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The potential of biofortification of rice, beans, cassava and maize throughout Latin America

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AgroSalud is a project coordinated at the Centro Internacional de Agricultura Tropical and aims to increase nutrition security in Latin America through biofortification – i.e. through plant breeding with the objective of increasing the micronutrient content in staple crops. Thus AgroSalud should help prevent the negative economic and health consequences of micronutrient malnutrition. The objective of the present study was to evaluate the cost-effectiveness of current AgroSalud crops to inform funding priorities for biofortification. For this ex ante evaluation the commonly used methodological framework of "disability-adjusted life years" (DALYs) was used. The data for the analysis was mostly taken from previous work of AgroSalud and from personal interviews with the experts involved in the project. For nine case studies enough data could be compiled to carry out an assessment. The analysis determined the burden of micronutrient deficiencies in various countries in the region and showed that in case of successful biofortification efforts and if a high degree of consumption of the crops can be achieved, biofortification can eliminate wide-spread mineral deficiencies and considerably reduce the burden of vitamin A deficiency. Furthermore the analysis has shown that on average also in Latin America biofortification promises to be a cost-effective micronutrient intervention – and in many cases even more cost-effective than alternative or complementary interventions. The single most important factor for success is the coverage rate of the biofortified crops. Thus given the smaller number of potential beneficiaries, results for crops targeted at smaller countries only are less clear.
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The potential of biofortification
of rice, beans, cassava and maize
throughout Latin America
International Food Policy Research Institute, Washington, DC
Contract No. 2010X012STE
April 2010
Alexander J. Stein
The potential of biofortification
of rice, beans, cassava and maize
throughout Latin America
International Food Policy Research Institute, Washington, DC
Contract No. 2010X012STE
April 2010
Alexander J. Stein
Alexander J. Stein, 2010
www.AJStein.de, Sevilla
Cover, design and layout: A.J. Stein
Images: Ionut Cojocaru (map/Wikipedia),
Paulius G (rice/SXC), Zsuzsanna Sebők (beans/SXC),
Nathalie Dulex (cassava/SXC) and Josep Altarriba (maize/SXC).
Produced in Spain.
Summary
AgroSalud is a research project coordinated by the Centro Internacional de Agricultura Tropical
(CIAT) in Cali, Colombia, that aims to increase food and nutrition security in Latin America
through biofortification – i.e. through plant breeding with the objective of increasing the nutrient
content in staple crops. Thus AgroSalud should help prevent the negative economic and health
consequences of malnutrition, in particular of iron, zinc, vitamin A and protein deficiency. The
objective of the present study was to evaluate the cost-effectiveness of current AgroSalud crops
to inform funding priorities for micronutrient biofortification in the region.
For this ex ante evaluation a commonly used methodological framework based on "disability-
adjusted life years" (DALYs) was used. The data for the analysis was mostly taken from current
and previous analyses done by AgroSalud and from personal interviews and communications
with the experts involved in the project. For nine country-crop combinations enough data could
be compiled to carry out an assessment of the biofortified crops in the form of case studies.
The analysis not only determined the burden of micronutrient deficiencies in various countries in
the region, it also showed that in case of successful biofortification efforts and if a high degree of
consumption of the crops can be achieved, biofortification can eliminate wide-spread mineral
deficiencies and considerably reduce the burden of vitamin A deficiency in the target countries.
Furthermore the analysis has shown that on average also in Latin America biofortification prom-
ises to be a cost-effective micronutrient intervention.
The analysis has also shown that biofortification is more cost-effective if it is done at the interna-
tional level, covering several countries and thus realising economies of scale. Of the individual
crops evaluated in this report, those targeting iron deficiency are the most cost-effective ones.
The crops targeting vitamin A deficiency also have some potential, however, uncertainties about
their acceptance and some of the data do not allow an unequivocal statement. Finally, the crops
aimed at controlling zinc deficiency are at best as cost-effective as industrial zinc fortification is
projected to be. Hence, a more careful and qualitative analysis on a case-by-case basis may be
required to decide which of the alternative interventions is preferable – or to determine to what
extent they complement each other.
Sensitivity analyses that probed the impact of changes to key parameters showed that the re-
sults are very robust; only changes in the coverage rates of the crops have the potential to influ-
ence the outcomes considerably. This corresponds to the underlying economic rationale of bio-
fortification, which is the exploitation of economies of scale. Therefore, investing in the dissemi-
2
nation of the biofortified crops is paramount. In this context a more structural limitation for
AgroSalud is the relative smallness of its target countries (apart from Brazil and to some extent
Mexico), which also limits a scaling up. This may be addressed though more international coor-
dination of basic biofortification efforts, beyond Latin America. Otherwise the use of potential
synergies in the execution of the in-country activities could also help improve the economics of
the AgroSalud crops. And in places where biofortification cannot immediately have an impact,
because other programmes are already in place to control micronutrient deficiencies, it may be
worth considering whether biofortification can help scaling back more costly interventions.
Acknowledgements
The author would like to acknowledge the valuable input and the friendly support he received
from Helena Pachón, Salomón Pérez, James García, Carolina González, Jaime Borrero,
Stephen Beebe, Hernán Ceballos, Luis Becerra, Edgar Burbano and Joe Tohme of CIAT, as
well as from Gary Atlin and Kevin Pixley of the Centro Internacional de Mejoramiento de Maíz y
Trigo (CIMMYT) in Mexico and from Anne Jacobsen.
3
Table of contents
Summary.....................................................................................................................................1
List of tables and figures..............................................................................................................3
1 Introduction..........................................................................................................................4
2 Methods...............................................................................................................................6
3 Data.....................................................................................................................................7
4 Results ..............................................................................................................................12
5 Discussion .........................................................................................................................13
6 Conclusions.......................................................................................................................26
References................................................................................................................................27
List of tables and figures
Table 1: Crop-nutrient combinations and potential target countries considered in this study .......5
Table 2: Results for biofortification in India with intake data at different levels of aggregation .....7
Table 3: Data availability for ex ante country studies on the potential impact of target crops....... 8
Table 4: Key data for the target countries.................................................................................. 13
Table 5: Main assumptions used in the analysis of AgroSalud crops......................................... 14
Table 6: Overview of the impact and cost-effectiveness of selected AgroSalud crops ...............15
Table 7: Overview of the combined impact and cost-effectiveness of the AgroSalud crops ....... 15
Table 8: Impact and cost-effectiveness of other micronutrient interventions in Latin America.... 16
Table 9: Sensitivity analysis for the crop consumption levels in NE-Brazil ................................. 18
Table 10: Results with a population-based attribution of the AgroSalud budget.........................19
Table 11: Results with the attribution of HarvestPlus monies ....................................................21
Table 12: Results with the same consumption shares for all crops............................................ 22
Table 13: Sensitivity analysis for the dissemination costs of biofortified maize ..........................22
Table 14: Overview of the impact and cost-effectiveness of zinc-rich crops in Nicaragua..........23
Figure 1: Cost-effectiveness of AgroSalud crops and alternative micronutrient interventions ....17
4
1 Introduction
Biofortification, in its broadest definition, is the process of adding nutritional value to a crop
(Montagnac et al. 2009). In this analysis biofortification refers to micronutrient enrichment of sta-
ple crops through plant breeding to address the negative economic and health consequences of
vitamin and mineral deficiencies in humans (Nestel et al. 2006). Apart from such "genetic" bio-
fortification also "agronomic" biofortification, i.e. the application of mineral fertilisers to increase
the mineral content in crops, is an approach that is currently being investigated (e.g. White &
Broadley 2009, Cakmak 2008). This latter approach will not be considered further in the present
study, in particular because its potential impact and cost-effectiveness are still unclear and
therefore no comparisons are possible. Hence, in the present document, "biofortification" refers
to the plant breeding approach only.
There is general agreement that dietary diversification would be the ideal remedy to address mi-
cronutrient malnutrition, but it is also understood that it is often difficult to achieve in resource-
poor areas of the world, at least in the short to medium term (e.g. Bouis 2002). Therefore, in the
past, pharmaceutical supplementation and industrial fortification were favoured as interventions
to control vitamin and mineral deficiencies. In this context biofortification has to be seen as a
new, food-based intervention that relies on agriculture to increase the nutritional quality of crops.
As such, biofortification has the potential to complement the existing micronutrient interventions,
in particular by targeting the rural poor who eat large quantities of staple crops and often have
little access to commercially processed food – i.e. among whom the impact of industrial fortifica-
tion is limited (e.g. Tanumihardjo et al. 2008). Moreover, if the coverage of the public health
system in rural areas is patchy, also the impact of pharmaceutical supplementation in these ar-
eas is limited. Apart from this advantage of extending the reach of micronutrient strategies, bio-
fortification also promises to be more cost-effective than current micronutrient interventions –
which themselves are already considered to be cost-effective public health interventions (e.g.
