Fortification in a Pandemic

The past year challenged and changed our world—and our work.

COVID-19 exacerbated an already pressing crisis of micronutrient deficiencies. The physical distancing and lockdowns needed to curb the spread of the disease reduced incomes for families, businesses, and governments and disrupted ongoing fortification, health, and social protection programs and supplies of nutritious foods in an inequitable way. It is likely these shocks increased multiple forms of malnutrition, including the hidden hunger of micronutrient deficiency. (1)

A 2020 study estimated that the pandemic would indirectly cause 168,000 additional child-deaths, 2.1 million maternal anemia cases, and US $29.7 billion future productivity losses due to excess stunting and child mortality by 2022 if interventions to reduce the burden of malnutrition did not scale up quickly. (2) In 2020, FFI’s work was more important than ever, and we stepped up to meet the increased need.

Large-scale fortification of staple foods including wheat flour, maize flour, and rice was—and continues to be—critical to counter the frightening rise in micronutrient malnutrition as a result of the COVID-19 pandemic.

Confronting COVID-19’s Challenges

Fortification of staple food at scale relies on international supply chains, and disruptions to global trade in 2020 impacted some countries’ ability to fortify. For example, fortification programs in Africa are almost entirely reliant on imported premix (the vitamins and minerals used in fortification) and fortifiable staples like grains can be imported prior to processing and fortification in-country. In short, the success of fortification programs in many low- and middle-income countries depends on favorable international trade conditions, to which the COVID-19 pandemic poses a significant challenge.

Effective food fortification programs also rely on strong quality control and monitoring systems at country-level, with essential roles to be played by private sector companies, government, and civil society. In many countries, restrictions on movement prevented routine regulatory enforcement and monitoring of fortified foods, constraining civil society initiatives to support fortification programs and hold those responsible accountable, and blocking government efforts to assess and track micronutrient deficiencies in the population. Many fortified food producers will continue to meet national fortification standards, whether enforcement mechanisms are active or not. Nevertheless, reduced enforcement lowers the bar for everyone, making it more difficult for responsible producers to compete with those that do not comply with national fortification standards.

Building the Way to a Healthier Future

But difficult times often inspire innovation and progress, and the past year was filled with FFI and partners’ creative solutions to serious challenges.

In 2020, FFI had two top priorities: to continue to assist countries in the planning, implementation, and monitoring of sustainable fortification programs and also to navigate new hurdles from COVID-19. We were flexible; our organizational structure allowed us to adjust to changing environments and respond quickly. We innovated new ways of providing technical assistance. We hosted meetings and trainings virtually. We conducted monitoring visits and mill readiness assessments with telephones and webcams. And we moved forward with a renewed sense of purpose and importance for the critical work of preventing micronutrient malnutrition.

Just as the pandemic did not end in 2020, the challenges to global nutrition will not end with the pandemic. Yet we remain optimistic that the pandemic will be a catalyst for bold change and a smarter, stronger, and healthier future for all.

(1) Headey, D., et al. Impacts of COVID-19 on childhood malnutrition and nutrition-related mortality. The Lancet. 2020.

(2) Osendarp, S., et al. The potential impacts of the COVID-19 crisis on maternal and child undernutrition in low and middle income countries. Research Square. 2020.