The critical case for food fortification during COVID-19

Nutrition is a key pillar of the global COVID-19 response, critical for the world to recover from the pandemic and become more resilient to future shocks. To accomplish this, it is important to assess current rates of hunger and malnutrition – where we were before the pandemic and what the situation is now.

Although the word produces enough food to feed its population, food insecurity has been rising since 2014. Before COVID-19, two billion people globally – 25.9% of the population – did not have regular access to safe, nutritious food and one in every nine people was undernourished. Five years into the 2030 Agenda for Sustainable Development, the world is off track to achieve the targets for hunger and malnutrition. The pandemic is expected to worsen the trend with up to 132 million additional people being undernourished by the end of this year. The recently released 2020 Global Hunger Index identifies alarming levels of hunger in 11 countries and serious levels in another 40. The report states that in many countries, the situation is either improving too slowly or even worsening.

The consequences of malnutrition are grave and long lasting, and addressing malnutrition in all its forms, particularly for women, infants, children and adolescents, is one of the greatest global health challenges.

Proper nutrition is critical for building a strong immune system and helping the body fight off disease and infection. In the context of COVID-19, the World Health Organization has stressed the importance of good nutrition and healthy diets to promote health. It is important particularly in times when the immune system might need to fight back. It is now more important than ever to consume healthy foods rich in essential micronutrients to strengthen immunity, enhancing resistance and supporting faster recovery.

As the governments around the world face the immediate crisis and long-term implications of COVID-19, nutrition must play an integral role in the response and we must ensure that the most vulnerable have access to adequate amounts of nutritious foods to cover their basic needs. The pandemic, and measures adopted to control it, have disrupted food systems, and people have turned towards cheaper, less nutritious, more shelf-stable foods. Fortification of key staple foods presents a major opportunity to reach entire populations with much-needed micronutrients that improve health and strengthen immune systems.

Food fortification is a proven and cost‐effective intervention for addressing micronutrient deficiencies. Large-scale food fortification, using critical micronutrients like iodine, iron, folic acid and vitamin A, has been associated with a 74% reduction in the odds of goiter, 34% reduction in anaemia in women, 41% reduction in the odds of neural tube defects and could protect nearly 3 million children annually from vitamin A deficiency, respectively. Other micronutrients such as vitamin D have been successfully added to foods (e.g. vitamin D fortified oil), and in the context of COVID-19, may call for additional support to strengthen evidence of their impact and support scale up.

Currently, approximately 150 countries globally have guidance or regulations in place for fortification programs, the majority of which are mandatory. Almost all these countries are implementing national salt iodization programs, 129 of which are mandatory. Eighty-five countries mandate at least one kind of cereal grain (maize, rice or wheat) fortification, and 26 mandate the fortification of edible oils.

In response to COVID-19, 200 countries have planned, introduced or adapted social protection and job measures. While many have provisions for food rations for the most vulnerable segments of society, nutrition is not necessarily included as a component of their strategies. These social protection programs present a major opportunity for governments and other stakeholders to reach populations with fortified foods. All relevant stakeholders, including governments, private sector, donors, and civil society, have a role to play in ensuring uninterrupted production, distribution and consumption of adequately fortified foods during the pandemic.

Nutrition International supports global and regional food fortification agendas, and provides technical and operational assistance to governments and industry partners in selected countries in Asia and Africa to promote fortification of staples, including wheat flour, maize flour, rice and edible oils, and condiments, primarily universal salt iodization and double-fortified salt.

Our priority in the wake of the pandemic has been to ensure production and availability of adequately fortified foods in the open market and through social protection programs without shortages or disruptions. This has required constant coordination with governments and industry partners to ensure the continuous prioritization of efforts and allocation of budget for monitoring and regulatory enforcement, and production and compliance to standards.

We have made necessary adaptations to our food fortification interventions to ensure they can continue throughout the pandemic. We have utilized digital technology and alternate platforms to find new ways to continuously engage with industry partners, government and multi-stakeholder fortification alliances to assess the on-the-ground situation and challenges, provide necessary technical and operational assistance and ensure fortification remains high on the agenda, without causing any disruptions to ongoing in-country fortification efforts.

Good nutrition is critical to all COVID-19 response efforts and is the foundation to building back stronger and more resilient so that people everywhere can thrive. Food fortification is an essential tool to getting the right nutrition to those who need it. Nutrition International thanks the governments, donors, and industry and development partners who are helping us support food fortification, especially throughout the COVID-19 pandemic, and our staff for their unrelenting support to the governments and industry partners in general and especially during these difficult times.

Manpreet Chadha

Senior Technical Advisor, Food Fortification

As part of the Nutrition International fortification team, Manpreet provides technical assistance and quality assurance for our programs that involve food fortification. Additionally, she monitors the global progress in the area, leads in knowledge management in food fortification, and represents Nutrition International as required with donors, panels, working groups and partners.

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