Meenakshi et al. 2009, Qaim et al. 2007). This economic advantage is due to economies of
scale that can be realised in the development of biofortified crops: unlike industrial fortification
and pharmaceutical supplementation that incur variable costs for each micronutrient dose deliv-
ered, the cost for the development of biofortified germplasm represents a fixed cost and there-
fore unit costs fall for each additional micronutrient dose delivered through a biofortified crop
(even if there are also variable costs that need to be incurred for the dissemination of biofortified
crops).
5
AgroSalud, a biofortification research project funded by the Canadian International Development
Agency (CIDA) and coordinated by the Centro Internacional de Agricultura Tropical (CIAT) in
Cali, Colombia, aims to increase food and nutrition security among vulnerable populations living
in Latin America and the Caribbean through biofortified crops.1 In the context of a review of
AgroSalud by HarvestPlus,2 the objective of the present study is to evaluate the cost-effective-
ness of biofortification of rice, beans, cassava and maize in Latin America to inform funding pri-
orities for biofortification in the region (see Table 1 for the crop-nutrient combinations of interest
to HarvestPlus and the corresponding target countries of AgroSalud).
Table 1: Crop-nutrient combinations and potential target countries considered in this study
Iron-rich
rice
Zinc-rich
rice
Iron-rich
beans
Zinc-rich
beans
Zinc-rich
maize
bC-rich
maize
bC-rich
cassava Total
Bolivia X
1
NE-Brazil X X
2
El Salvador X X X
3
Guatemala X X
2
Haiti X X X X X X X
7
Honduras X X X
3
Mexico X
1
Nicaragua X X X
3
Total 3 4 2 5 5 2 1 22
Note: bC = beta-carotene. Source: Pachón (2010).
The aim of these biofortification efforts is to help address iron deficiency (FeD), zinc deficiency
(ZnD) and vitamin A deficiency (VAD) in the region. In as far as data availability permits, the
evaluation includes (1) an ex ante impact assessment of the number of DALYs that can be
saved through biofortification of these four crops in Latin America and (2) a ranking of the crop-
nutrient combinations and countries. On the latter further recommendations are based regarding
the modification of current AgroSalud priorities. As far as possible, the study also considers the
cost-effectiveness of alternative interventions and comments on other impact assessment work
that has been conducted by AgroSalud. While so far already various impact assessments or
economic evaluations of biofortified crops have been carried out in case studies of individual
1 For more details about the project and the organisations involved see http://www.AgroSalud.org/,
http://www.acdi-CIDA.gc.ca/home and http://www.CIAT.cgiar.org/, respectively.
2 For more details about HarvestPlus see http://www.HarvestPlus.org/.
6
crops or countries (Meenakshi et al. 2009, Stein et al. 2008a/b, 2007, 2006, Ma et al. 2007,
Javelosa 2006, Zimmermann & Ahmed 2006, Sandler 2005, Zimmermann & Qaim 2004, Dawe et
al. 2002), this study represents a comprehensive evaluation of a complete set of biofortified
crops in an entire world region.
2 Methods
For the ex ante evaluation of biofortified crops a common methodological framework has crystal-
lised (Meenakshi et al. 2009, Stein et al. 2008a/b, 2007, 2006, Ma et al. 2007, Javelosa 2006,
Zimmermann & Ahmed 2006, Sandler 2005, Zimmermann & Qaim 2004). This framework builds
on "disability-adjusted life years" (DALYs), which are frequently used to measure the burden of
disease in developing countries.3 Specifically for the use in impact assessment and cost-effec-
tiveness studies of biofortification, the DALYs method has been developed further (Stein et al.
2005). Within this framework, the number of DALYs that can be saved through the consumption
of biofortified crops are estimated to measure the potential health impact of these crops. In a
subsequent step this health benefit is then used for cost-effectiveness analyses (CEAs) of the
biofortification efforts. Given the widespread use of DALYs, also in CEAs, this framework is also
used in the present study. Thus the results are comparable not only across the results of previ-
ous work on biofortified crops, they can also be used to compare the cost-effectiveness of biofor-
tification versus other micronutrient interventions or public health interventions. Such compari-
sons are useful for decision makers and donors alike to ensure that scarce resources are spent
on the most efficient and promising projects, thereby maximising the impact on public health.
While some previous studies of biofortified crops have used detailed household data to simulate
the impact of the consumption of biofortified crops at the level of the individual (Stein et al.
2008a/b, 2007, 2006), the other studies used average consumption data to derive the impact of
biofortification on the burden of micronutrient deficiencies in the respective region. As Meenakshi
et al. (2009) have used the same data to calculate the impact of iron-rich and zinc-rich rice and
wheat in India as have Stein et al. (2008a, 2007) – but using average consumption figures to be
consistent with the other case-studies in that paper – the results of these two studies can be
compared. Table 2 shows that both methods can indeed yield similar results (for iron-rich wheat
and zinc-rich rice), but that this need not be the case (for iron-rich rice and zinc-rich wheat).
3 For instance DALYs are used by the World Health Organization (WHO), see
http://www.WHO.int/topics/Global_Burden_of_Disease/.
7
However, even in the cases where there is a bigger difference in the results when using the two
methods, the orders of magnitude of the results are still comparable – in a note to their analysis,
Meenakshi et al. (2009) write that the figures are "somewhat different". Also, across all case
studies the average results are similar. Hence, while using average data my not yield the precise
results that can be obtained from individual data, the results may nevertheless be used to gauge
the overall impact and cost-effectiveness of a programme, in particular as doing the analyses
with individual data is much more resource intensive (both in terms of time and data needed).
Given these practical considerations, in the following only average consumption data are used.
When calculating the efficacy of the biofortified crops in decreasing the adverse health outcomes
of the respective micronutrient deficiency (see "dose-response" in Stein et al. (2005) and
Meenakshi et al. (2009)), recommended dietary allowances (RDAs) rather than estimated aver-
age requirements (EARs) were used as threshold for sufficiency. RDAs were primarily used to
obtain a set of results based on a consistent methodology across the various studies mentioned
above; otherwise there are conceptual considerations that support the use of EARs as threshold
in the assessment of group intakes (Stein 2006, Stein et al. 2008a, Pachón 2010). As EARs are
lower than RDAs, it would be easier for the biofortified crops to close the intake gap and achieve
sufficiency, i.e. by using RDAs the impact of the biofortified crops is underestimated.
Table 2: Results for biofortification in India with intake data at different levels of aggregation
Reduction of burden (percent) Cost per DALY saved (USD)
Individual data Average data Individual data Average data
Iron-rich rice 12-38 5-15 0.3-4 3-17
Iron-rich wheat 7-26 7-39 0.6-9 1-10
Zinc-rich rice 18-41 20-56 0.4-4 1-6
Zinc-rich wheat 2-12 9-48 2-40 1-11
Average 10-29 10-39 1-14 2-11
Source: The results derived from average consumption data are taken from Meenakshi et al. (2009), the results de-
rived from individual consumption data are taken from Stein et al. (2008a) for iron and from Stein et al. (2007) for zinc.
3 Data
The data used for the analysis is taken from current and previous analyses done by AgroSalud
using CIAT's MAIN model (García Castro et al. 2008, Jacobsen 2008, Meenakshi et al. 2009,
Pérez Suárez 2010, CIAT 2010). For nine country-crop combinations there is enough data to
carry out sound ex ante impact assessments of the biofortified crops through individual country
8
studies (Table 3). This data – mainly population, health and consumption data – has been
checked for consistency and where necessary its validity has been confirmed by competent
AgroSalud experts; for NE-Brazil and Mexico some additional or updated health data has also
been added (DHS 1997, WHO 2009). Moreover, in the subsequent calculations the data has
been complemented by integrating the estimated costs of the budget for the second phase of
AgroSalud (Pachón 2010), by updating information on the likely biofortification successes and by
additional cost information that was obtained from the respective AgroSalud experts (see in the
following). Nevertheless, the cost estimates for the eventual distribution and marketing of the
biofortified crops are only provisional and quite possibly they represent underestimations; overall
the details of the eventual dissemination of the crops are not very clear yet.
Table 3: Data availability for ex ante country studies on the potential impact of target crops
Iron-rich
rice
Zinc-rich
rice
Iron-rich
beans
Zinc-rich
beans
Zinc-rich
maize
bC-rich
maize
bC-rich
cassava
Bolivia n/a
NE-Brazil OK OK
El Salvador n/a n/a n/a
Guatemala n/a n/a
Haiti n/a n/a n/a n/a n/a n/a
n/a *
Honduras OK OK OK
Mexico
OK
Nicaragua OK OK OK
Note: NE-Brazil = Northeast Brazil; OK = data available to carry out an analysis; n/a = not enough data available
for an analysis; * = provisional assumptions used.
