: I0, I3, Q16, Q18.

The Human and Economic Cost of Hidden Hunger

Iron deficiency is a widespread nutrition and health problem in developing countries, causing impairments in physical activity and cognitive development, as well as maternal mortality. Although food fortification and supplementation programmes have been effective in some countries, their overall success remains limited. Biofortification, that is, breeding food crops for higher micronutrient content, is a relatively new approach, which has been gaining international attention recently. We propose a methodology for ex ante impact assessment of iron biofortification, building on a disability-adjusted life years (DALYs) framework. This methodology is applied in an Indian context. Using a large and representative data set of household food consumption, the likely effects of iron-rich rice and wheat varieties are simulated for different target groups and regions. These varieties, which are being developed by an international public research consortium, based on conventional breeding techniques, might be ready for local distribution within the next couple of years. The results indicate sizeable potential health benefits. Depending on the underlying assumptions, the disease burden associated with iron deficiency could be reduced by 19-58%. Due to the relatively low institutional cost to reach the target population, the expected cost-effectiveness of iron biofortification compares favourably with other micronutrient interventions. Nonetheless, biofortification should not be seen as a substitute for other interventions. Each approach has its particular strengths, so they complement one another.

Zinc deficiency and DALYs in India: impact assessment and economic analyses

1. schubert, d. Nat. Biotechnol. 27, 802–803; author reply 803 (2009). 2. Beachy, r. et al. Nat. Biotechnol. 20, 1195–1196; author reply 1197 (2002). 3. http://www.cspinet.org/integrity/. 4. Jacobson, M.F. Lifting the veil of secrecy: corporate support for health and environmental professional associations, charities, and industry front groups. CSPI and its Integrity in Science Project, <http://cspinet.org/new/pdf/ lift_the_veil_intro.pdf> (8 september 2003). 5. schubert, d. Bush’s “sound science”: turning a deaf ear to reality. The San Diego Union Tribune <http://legacy. signonsandiego.com/uniontrib/20040709/news_lzle9schubert.html> (9 July 2004). 6. Heilprin, J. WHo to rely less on Us research. Associated Press Online. <http://www.sfgate.com/cgi-bin/article/ article?f=/n/a/2006/01/27/national/w150409s47.dTL> (27 January 2006). 7. Anonymous. Nature Biotechnology replies. Nat. Biotechnol. 27, 803 (2009). 8. sharpe, V.A. & Gurian-sherman, d. competing interests. Nat. Biotech. 21, 1131 (2003). ways to influence policy independently of formal lobbying, including those outlined by Jacobson4, as well as the ‘sound science’ approach promoted by Newt Gingrich and the Bush administration5. Finally, with respect to the ban of ILSI from WHO activities, I did not claim that they were banned from all WHO activities. Because of space limitations, I cited a text that was heavily referenced regarding the details of the WHO incident. Additional references include the Associated Press6 and CSPI3. My conclusion that Wayne Parrott is not simply a public sector plant biologist and should not have been introduced as such remains the same and was in fact confirmed by Nature Biotechnology7. However, it should be the responsibility of Nature Biotechnology to document these conflicts of interest, not a concerned reader, such as myself. A similar conflict with industry-funded plant COMPETING INTERESTS STATEMENT The author declares competing financial interests: details accompany the full-text HTML version of the paper at http://www.nature.com/ naturebiotechnology/.

Genetic engineering for the poor: Golden Rice and public health in India.

Background Micronutrient malnutrition is a public health problem in many developing countries. Its negative impact on income growth is recognized in principle, but there are widely varying estimates of the related economic cost. Objective To discuss available studies that quantify the cost of micronutrient malnutrition, and to develop an alternative framework and apply it to India. Methods Detailed burden of disease calculations are used to estimate the economic cost of micronutri- ent malnutrition based on disability-adjusted life years (DALYs) lost. Results The short-term economic cost of micronutri- ent malnutrition in India amounts to 0.8% to 2.5% of the gross domestic product. Conclusions Although the results confirm that micro- nutrient malnutrition is a huge economic problem, the estimates are lower than those of most previous studies. The differences may be due to differences in underlying assumptions, quality of data, and precision of calculation, but also to dynamic interactions between nutrition, health, and economic productivity, which are difficult to capture. Clear explanation of all calculation details would be desirable for future studies in order to increase credibility and transparency.

Low-Level Presence of New GM Crops: An Issue on the Rise for Countries Where They Lack Approval

Although less obvious than outright lack of sufficient food, >micronutrient malnutrition represents an economic and public health problem in many countries. Over the last years > zinc deficiency has emerged as another major micronutrient deficiency, with a large proportion of the population being at risk, especially in the developing world. However, simple quantification of the number of people who suffer from a condition fails to take account of the depth of the problem. For comparison, monitoring or impact assessment purposes as well as > cost-effectiveness or more general economic analyses, the health loss of a condition needs to be measured in a more comprehensive index. In this chapter the concept of disability-adjusted life years (>DALYs) is explained and a framework for its application to zinc deficiency is provided. DALYs were developed by the World Bank in collaborationwith theWorld Health Organization (WHO) and are today used by many relevant organizations and for analyses in very different fields, in particular at the global level or in developing countries. By weighting the loss of an individual’s functioning due to ill health – relative to death and complete health – DALYs allow measuring morbidity and mortality in a single index that can be aggregated and compared across different conditions. The methodology is explained and discussed, and general data and parameters to calculate the loss of DALYs due to zinc deficiency are reported for the example of India. List of Abbreviations: AADO, average age of death or onset of disease; cf, confer; DALY, disability-adjusted life year; FAO, Food and Agriculture Organization; >GBD, global burden of disease; GDP, gross domestic product; IZiNCG, International Zinc Nutrition Consultative Group; N/A, not applicable; >QALY, quality-adjusted life year; r, discount rate; RDI, recommended dietary intake; SEAR-D, countries in the WHO’s South-East Asia region with high child and high adult mortality; t, time; UN, United Nations; US

Health benefits of biofortification - an ex-ante analysis of iron-rich rice and wheat in India

, United States Dollar;WHO, World Health Organization; WTP, willingness-to-pay; YLD, years lived with disability; YLL, years of life lost; yr, year; ZnD, zinc deficiency