News

Gates Foundation calls for more fortification to fight malnutrition

The 2024 Gates Foundation Goalkeepers Report advocates for fortifying everyday staples like bouillon cubes to combat malnutrition in vulnerable populations.

As food insecurity worsens due to climate change, bouillon fortification programmes in countries like Nigeria and ‘double fortification’ of salt developments aim to deliver key nutrients such as iron and folic acid to millions of people. This approach follows the success of salt iodisation as a proven strategy to address micronutrient deficiencies on a large scale.

In its eighth annual Goalkeepers Report, the Bill & Melinda Gates Foundation urged world leaders to increase global health spending to tackle malnutrition, which co-chair Bill Gates describes as “the world’s worst child health crisis.” Titled The Race to Nourish a Warming World, the report warns that without immediate intervention, climate change will lead to an additional 40 million cases of stunting and 28 million cases of wasting by 2050. However, by scaling up solutions like food fortification, governments can address both malnutrition and strengthen resilience to climate change.

The report advocates for urgent action to support global health funding, emphasising the need to fully finance programmes that have already proven effective in saving lives. Among these is the Child Nutrition Fund, a new platform designed to coordinate donor financing for critical nutrition initiatives.

Fortifying bouillon cubes in Nigeria

Nigeria is taking steps to fortify bouillon cubes, a daily staple in most households, to deliver essential nutrients like iron, folic acid, zinc, and vitamin B12. The initiative is part of the Nigerian government’s broader strategy to combat malnutrition, which remains a leading cause of child mortality. Fortifying bouillon cubes offers a practical and scalable way to improve public health by addressing micronutrient deficiencies that are widespread among women and children in the region.

According to the Goalkeepers Report, the impact of fortified bouillon cubes could be substantial. The programme is expected to prevent up to 16.6 million cases of anaemia annually and halve the number of deaths and stillbirths from neural tube defects, potentially saving 11,000 lives each year. Ladidi Bako-Aiyegbusi, director of Nutrition at Nigeria’s Ministry of Health and Social Welfare, emphasises that folate deficiency is particularly problematic, contributing to high rates of anaemia and birth defects.

The government’s collaboration with public and private partners, including major food producers like Dangote and Promasidor, ensures the feasibility of large-scale production and distribution of fortified bouillon cubes. The goal is to make fortified products affordable and widely available to vulnerable groups across the country.

The success of salt fortification

Fortification as a public health strategy has a long history, with iodised salt being one of the earliest and most successful examples. Widespread goitre and cognitive impairments led the United States and Switzerland to introduce iodised salt in the 1920s to combat iodine deficiency. The success of this initiative resulted in the near elimination of iodine deficiency disorders in both countries, and it set the stage for similar interventions worldwide.

Today, according to UNICEF, around 86% of households globally consume iodised salt – a big leap from just 20% in the 1990s. However, iodine deficiency remains a concern in regions with iodine-poor soils. The success of salt iodisation also paved the way for further innovations, such as double fortification, which addresses both iodine and iron deficiencies.

Expanding double fortification

India has been at the forefront of developing double-fortified salt, combining iodine and iron to tackle two of the most common nutritional deficiencies. Iron deficiency is the leading cause of anaemia globally, affecting 2 billion people and leading to poor pregnancy outcomes and developmental delays in children. Double-fortified salt offers a way to meet 100% of daily iodine needs and 30-60% of daily iron requirements, making it a powerful tool in improving public health.

India’s National Institute of Nutrition led the research and development of double-fortified salt, overcoming significant technical challenges to stabilise both nutrients in a single product. Since its introduction, double-fortified salt has been widely accepted in India and other countries, such as Bangladesh. Its success highlights the potential of combining essential nutrients in widely consumed products to address hidden hunger at scale.

The rise of fortified products: From instant noodles to dairy

In addition to salt, other staple foods have been fortified to improve public health. Initiatives like the Millers for Nutrition programme are working to scale up fortification by supporting local millers in fortifying staple foods like rice, flour, and edible oils. In Indonesia, Royco stock powder, produced by Unilever, delivers 15% of the daily iodine requirement per 2g serving. These products make it easier for consumers to access essential nutrients through everyday meals​.

In dairy, products like Horlicks have been fortified with a wide range of nutrients. Classic Malt Horlicks, widely consumed in South Asia, contains 23 vital nutrients, including proteins, zinc, vitamin C, and folic acid. Fortified variations of Horlicks, such as Junior Horlicks and Horlicks Women’s Plus, cater to specific populations, including young children and pregnant women, ensuring they receive nutrients tailored to their needs​.

However, these initiatives are not without controversy. Some nutritionists find that the benefits of fortification do not outweigh the nutritional deficiencies of certain fortified products entirely, making their promotion unjustifiable. In 2019, for example, a government advisor in Nepal resigned from her post to protest a major instant noodle fortification programme in the country, calling the programme a promotion of ‘junk food’.

The future of food fortification

As the global food fortification market grows, projected to reach $286 billion by 2034, there are also opportunities to expand the scope of fortification. Currently, most large-scale programmes focus on key nutrients like iodine, iron, and folic acid. However, future efforts could include additional nutrients such as vitamin D, omega-3 fatty acids, and selenium, which play critical roles in immune function, brain development, and cardiovascular health​.

And while traditional staples like rice, flour, and salt remain central to fortification efforts, there are opportunities to fortify other widely consumed items. For example, fortified plant-based dairy products are increasingly common in higher-income countries, where they provide vitamin D and calcium to address bone health issues. In Africa, fortified edible oils and sugar are emerging as effective vehicles for delivering vitamin A​.