To be able to include an assessment of the potential impact of beta-carotene-rich cassava, the
data that was necessary to carry out an analysis of the impact of this crop in Haiti was derived
from a number of assumptions and extrapolations from data from other countries (in consultation
with Helena Pachón of AgroSalud and in addition to available health data and nutrition data
(UNICEF 2010, WHO 2009, FAO 2009, Dessalines 2008). In the following, summaries of the
personal communications by these latter experts are given crop-wise and subsequently the main
assumptions are provided in an overview (Table 5 further below).
3.1 Rice
Personal communication by Jaime Borrero (CIAT, March 2010): The baseline content of Fe and
Zn in rice in Latin America is 2-3 ppm and 17-18 ppm, respectively. With biofortification possible
9
targets are 6 ppm for Fe and 22 ppm for Zn (and in pessimistic scenarios 4 ppm and 20 ppm,
respectively). No post-harvest losses are expected to occur, neither is it expected that the bio-
availability of the minerals changes. Currently, in 2010, the target levels are being achieved, i.e.
by 2015 the mineral-rich rice can be available in agronomically interesting lines and distribution
can start in 2020 (or in an optimistic scenario already directly in 2015). The share of biofortified
rice in overall rice production that can be achieved realistically is 80 percent (with 70 percent
representing a more pessimistic scenario). Target countries for biofortified rice are the Domini-
can Republic, Colombia, Brazil, Bolivia, Nicaragua, Cuba and Panama. (While in most of these
countries the distribution systems are regular to good, it can be expected that it will take some-
what longer in Nicaragua.) Costs that arise in addition to the AgroSalud budget in each target
country are the costs for 3-4 professionals that multiply the seeds over 2-3 years.
3.2 Beans
Personal communication by Stephen Beebe (CIAT, March 2010): The baseline content of Fe
and Zn in beans is 55 ppm and 28 ppm, respectively. The target for biofortification is to reach
110 ppm for Fe and 50 ppm for Zn (or in a pessimistic scenario 95 ppm and 48 ppm, respec-
tively). Under normal handling conditions that prevail in Latin America no post-harvest losses are
expected (or in a pessimistic scenario they would not exceed 10 percent). The bioavailability of
the additional Fe and Zn is expected to remain unchanged. The maximal share of biofortified
beans in overall bean cultivation could reach 50 percent. It could take another 5 years to reach
the optimistic levels of mineral content; after that it can take 10 years to reach the maximal cov-
erage (or in a pessimistic scenario 20 years). To improve the adoption, new innovative options
are needed (e.g. the generation of demand for biofortified beans through NGOs). Target coun-
tries within Latin America for the beans are Nicaragua, Honduras, Haiti, El Salvador, Guatemala,
and Northeast Brazil (NE-Brazil); the Andean countries are less of a target as consumption there
is lower. In addition to the AgroSalud budget, there is approx. one breeder per country who will
(have to) dedicate about 33 percent of their time for 5-6 years for the necessary in-country work.
3.3 Cassava
Personal communication by Hernán Ceballos (CIAT, March 2010): The breeding target for beta-
carotene in cassava is 15 µg per gram of fresh root (which corresponds approx. to 45 µg beta-
carotene per gram of dry root). In 2010 this target has been achieved. Now the beta-carotene-
trait will be combined with agronomic traits to ensure adoption by farmers and by 2015 the cor-
responding genotype should be available; then multiplication and promotion activities should last
10
until 2020, when the biofortified cassava finally will be distributed to farmers. (However, already
now cassava with 10 µg beta-carotene is being distributed!) The main agronomic trait that is
being targeted is increasing the time to post-harvest physiological deterioration (PPD, which cur-
rently occurs already 24-48 hours after harvest). This reduces farmers' risk of losing their har-
vest (either before they can process it for own consumption or e.g. on the way to the market). It
seems as if the antioxidative properties of beta-carotene actually help in reducing PPD. The
breeding target of 15 µg was set in the belief that the conversion rate of the beta-carotene into
retinol would be 12:1. However, feeding trials have shown that the conversion rate is around 4:1.
The target region for biofortified cassava is (primarily) Africa. However, in Latin America also
Haiti and NE-Brazil could be potential targets and to a lesser extent Paraguay, Colombia or the
Dominican Republic (where the benefits could perhaps materialise rather in the poultry industry
where beta-carotene-rich feed could eliminate the need to add beta-carotene as colouring for the
egg yolk). In both former countries reaching a coverage of 25 percent is reasonable (in a pessi-
mistic scenario 15 percent should still be reached). At least in Africa the colour change of the
biofortified cassava should not pose a problem as people actually like colour, therefore some-
times e.g. palm oil is added to gari (cassava flour). Costs for the R&D have to be obtained from
HarvestPlus. HarvestPlus will also have to support basic activities like bioavailability and effec-
tiveness studies or the establishment of foundation planting material. However, there will be little
need for dissemination activities, as plenty organisations (like HKI or World Vision) will take on
this task (once effectiveness has been demonstrated).
Personal communication by Luis Becerra (CIAT, March 2010): In four years the beta-carotene
content in cassava can be increased from the current 15 micrograms to 30 micrograms.
3.4 Maize
Personal communication by Gary Atlin (CIMMYT, March 2010): There is relatively little food use
of yellow maize in tropical Latin America; high consumption rates of yellow maize are restricted
to Panama and Haiti – which have maize consumption rates that are low for the region (20-25 kg
per capita per year), although these rates are no doubt higher among the poor. The prospects
for widespread adoption of yellow maize for food use in high maize consumption countries may
be quite limited. To convert CIMMYT's best yellow quality-protein maize (QPM) open pollinated
varieties (OPVs) to high pro-vitamin A and produce adequate foundation seed will take about
three years, require the full-time attention of 1 technician and 2 assistants, as well as a total of
0.5 person years of a scientist; total cost would be approximately $200,000 per year.
11
For zinc potential impact is greater: There are already fairly high zinc levels in CIMMYT's elite
white QPM germplasm and the demand for white maize for food in the region is much greater
than for yellow maize. Generating and validating white maize hybrids and OPVs with levels
around 40 ppm could be done within three years; to have large quantities of foundation seed
ready for commercial seed production would take an additional year. Raising levels above 40
ppm would require a long-term breeding investment, but significant progress could be made in
six years (although this would require a about $200,000 investment per year).
Personal communication by Kevin Pixley (CIMMYT, March 2010): For zinc the baseline content
in maize is approximately 22 ug/g; 40 ug/g are the target level, with 31 ug/g representing an in-
termediate level for the breeding efforts. The target level could be reached by 2013-18 and the
seeds could then be distributed to farmers by 2015-20. Post-harvest losses are not known, but
could be negligible when the whole grain is consumed. Similarly, the bioavailability of the zinc in
the maize is not known. 4-10 years after it has been released to farmers the zinc-rich maize
could reach overall cultivation shares of 2-20 percent. Additional costs could arise for marketing.
The baseline content of beta-carotene in maize is 0 ug/g for white maize and 1.5 ug/g for yellow
maize; the intermediate target in biofortified maize is 8 ug/g, with the final target being 15 ug/g of
beta-carotene. CIMMYT may be ready to release cultivars at the intermediate target level within
3-4 years; the complete target will likely take 6-10 years. At about the same time the first seeds
can then be distributed to farmers. Beta-carotene maize may be ready for distribution to farmers
1-2 years earlier than zinc maize, i.e. it may be ready by 2014-18 as there are already some
pretty good hybrids that have been evaluated in yield trials. Post-harvest losses of beta-carotene
are expected to be about 50 percent from harvest to plate and the expected bioavailability of the
beta-carotene in the maize could be as high as 3:1 (according to two studies) or as low as 12:1
(with a pessimistic view). But a realistic estimate is rather around 6:1. Beta-carotene maize in
Mexico will be accepted first and foremost for use in the chicken feed industry; the area of culti-
vation may grow within the range suggested for zinc (2-20 percent), but the consumption as hu-
man food will likely be slower than the 4-10 years used for zinc; for sure it takes longer than that
for most new varieties to become popular and gain market share. Regarding the marketing of
beta-carotene maize, a bare-bones approach would involve mostly radio messages, while more
aggressive strategies would include television, magazines, free sample distribution, etc. (The
difference between success and failure of two equally good varieties is usually marketing.)
12
3.5 Seeds
Personal communication by Edgar Burbano (CIAT, March 2010): There can be considerable
differences regarding the coverage rate of the biofortified seeds if not the whole country is con-
sidered but rather the actual target region. For instance, while with 2-3 materials of quality-pro-
tein maize (QPM) a coverage of 5 percent over three years and 10 percent over ten years may
be achieved in all of Colombia, in the same times the coverage in areas where malnutrition is
prevalent may reach 25 percent and 50 percent, respectively. To commercialise newly devel-
oped material in Colombia, the material first needs to be increased, then, to be legalised, the
official agricultural evaluation trials (Pruebas de Evaluación Agronómicas, PEA) have to be con-
ducted before the material can be registered, and finally the seeds have to be certified. The PEA
costs 6,300,000 COP for the trial of 1-9 materials in 1-3 zones. In addition staff costs of
6,000,000 COP have to be considered. The registration of the material itself, with the "Comité
Nacional de Cultivares", costs again 1,600,000 COP per material. Finally, the costs for the
maintenance of the trait in future seeds is about 10,000,000 COP per year. For logistics and dis-
tribution another 50,000 USD could be needed to support local administrations, NGOs or com-
panies. The actual costs for the multiplication of the certified seed will be borne by the seed
companies (with which CIMMYT and CIAT seek to collaborate), as they get the biofortified mate-
rial for free but can hope to sell the seeds easier as they are superior to the normal seeds while
the costs for the company are the same. (Currently in Colombia one kilogram of conventional
seeds costs around 5,000-6,000 COP, which is also the price for QPM seeds; hybrid seed sells
at 15,000 COP and GM seeds sells at 35,000 COP.)
4 Results
For this study, for nine country-crop combinations there was enough data to carry out sound ex
ante impact assessments of biofortified crops through individual country studies (Table 3). In
addition, to include an assessment of the potential impact of beta-carotene-rich cassava, an
analysis was carried out for the impact of this crop in Haiti based largely on a number of as-
sumptions and extrapolations from data from other countries, i.e. these results have to be inter-
preted cautiously. To give an overview of the burden of the micronutrient deficiencies in the tar-
get countries, the absolute and relative numbers of DALYs lost due to the respective deficiency
are provided in Table 4. Then the impact and cost-effectiveness results for the individual crop-
nutrient combinations in each target country are reported in Table 6 and the results for overall
diet-nutrient combinations in each target country are reported in Table 7. For comparison, Table
8 provides an overview of the impact and cost-effectiveness of other micronutrient interventions
13
in Latin America. These latter results were estimated within the CHOICE project of the World
Health Organization (WHO 2010), for which a similar methodology is used (see fn 3). Here, as
far as possible, the results are reported in the same format to facilitate comparison.
Table 4: Key data for the target countries
Population
(million)
GNI per
capita (USD)
DALYs lost
('000)
DALYs lost
per 1m capita
NE-Brazil FeD 48 7,300 * 99 2,067
Honduras ZnD 7.2 1,740 15 2,029
Nicaragua ZnD 5.4 1,080 9 1,664
Mexico VAD 106 9,990 83 784
Haiti VAD 9.9 n/a 21 2,091
All all 176 n/a 226 1,284
Source: Own calculations, gross national income (GNI )per capita is for 2008, taken from World Bank (2010).
5 Discussion
5.1 Overall appraisal and sensitivity analyses
The calculations of the burden of iron deficiency in NE-Brazil, of zinc deficiency in Honduras and
Nicaragua and of vitamin A deficiency in Mexico and Haiti show – only for these few case stud-
ies – the loss of several hundred thousand DALYs each year in absolute terms and an annual
loss of far over 1,000 DALYs per 1 million individuals (Table 4).4 Biofortification of the main sta-
ple crops consumed in these countries could more than halve this burden and save tens of thou-
sands of years of healthy lives – at a cost of 10-20 USD/DALY saved (Table 7). As such, on
average biofortification in Latin America is more cost-effective than fortification, which itself is
projected to cost between 20-200 USD/DALY saved, and which is considered more cost-effec-
tive than supplementation (Table 8).5
4 For comparison, in India FeD, ZnD and VAD cause the loss of 3,943 DALYs, 2,758 DALYs and 2,267
DALYs per 1 million individuals of its population, respectively (own calculations).
5 While ex-post studies in the region found that supplementation and fortification are effective in controlling
micronutrient deficiencies (Mora and Bonilla 2002, Mora et al. 2000), they did not analyse the cost-
effectiveness of these programmes. Therefore in this assessment we use the estimations of Baltussen
et al. (2004) and WHO (2010), which are reported in Table 8. Most of these values are below the
threshold of USD 500-1000 that is commonly used to gauge cost-effectiveness (Stein et al. 2005).
14
Table 5: Main assumptions used in the analysis of AgroSalud crops
NE-Brazil Honduras Nicaragua Mexico Haiti
Iron-rich
rice
Iron-rich
beans
Zinc-rich
rice
Zinc-rich
beans
Zinc-rich
maize
Zinc-rich
rice
Zinc-rich
beans
Zinc-rich
maize
bC-rich
maize
bC-rich
cassava
Total population [m] 48 7 5 106 10
Current intake of crop by
children [g/d, different ages] 204 67 131 56 120 131 45 120 27 30
Current intake of micro-
nutrient by children [µg/d] ] 11,524 5,131 4,044 265 91-152
Recommended intake
for children [µg/d] 14,000 10,000 500 500
Baseline micronutrient
content in crop [µg/g] 2.5 55 17.5 28 22 17.5 28 22 1.5 0.5
Micronutrient content
with biofortification [µg/g] 4-6 95-110 20-22 48-50 31-40 20-22 48-50 31-40 8-15 15
Post-harvest loss
of micronutrient [%] 0% 0-10% 0% 0-10% 0-10% 0% 0-10% 0-10% 50% 33-67%
Bioavailability /
bioconversion 100% 90-100% 100% 100% 100% 100% 100% 100% 17-25% 17-25%
Adoption / consumption
share of biofortified crops 75-90% 55-60% 70-80% 50% 2-20% 75-85% 55-60% 7-30% 2-20% 15-25%
Release of seeds to farmers
(year) 2016-21 2016 2016-21 2016 2015-20 2016-21 2016 2015-20 2014-18 2015-20
Full coverage reached
(year) 2022-30 2025-30 2022-30 2025-30 2018-29 2022-30 2025-30 2018-29 2019-29 2021-29
Phase II annual costs (incl.
in-country costs, '000 USD) 290-350 275-330 160-195 155-185 250-300 225-270 220-260 310-370 250-300 100-120
National costs for logistics
and distribution ('000 USD) 75-90 50-60
National annual costs for
maintenance ('000 USD) 8.3-10 5.5-6.6
15
Table 6: Overview of the impact and cost-effectiveness of selected AgroSalud crops
High impact scenario Low impact scenario
DALYs saved
('000)
DALYs saved
per 1m capita
Cost per
DALY (USD)
Cost per capita
(cents)
DALYs saved
('000)
DALYs saved
per 1m capita
Cost per
DALY (USD)
Cost per capita
(cents)
NE-Brazil Fe-rich rice 75 1,567 2.3 0.1 39 826 10 0.1
Fe-rich beans 98 2,062 1.9 0.1 92 1,931
3.0 0.1
Honduras Zn-rich rice 2.9 409 35 0.4 1.5 208
165 0.5
Zn-rich beans 2.5 340 46 0.4 2.0 283 81 0.4
Zn-rich maize 2.6 366 32 0.4 0.3 35
853 0.5
Nicaragua Zn-rich rice 1.8 337 73 0.6 0.9 173
337 0.8
Zn-rich beans 1.3 233 116 0.6 1.0 178
225 0.7
Zn-rich maize 2.0 372 55 0.6 0.5 85
604 0.8
Mexico bC-rich maize 6.7 64 18 0.0 0.2 2
1,408 0.1
Haiti * bC-rich cassava 7.0 714 9.8 0.2 1.7 175 87 0.2
Note: * The analysis for Haiti was based largely on a number of assumptions and extrapolations from data from other countries, i.e. these results have to be interpreted cautiously.
Table 7: Overview of the combined impact and cost-effectiveness of the AgroSalud crops
High impact scenario Low impact scenario
DALYs saved
('000)
DALYs saved
per 1m capita
Cost per
DALY (USD)
Cost per capita
(cents)
DALYs saved
('000)
DALYs saved
per 1m capita
Cost per
DALY (USD)
Cost per capita
(cents)
NE-Brazil Fe-rich
rice & beans 99 2,067 3.7 0.2 99 2,067
7.0 0.2
Honduras Zn-rich rice, beans
& maize 15 2,029 21 1.1 15 2,029 43 1.3
Nicaragua Zn-rich rice, beans
& maize 9.0 1,664 44 1.9 9.0 1,664 90 2.3
Mexico bC-rich maize 6.7 64 18 0.0 0.2 2
1,408 0.1
Haiti bC-rich cassava 7.0 714 9.8 0.2 1.7 175 87 0.2
All all 136 774 9.7 0.2 124 706 21 0.2
16
Table 8: Impact and cost-effectiveness of other micronutrient interventions in Latin America
95% coverage rate 50% coverage rate
DALYs saved
('000)
DALYs saved
per 1m capita
Cost per
DALY (I$)
Cost per capita
(cents)
DALYs saved
('000)
DALYs saved
per 1m capita
Cost per
DALY (I$)
Cost per capita
(cents)
AMR B Fe fortification * 139 n/a 134 n/a 73 n/a 214 n/a
Fe supple-
mentation * 247 n/a (669) n/a 130 n/a (487) n/a
Zn fortification n/a 824 18 1 n/a 433 27 1
Zn supple-
mentation n/a 1,100 (70) 8 n/a 579 (79) 5
Zn fortification &
supplementation n/a 1,056 (130) 14 n/a 556 (135) 8
VA fortification n/a 824 34 3 n/a 433 43 2
VA supple-
mentation n/a 1,392 (287) 40 n/a 733 (90) 7
AMR D Zn fortification n/a 1,210 24 3 n/a 637 28 2
Zn supple-
mentation n/a 2,524 (41) 10 n/a 1,328 (43) 6
Zn fortification &
supplementation n/a 2,089 (86) 18 n/a 1,099 (72) 8
VA fortification n/a 351 155 5 n/a 185 169 3
VA supple-
mentation n/a 737 (675) 50 n/a 388 (209) 8
Notes: Results are reported for the year 2000 and in international dollars (I$); if converted I$ 1 = USD 1, also see http://www.who.int/choice/costs/ppp/en/. Results in brackets indi-
cate that another intervention in the same column for the same micronutrient in the same region is more cost-effective – this is consistently the case for fortification,
which thus dominates supplementation.
AMR D = South American subregion with high rates of adult and child mortality (Bolivia, Ecuador, Guatemala, Haiti, Nicaragua and Peru),
AMR B = South American subregion with low adult and child mortality (rest of Latin America except Cuba, which belongs to AMR A); also see
http://www.who.int/choice/demography/american_region/en/. Sources: * Baltussen et al. (2004, for AMR B only), all other results from WHO (2010).
17
Figure 1: Cost-effectiveness of AgroSalud crops and alternative micronutrient interventions
0
20
40
60
80
100
120
140
160
180
200
220
240
FeBeanBrazOpti
FeRiceBrazOpti
FeRiceBrazPess
FeBeanBrazPess
FeFortification95
FeFortification50
FeSupplem50
FeSupplem95
ZnFortification95
ZnFortification50
ZnMaizHondOpti
ZnRiceHondOpti
ZnSupplem95
ZnBeanHondOpti
ZnMaizNicarOpti
ZnRiceNicarOpti
ZnSupplem50
ZnBeanHondPess
ZnBeanNicarOpti
ZnRiceHondPess
ZnBeanNicarPess
ZnRiceNicarPess
ZnMaizNicarPess
ZnMaizHondPess
bCCassHaitiOpti
bCMaizMexOpti
VAfortification95
bCCassHaitiPe ss
VAsupplem95
VAfortification50
VAsupplem50
bCMaizMexPess
USD/DALY
853
669
487
60
337
1,408
67
Iron interventions Zinc interventions VA interventions
Notes: Values indicate USD/DALY saved. Green columns represent the cost-effectiveness of biofortified crops in the high impact scenarios, red columns represent the
low impact scenarios and light/grey columns represent the cost-effectiveness of alternative micronutrient interventions in Latin America to provide appropriate micro-
nutrient-specific benchmarks. Source: Table 6 and Table 8.
18
However, there are large differences in the cost-effectiveness of the various biofortified crops,
which can cost as little as 2 USD/DALY for iron-rich beans in NE-Brazil under more optimistic as-
sumptions or as much as 1,400 USD/DALY for beta-carotene-rich maize in Mexico under pessimis-
tic assumptions (Figure 1). For these differences various reasons may be responsible. These are
discussed in the following and where appropriate examined by means of sensitivity analyses.
The consumption of the targeted crops (rice and beans) in NE-Brazil appears to be relatively high.
Although these figures were estimated by AgroSalud based on the last World Bank's Living Stan-
dards Measurement Study for Brazil, a sensitivity analysis was done to determine the potential im-
pact of lower consumption levels of these crops. The results indicate that also with a lower con-
sumption of the target crops the initial results would hardly change (Table 9).
Table 9: Sensitivity analysis for the crop consumption levels in NE-Brazil
High impact scenario Low impact scenario
DALYs
saved
('000)
DALYs
saved per
1m capita
Cost per
DALY
(USD)
DALYs
saved
('000)
DALYs
saved per
1m capita
Cost per
DALY
(USD)
Fe-rice 75 1,567 2.3 39 826 10
Fe-rice
(rice consumption -25%) 64 1,335 2.7 33 685 12
Fe-beans 98 2,062
1.9 92 1,931 3.0
Fe-beans
(bean consumption -25%) 96 2,002 1.9 87 1.825 3.2
Another factor for the high cost-effectiveness of iron-rich crops in NE-Brazil could be that iron defi-
ciency is a rather important public health problem in NE-Brazil (with over 2,000 DALYs lost per 1
million inhabitants), whereas, e.g., vitamin A deficiency in Mexico is less of a problem (with less
than 800 DALYs lost per 1 million inhabitants). In absolute terms the number of DALYs lost in
Mexico is nevertheless big compared to other target countries, simply because Mexico is a very
populous country (Table 4). This also explains why under optimistic assumptions beta-carotene-rich
maize in Mexico can still be very cost-effective. Therefore, the poor cost-effectiveness of the beta-
carotene-rich maize in Mexico under pessimistic assumptions – as well as the poor cost-effective-
ness of the zinc-rich maize in Honduras and Nicaragua – can rather be explained by the very low
adoption rates assumed for a low impact scenario, which result in very low consumption shares of
the biofortified maize (Table 5). In the case of Honduras and Nicaragua, another reason is that they
are rather small countries where the burden of micronutrient deficiencies in absolute terms is nec-
essarily small, even if the respective micronutrient deficiency affects a rather big proportion of the
population (Table 4). Hence, the impact in terms of the number of DALYs that can be saved can
19
only be comparatively modest. Then, if the costs for the development of the biofortified crops are
attributed equally on the beneficiary countries, a relatively small benefit in terms of DALYs saved
needs to compensate relatively important costs – i.e. cost-effectiveness is low because the econo-
mies of scale of biofortification cannot fully unfold.
To determine the potential influence of the attribution of the AgroSalud budget on the individual
crop-country combinations, the analysis was re-run with the AgroSalud budget being attributed to
each crop-country combination based on the population size of the target country instead of attrib-
uting the budget equally across all micronutrient-crop combinations in all target countries, using this
as a proxy of the number of potential beneficiaries of the respective biofortified crops (Table 10). As
could be expected, the cost-effectiveness of the biofortified crops in the bigger countries (NE-Brazil
and Mexico) decreases somewhat, while targeting crops at the smaller countries becomes slightly
more efficient (compared to the results of Table 6). However, the only country where the attribution
changes the results more noticeably is Mexico – which also was to be expected, as Mexico was
attributed a bigger share of the costs although the share of its population suffering from vitamin A
deficiency is relatively small (Table 4). This little sensitivity to the attribution of the central Agro-
Salud budget may be due to the importance of the in-country costs (for adaptive breeding, registra-
tion, dissemination, marketing, maintenance, etc.), which means that – where and in as far as pos-
sible – also in these fields synergies should be exploited across borders.
Table 10: Results with a population-based attribution of the AgroSalud budget
High impact scenario Low impact scenario
Cost per DALY (USD) Cost per DALY (USD)
equal shares population-based equal shares population-based
NE-Brazil Fe-rich rice 2.3 3.1 10 14
Fe-rich beans 1.9 2.6 3.0 4.2
Honduras Zn-rich rice 35 31 165 147
Zn-rich beans 46 41 81 72
Zn-rich maize 32 29 853 759
Nicaragua Zn-rich rice 73 65 337 300
Zn-rich beans 116 103 225 198
Zn-rich maize 55 49 604 538
Mexico bC-rich maize 18 39 1,408 2,792
Haiti bC-rich cass. 9.8 8.9 87 79
Indeed, one of the main rationales for biofortification is the potential to realise economies of scale
across countries. Therefore, analysing a biofortification programme at a disaggregated level, like
above, may have its shortcomings, especially if a "fair" attribution of the overall programme costs to
20
the individual countries or sub-regions is difficult. To address this issue, also more aggregated
analyses were carried out, looking at the overall impact and cost-effectiveness of the selected bio-
fortified crops in all chosen target countries. This approach yielded the above-mentioned result of
10-20 USD/DALY saved – under optimistic and pessimistic assumptions, respectively (Table 7).
This result indicates that at the larger scale outliers of individual case studies are counterbalanced,
thus showing that also in Latin America biofortification as such could be a viable micronutrient in-
tervention. Moreover, while fortification and supplementation can become more expensive on a per-
capita basis when the programmes are expanded and can reach costs of up to 50 cents per capita
for a common intervention like vitamin A supplementation (Table 8), the costs per capita for
biofortification do not exceed 1 cent per capita and remain stable across different scenarios (Table
7).This also shows that the funds necessary to implement biofortification are relatively minor and
within the possibilities of the target countries.
Another issue related to the attribution of the central AgroSalud budget is the comprehensiveness
of the costs considered in the initial analysis. The information on the costs that need to be incurred
for the biofortified crops to have an impact were elicited from AgroSalud staff. However, this infor-
mation was almost exclusively based on the AgroSalud budgets (for 2004-2009 and the one
planned for 2011-2015). In the interviews with the breeders and other staff at CIAT, the cost data
was complemented as good as possible with estimates for the in-country costs (without which no
impact will be achieved as the in-country activities will be crucial to that the biofortified crops are
adopted widely and speedily). However, it could still be that these future costs are underestimated,
although, given discounting, the impact on the cost-effectiveness results may be small. Similarly,
HarvestPlus has given funds to CIAT, CIMMYT and Embrapa to work on biofortification – and part
of this work also benefits the biofortification efforts of AgroSalud. To assess the impact of more
comprehensive costing of the AgroSalud crops, the cost-effectiveness analysis was repeated with
cost estimates that included attributed shares of the HarvestPlus monies. For instance, while for
rice and cassava virtually no additional costs were attributed to Latin America for the period 2004-
10, for beans USD 700,000 were attributed and for maize even USD 2.25 million; minor costs were
also attributed for coordination work and for Brazil-specific work by Embrapa. The results show that
this consideration of more comprehensive work on biofortification does not affect the overall cost-
effectiveness of the individual crops (Table 11). Only in the case of biofortified maize the cost-effec-
tiveness changes to a greater extent – given that the attributed costs are somewhat greater while
the assumed coverage, and thus the impact, is relatively small.
21
Table 11: Results with the attribution of HarvestPlus monies
High impact scenario Low impact scenario
Cost per DALY (USD) Cost per DALY (USD)
initial results extended costs initial results extended costs
NE-Brazil Fe-rich rice 2.3 2.4 10 11
Fe-rich beans 1.9 2.1 3.0 3.3
Honduras Zn-rich rice 35 36 165 167
Zn-rich beans 46 52 81 90
Zn-rich maize 32 44 853 1,109
Nicaragua Zn-rich rice 73 74 337 340
Zn-rich beans 116 127 225 243
Zn-rich maize 55 70 604 745
Mexico bC-rich maize 18 22 1,408 1,662
Haiti bC-rich cass. 9.8 11 87 95
Part of the differences in the cost-effectiveness of the various biofortified crops may also be due to
the very different final adoption shares estimated by the breeders (Table 5). To assess the sensiti-
vity of the results to changes in the assumed coverage of the micronutrient-rich crops, the initial
calculations were re-run using the same coverage rates for all crops (50 percent in the high impact
scenario and 20 percent in the low impact scenario) while keeping all other parameters unchanged
(Table 12). As could be expected, the results for biofortified rice (for which before very high cover-
age rates were assumed) become less advantageous, in particular in the low impact scenario. On
the other hand the maize results improve considerably – again most pronounced in the low impact
scenario. (In the case of beta-carotene-rich maize in Mexico, the result for the low impact scenario
even improves by one order of magnitude!) While it is justified to assume better acceptance of min-
eral-rich crops as they are not expected to be noticeably different from familiar varieties (unlike
beta-carotene-rich crops, which take on a darker hue), this sensitivity analysis clearly shows the
importance of the coverage rate of biofortified crops on the final outcome: Being too pessimistic in
projecting the possible coverage rate will unduly worsen any assessment of biofortified crops, but
being too optimistic will similarly bias the results and produce a partial assessment.
To elaborate on the finding of the importance of the coverage rate of the biofortified crops an addi-
tional analysis was carried out for the micronutrient-rich maize in the low impact scenario (the crop
and scenario with the lowest assumed coverage rates in the initial analysis). As far as insufficient
uptake of the biofortified crops is not due to inherent shortcomings in the germplasm that prevents
farmers from adopting the crops, but rather due to less intense extension and marketing activities,
greater investments in the dissemination of the crops are likely to be compensated by the bigger
impact that can be achieved with greater coverage rates. Being conservative, it was assumed that
22
a 10-fold increase in the costs for logistics and distribution only leads to a 5-fold increase in the
coverage of the biofortified maize. Yet, as Table 13 shows, even with these cautious assumptions
the additional investment into the dissemination of the crops pays off and increases impact and
cost-effectiveness considerably.
Table 12: Results with the same consumption shares for all crops
High impact scenario with
50 percent consumption share
Low impact scenario with
20 percent consumption share
DALYs
saved
('000)
DALYs
saved per
1m capita
Cost per
DALY
(USD)
DALYs
saved
('000)
DALYs
saved per
1m capita
Cost per
DALY
(USD)
NE-Brazil Fe-rich rice 59 1,242 2.9 20 428 20
Fe-rich beans 98 2,062 1.9 70 1,459 3.9
Honduras Zn-rich rice 1.9 264 54 0.4 61
555
Zn-rich beans 2.5 340 45 0.8 118 193
Zn-rich maize 5.9 821 14 2.4 332 90
Nicaragua Zn-rich rice 1.3 245 100 0.3 60
971
Zn-rich beans 1.3 233 115 0.5 84
474
Zn-rich maize 3.7 672 30 1.6 286 178
Mexico bC-rich maize 16 148 7.6 2.2 21
142
Haiti bC-rich cass. 11 1,091 6.3 2.3 229 65
Note: Consumption shares in NE-Brazil and Nicaragua are increased by 10 and 5 percent in the high and low impact
scenarios, respectively, to take account of measures that are planned to market products made from biofortified crops.
Table 13: Sensitivity analysis for the dissemination costs of biofortified maize
Low impact scenario Low impact scenario
with cost & coverage increases *
DALYs
saved
('000)
DALYs
saved per
1m capita
Cost per
DALY
(USD)
DALYs
saved
('000)
DALYs
saved per
1m capita
Cost per
DALY
(USD)
Honduras Zn-rich maize 0.3 35
844 1.2 171 232
Nicaragua Zn-rich maize 0.5 85 599 2.1 388 165
Mexico bC-rich maize 0.2 2 1,399 1.1 11
344
Within the AgroSalud programme there are micronutrient deficiencies within one country that are
targeted by several crops at the same time. This is not only the case for three zinc-rich crops, simi-
lar overlaps also exist for the iron-rich and the beta-carotene-rich crops (Table 1). In these cases
the economic rationale for parallel biofortification of different crops with the same micronutrient for
the same target countries could be questioned: As an exemplary analysis of all possible combina-
tions of zinc-rich crops targeted at Nicaragua shows, any combination of two of the three crops vir-
23
tually yields the same result as the biofortification of all three crops – but at lower costs (Table 14).
While there may be good reasons to target different crops to reach different population groups, it
may be worth considering to drop one crop and to used the freed funds to promote the dissemina-
tion of the remaining crops to obtain higher consumption levels of these. Similarly, in NE-Brazil iron
biofortification of beans has effectively the same impact as iron biofortification of both beans and
rice (Table 6, Table 7), i.e. in this case it could be more efficient to focus the biofortification efforts
on beans only.
Table 14: Overview of the impact and cost-effectiveness of zinc-rich crops in Nicaragua
High impact scenario Low impact scenario
DALYs
saved
('000)
DALYs
saved per
1m capita
Cost per
DALY
(USD)
DALYs
saved
('000)
DALYs
saved per
1m capita
Cost per
DALY
(USD)
Zn-rich rice 1.8 337 73 0.9 173 334
Zn-rich beans 1.3 233 115 1.0 178 223
Zn-rich maize 2.0 372 54 0.5 85
599
Zn-rich
rice & maize 8.9 1,640 30 8.6 1,590 64
Zn-rich
rice & beans 8.8 1,626 30 8.7 1,602 61
Zn-rich
maize & beans 8.9 1,629 30 8.7 1,590 62
All 9.0 1,664 44 9.0 1,664 89
Another issue that could have an impact on the result of the present analysis are the micronutrient
programmes existing in several Latin American countries (MI 2010, MOST 2005, Mora and Bonilla
2002, Mora et al. 2000). Because of these interventions the burden of the respective micronutrient
deficiencies – and thus the additional impact of biofortified crops – is likely to be smaller than in
settings where micronutrient deficiencies are not controlled. Yet even in these countries it could
make sense to introduce biofortified crops: while the crops may not save many additional DALYs,
they could help scale down more costly current micronutrient programmes, thus freeing scarce re-
sources in the public health sector. For instance, in Mexico various food items are currently fortified
with vitamin A (MOST 2005), which could help explain why vitamin A deficiency is a relatively small
problem in Mexico (Table 4). Yet, vitamin A fortification costs 34-43 USD/DALY saved (Table 8),
whereas even in the presence of such fortification, beta-carotene-rich maize may cost as little as 18
USD/DALY saved (Table 7). In this case, i.e. if wide-spread consumer acceptance of yellow maize
can be achieved, the more costly vitamin A fortification could be scaled back and be replaced by
the beta-carotene-rich maize – which then could save more DALYs without increasing costs (i.e.
24
the cost per DALY saved through the beta-carotene-rich maize would fall, the more vitamin A fortifi-
cation is scaled back). On the other hand, where existing micronutrient programmes are not fully
effective in controlling micronutrient deficiencies, biofortified crops could complement these meas-
ures and help reduce the burden of micronutrient deficiencies further. For instance, even with a
comprehensive vitamin A supplementation programme, in Haiti the prevalence rate of vitamin A de-
ficiency in pre-school children is still at 32 percent (MI 2010). Here biofortified crops could possibly
help reach those population groups that so far have not been covered effectively – and do so at
relatively lower costs than vitamin A supplementation (Figure 1, right panel). Also, once biofortified
crops are introduced, the vulnerability of the population to external or internal shocks (whether
natural disasters or political turmoil) is reduced as people do not rely on the more susceptible distri-
bution of supplements or the processing of food to improve their micronutrient intake.
5.2 Individual assessment by micronutrient-crop combination
As Figure 1 clearly shows, both iron-rich rice and iron-rich beans are vastly more cost-effective than
the alternative interventions. Moreover, as Table 7 shows and as has been discussed in the previ-
ous section, iron-rich beans on its own has virtually the same impact as iron-rich rice and iron-rich
beans together while obviously being cheaper. Hence – given all shortcomings of a quantitative
analysis based on aggregated and partly only estimated data and that moreover not even covers
half of all micronutrient-crop-country combinations of the underlying programme – the most prom-
ising and economic crop to develop further are iron-rich beans. To what extent it is worthwhile to
continue work on iron-rich rice, given that this is the only crop targeted at Bolivia, cannot be an-
swered based on the current analysis.
On the other hand, all the zinc-rich crops are consistently less cost-effective than the estimated
cost-effectiveness of zinc fortification and mostly also of zinc supplementation (Figure 1). However,
with a combined introduction of all three crops in parallel, their cost-effectiveness improves some-
what (Table 7). And as the exemplary analysis for Nicaragua has shown, introducing a combination
of two zinc-rich crops in parallel improves the cost-effectiveness even further (Table 14), in particu-
lar if a higher coverage rate of the zinc-rich maize can be achieved (Table 12). Yet, it seems zinc-
rich crops will at best be at the same level of cost-effectiveness as industrial zinc fortification, i.e.
their further funding would require convincing qualitative arguments in their favour – or the zinc
biofortification efforts need to reach larger populations beyond those of small Central American
countries and Caribbean islands (Table 1).
Beta-carotene-rich maize is only targeted at Mexico and Haiti (Table 3). While for an analysis of the
latter not enough data was available, the results for Mexico do not send a clear message – be-
25
cause of the very wide range of possible outcomes. If a sufficient coverage rate of the maize can be
achieved, which may be difficult given its colour, beta-carotene-rich maize in Mexico can be more
cost-effective than alternative interventions (Figure 1, Table 12). In addition, as discussed in the
previous section, it may represent a useful and economic intervention if its introduction allows scal-
ing back more costly current measures. However, the uncertainty over its acceptance and the ex-
tremely poor cost-effectiveness in the low impact scenario make it a risky investment. (However, as
Table 8 shows, also the cost-effectiveness of alternative vitamin A interventions varies considera-
bly.) To reduce this uncertainty, it may be recommendable to carry out studies on the potential ac-
ceptance of this maize or to develop concrete measures that ensure its ultimate acceptance.
Finally, beta-carotene-rich cassava is only targeted at Haiti (with most of the cassava-related bio-
fortification being done for Africa). Despite the lack of data for a sound analysis, an analysis has
nevertheless been carried out based on various assumptions and extrapolations to obtain an idea
of the possible orders of magnitude of the impact and cost-effectiveness of this crop. While the
cost-effectiveness-range of the best alternative intervention is 155-169 USD/DALY for vitamin A
fortification in high mortality Latin American countries (Table 8), the range for biofortified cassava in
Haiti is 10-87 USD/DALY (Table 6). Moreover, as discussed in the previous section, introducing
biofortified crops in Haiti could help reduce the population's vulnerability to shocks affecting the
provision of alternative interventions. Yet, given the uncertain data base, also regarding the costs of
establishing and disseminating new crop varieties in Haiti, a decision on the further development of
beta-carotene-rich cassava for Latin America would benefit from more detailed in-country expertise
confirming the scope of vitamin A deficiency and the feasibility of introducing biofortified cassava on
a larger scale (even if in other respects it can perhaps "free-ride" on the work that is being done for
Africa anyway).
In terms of targeting individual countries, it has become clear that for the biofortified crops to be-
come cost-effective, they have to be consumed by a great number of potential beneficiaries, i.e.
they need to be targeted also at populous countries where the respective micronutrient deficiency is
a public health problem (like NE-Brazil). However, once the crops are developed for such a big
country, smaller countries can "free-ride" on this development – this spreading of the benefits lies at
the very heart of the economic rationale for carrying out biofortification. And while bigger and richer
countries may be more likely to have the infrastructure and the means to disseminate the bioforti-
fied crops themselves, smaller and poorer countries may need more external support for dissemi-
nation activities to reach the coverage rates needed. (For instance, for differences in per-capita in-
comes of the countries analysed, please see Table 4). On the other hand, targeting biofortification
26
efforts only at small countries may indeed result in not enough beneficiaries being reached for
making the undertaking much more cost-effective than alternative interventions.
6 Conclusions
In this report the burden of micronutrient malnutrition in various Latin American countries has been
quantified and the potential impact of biofortified crops that are currently being developed in the
framework of the AgroSalud programme, which is coordinated at the Centro Internacional de Agri-
cultura Tropical (CIAT), has been shown: In case of successful biofortification efforts and if a high
degree of consumption can be achieved, the ex ante calculations indicate that biofortification can
eliminate wide-spread mineral deficiencies and considerably reduce the burden of vitamin A defi-
ciency. While there are some outliers, the analysis has shown that on average also in Latin Amer-
ica biofortification promises to be a cost-effective micronutrient intervention – in many cases even
more cost-effective than other analyses project industrial fortification to be.
The analysis has also shown that biofortification is more cost-effective if it is done in the framework
of a bigger programme at the international level, covering several countries and thus realising
economies of scale; focusing efforts on smaller countries or countries with only a small malnour-
ished sub-population yields less clear-cut results. Results can also be optimised by avoiding paral-
lel biofortification of too many crops with the same micronutrient for the same target countries.
However, the single most important factor to improve impact and cost-effectiveness is increasing
the coverage of the biofortified crops, which justifies higher investments in agricultural extension
and social marketing of the crops, where necessary. (The underlying rationale is that the health
gains arising from higher consumption rates of biofortified crops more than compensate the costs
that need to be incurred to achieve these rates.)
In countries where other micronutrient programmes already exist the results for the impact and
cost-effectiveness of biofortification can be biased. Judging from the overall results for biofortifica-
tion, the introduction of micronutrient-rich crops also in these countries could be sensible if it sub-
sequently helps to scale back more costly micronutrient interventions that are currently in place –
and thus frees scarce resources in the public health sector. Similarly, the introduction of biofortified
crops, if successful, could decrease the population's vulnerability to shocks affecting alternative in-
terventions.
Of the individual crops evaluated in this report, those targeting iron deficiency are the most cost-
effective ones. The crops targeting vitamin A deficiency also have some potential, however, uncer-
tainties about their acceptance or the underlying data base of the analysis do not allow an unequi-
27
vocal statement. Finally, while not necessarily being expensive, either, the crops aimed at control-
ling zinc deficiency are at best as cost-effective as industrial zinc fortification is projected to be.
Hence, a more careful and qualitative analysis on a case-by-case basis may be required to decide
which of the alternative interventions is preferable – or to determine to what extent they comple-
ment each other.
Overall, various sensitivity analyses that probed the impact of changes to key parameters showed
that the results are very robust; only changes in the coverage rates of the crops have the potential
to influence the outcomes considerably. This corresponds to the underlying economic rationale of
biofortification, which is the exploitation of economies of scale. In this context the main limitation for
AgroSalud is the relative smallness of its target countries (e.g. compared to much more populous
countries in Asia for which previous analyses of biofortification were carried out). Where possible,
more international coordination of basic biofortification efforts, beyond Latin America, could address
this more structural problem. Otherwise the use of potential synergies in the execution of the in-
country activities, with concomitant cost reductions at the national levels, could help improve the
economics of the AgroSalud crops.
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The potential of biofortification
of rice, beans, cassava and maize
throughout Latin America
International Food Policy Research Institute, Washington, DC
Contract No. 2010X012STE
April 2010
Alexander J. Stein
AgroSalud is a project coordinated at the Centro Internacional de Agricultura Tropical and
aims to increase nutrition security in Latin America through biofortification – i.e. through
plant breeding with the objective of increasing the micronutrient content in staple crops.
Thus AgroSalud should help prevent the negative economic and health consequences of
micronutrient malnutrition. The objective of the present study was to evaluate the cost-
effectiveness of current AgroSalud crops to inform funding priorities for biofortification.
For this ex ante evaluation the commonly used methodological framework of "disability-
adjusted life years" (DALYs) was used. The data for the analysis was mostly taken from
previous work of AgroSalud and from personal interviews with the experts involved in the
project. For nine case studies enough data could be compiled to carry out an assessment.
The analysis determined the burden of micronutrient deficiencies in various countries in
the region and showed that in case of successful biofortification efforts and if a high degree
of consumption of the crops can be achieved, biofortification can eliminate wide-spread
mineral deficiencies and considerably reduce the burden of vitamin A deficiency. Further-
more the analysis has shown that on average also in Latin America biofortification promi-
ses to be a cost-effective micronutrient intervention – and in many cases even more cost-
effective than alternative or complementary interventions. The single most important factor
for success is the coverage rate of the biofortified crops. Thus given the smaller number of
potential beneficiaries, results for crops targeted at smaller countries only are less clear.
... Over the last 15 years, several studies have used DALYs in cost-effectiveness analyses to quantify the effect of crop biofortification in different countries (e.g., De Steur et al. 2017;Lividini and Fiedler 2015;Meenakshi et al. 2010;Sayre 2011;Qaim et al. 2007;Stein 2010a;Stein 2010b). Most of these studies evaluated biofortification with single micronutrients in specific crops; a few evaluated several micronutrients in the same crop. ...
... However, as Figure 1 also shows, biofortification is not highly cost-effective under all possible assumptions. If plant breeders biofortify crops that are not widely eaten in a certain context or that contain too low amounts of bioavailable micronutrients to effectively address widespread deficiencies, the cost per DALY saved can also be above common thresholds for cost-effectiveness (Asare-Marfo et al. 2013;Funes et al. 2015;Stein 2010b). Hence, proper project plan-ning and implementation are important, which is true for biofortification as for any other micronutrient intervention. ...
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Council for Agricultural Science and Technology (CAST) - Issue Paper 69 https://www.cast-science.org/wp-content/uploads/2020/10/CAST_IP69_Biofortification-1.pdf
... As mentioned above, Categories 3 and 4 studies utilize the distribution of key HCES variables as opposed to point estimates. Stein (2010) discussed this issue and compared estimates of the cost-effectiveness of iron and zinc, rice and wheat biofortification in India using the EAR method with the RDA method presented in Meenakshi et al. (2010). Stein concluded that while the EAR method is more precise and while differences in the estimates may exist, the RDA method-derived estimates still provide reasonable estimates of the feasibility of biofortification. ...
... Second, studies should ideally utilize a data source with distributional data. First noted by Stein (2010), utilizing distributions results in more precise estimates and allows for estimating the prevalence of inadequate intake. Without distributional data, assumptions must be made about coefficients of variation in intake to calculate prevalence (Arsenault et al., 2015). ...
... For Malawi, we estimate that zinc deficiency (ZnD) leads to an annual loss of 6,500 ''disability-adjusted life years'' (DALYs), i.e. person-years lost to disability and shortened life, per million population (.99,900 DALYs in total), and .3,800 instances of child mortality per year using established methodologies 24,25 . This is higher than the 2,750, 2,020 and 1,660 DALYs estimated to be lost due to ZnD per million population in India, Honduras and Nicaragua, respectively 24 . ...
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Selenium (Se) is an essential human micronutrient with critical roles in immune functioning and antioxidant defence. Estimates of dietary Se intakes and status are scarce for Africa although crop surveys indicate deficiency is probably widespread in Malawi. Here we show that Se deficiency is likely endemic in Malawi based on the Se status of adults consuming food from contrasting soil types. These data are consistent with food balance sheets and composition tables revealing that >80% of the Malawi population is at risk of dietary Se inadequacy. Risk of dietary Se inadequacy is >60% in seven other countries in Southern Africa, and 22% across Africa as a whole. Given that most Malawi soils cannot supply sufficient Se to crops for adequate human nutrition, the cost and benefits of interventions to alleviate Se deficiency should be determined; for example, Se-enriched nitrogen fertilisers could be adopted as in Finland.
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While less apparent than outright hunger or obesity, the lack of essential vitamins and minerals in people’s diets is one of the leading contributors to the global burden of disease. Current interventions, such as supplementation or fortification, are being implemented with varying success, but—while important—overall progress in the fight against micronutrient malnutrition has been limited. Biofortification, the breeding of crops for higher contents of vitamins and minerals, is a new approach to complement existing interventions. This chapter gives an overview of the problem of micronutrient malnutrition and how it is measured; it briefly discusses current micronutrient interventions, and then presents the reasoning behind biofortification before it examines the feasibility of biofortifying crops and summarizes studies on their potential impact and economic justification. After listing current biofortification programs, the chapter looks into the political controversy surrounding genetic engineering in agriculture and how it relates to biofortification; it then concludes with an assessment of the current status of biofortification and its potential. Keywords: hunger, malnutrition, vitamin A deficiency, iron deficiency, zinc deficiency, public health, biofortification, plant breeding, genetically modified organisms, disability-adjusted life years
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  Cassava is a drought-tolerant, staple food crop grown in tropical and subtropical areas where many people are afflicted with undernutrition, making it a potentially valuable food source for developing countries. Cassava roots are a good source of energy while the leaves provide protein, vitamins, and minerals. However, cassava roots and leaves are deficient in sulfur-containing amino acids (methionine and cysteine) and some nutrients are not optimally distributed within the plant. Cassava also contains antinutrients that can have either positive or adverse effects on health depending upon the amount ingested. Although some of these compounds act as antioxidants and anticarcinogens, they can interfere with nutrient absorption and utilization and may have toxic side effects. Efforts to add nutritional value to cassava (biofortification) by increasing the contents of protein, minerals, starch, and β-carotene are underway. The transfer of a 284 bp synthetic gene coding for a storage protein rich in essential amino acids and the crossbreeding of wild-type cassava varieties with Manihot dichotoma or Manihot oligantha have shown promising results regarding cassava protein content. Enhancing ADP glucose pyrophosphorylase activity in cassava roots or adding amylase to cassava gruels increases cassava energy density. Moreover, carotenoid-rich yellow and orange cassava may be a foodstuff for delivering provitamin A to vitamin A–depleted populations. Researchers are currently investigating the effects of cassava processing techniques on carotenoid stability and isomerization, as well as the vitamin A value of different varieties of cassava. Biofortified cassava could alleviate some aspects of food insecurity in developing countries if widely adopted.
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Golden Rice has been genetically modified to produce beta-carotene in the endosperm of grain. It could improve the vitamin A status of deficient food consumers, especially women and children in developing countries. This paper analyses potential impacts in a Philippine context. Since the technology is still at the stage of R&D, benefits are simulated with a scenario approach. Health effects are quantified using the methodology of disability-adjusted life years (DALYs). Golden Rice will not completely eliminate the problems of vitamin A deficiency, such as blindness or increased mortality. Therefore, it should be seen as a complement rather than a substitute for alternative micronutrient interventions. Yet the technology could bring about significant benefits. Depending on the underlying assumptions, annual health improvements are worth between US$ 16 and 88 million, and rates of return on R&D investments range between 66% and 133%. Due to the uncertainty related to key parameters, these results should be treated as preliminary.
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