biofortification - copenhagen consensus center · in principle, biofortification is an extremely...

BIOFORTIFICATION

J.V. Meenakshi

BEST PRACTICE PAPER: NEW ADVICE FROM CC08

C O P E N H A G E N C O N S E N S U S C E N T E R C O P E N H A G E N B U S I N E S S S C H O O L • S O L B J E R G P L A D S 3 • 2 0 0 0 F R E D E R I K S B E R G • D E N M A R K

+ 4 5 3 8 1 5 2 2 5 5 • I N F O . C C C @ C B S . D K • W W W . C O P E N H A G E N C O N S E N S U S . C O M

copenhagen consensus center best practice paper: new advice from cc08

BestPracticePaper

Cost‐EffectivenessofBiofortification

J.V.Meenakshi

ThispaperisbasedandbuildsonearlierworkbyHarvestPlusresearchcollaborators(seeMeenakshietal,2007).I

amgratefultoareviewerforhelpfulcommentsonanearlierdraft.Theusualdisclaimerapplies.Coverimagecredit:TheInternationalRiceResearchInstitute,2002.

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PREFACEFortwoyearsbeforeCopenhagenConsensus2008,ateamofexpertswrotepapersidentifyingthebestwaystosolvetheworld’sbiggestproblems.Thosepapersshowedthatwehavetheknowledgetodotremendousamountsofgoodineachoftheseareas.Thatresearchwasutilizedbyapaneloftopeconomists,includingNobellaureates,whowerecommissionedbytheCopenhagenConsensusCentertoidentifythemosteffectiveinvestments.TheprioritizedlistproducedbyCopenhagenConsensus2008providesgovernments,donorsandphilanthropistswithaguidetotheareaswhererelativelysmallamountsofmoneycanproveextremelypowerful.Theresearchthatprovidedthebuildingblockstothisprocess–andafulldescriptionoftheoutcome–formthebook,‘GlobalIssues,GlobalSolutions,VolumeTwo’,publishedbyCambridgeUniversityPressin2009.Thisisanexcellentoverviewofglobalproblemsandthemostpromisingsolutions.GiventhelevelofinterestinCopenhagenConsensus2008,theCopenhagenConsensusCenterdecidedtocommissionaspecificsetofpapersthatdealwiththespendingoptionsgivenhighestprioritybytheexpertpanel.ThegoaloftheseBestPracticePapersistoprovideclearandfocusedempiricalrecommendationsonthecostsandbenefitsofimplementingthesolutions,andadviceonhowtodoso.TheproblemsdealtwithbyCopenhagenConsensus2008arevast.Thepracticalapproachesidentifiedhereproveincrediblypowerfulreading.TheCopenhagenConsensusCenterhopesthattheyshallproveaninvaluableresource,andfurtheradvancethegoalofpromotingthemostsoundinvestmentstohelphumanity.BjornLomborgCopenhagen,2009

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INTRODUCTIONByanystandard,themagnitudeofmicronutrientundernutritionisimmense.Nearly2billionpeoplesufferfromirondeficiency,aquarteroftheworld’spopulationisatriskofinadequatezincintakes,andthemagnitudesforvitaminAdeficiencyaresimilarlyhigh.Unlikethecasewithinsufficientenergyintakes,micronutrientmalnutritionhasoftennoobviousmanifestationsexceptinextremecases,andisforthisreasonoftentermed“hiddenhunger”.Itisonlyappropriate,then,thatofthetoptensolutionsrankedbytheCopenhagenConsensus,fiveareaddressedtoreducingmalnutrition.Itisalsoanacknowledgementthataproblemsowidespreadneedsmorethanjustonesetofsolutionsorinterventionstohaveappreciableimpact(Horton,AldermanandRivera,2008a).Biofortificationisonesuchintervention,rankedfifthbytheConsensus(CopenhagenConsensus,Results,2008),alongwithsupplementation(ranked#1),fortification(ranked#2),dewormingandschoolnutritionprograms(ranked#6)andcommunity‐basednutritionpromotion(ranked#9).Thepremiseofbiofortificationisthatadiversedietrichinmicronutrientsisoutofreachofmanyoftheworld’spoor.Becausefoodsthatarehighinmicronutrientssuchasvegetables,fruits,dairy,andmeatsareexpensive,resource‐poorpeoplerelyprimarilyonafewstarchystaplesthatarerichinenergy,butnotinmicronutrients.Dietarydiversitytoachievemicronutrientintakeadequacyisaluxurythatthepoorcanoftennotafford.Byenhancingthemicronutrientcontentoftheseenergy‐richstaples,micronutrientintakesingeneral,andamongthepoorinparticular,canbeincreased,therebyleadingtoareductionintheprevalenceofmicronutrientundernutrition.TheobjectiveofbiofortificationistodevelopmicronutrientdensestaplecropstoachieveprovitaminsA,ironandzincconcentrationsthatcanhaveameasurableimpactonnutritionalstatus.Forthebiofortificationstrategytobesuccessfulandcost‐effective,threequestionsmustbeanswered:first,plantbreedersmustsucceedinfindinglineswithhighmicronutrientcontentthatcanbebredintolocalvarieties.Second,thenutritionalefficacyofabiofortifiedcropmustbeestablished,andthird,bothfarmersandconsumersmustacceptthenewvarietyandmakeitanimportantpartofwhattheyproduceandconsume,sothatitbecomesacost‐effectiveintervention.Thusfartheanswertothefirstquestionappearstobepositive,inthatitispossibletoincreasethecontentofsomemicronutrients(butnotothers)totheminimumtargetlevelsthathavebeensetbynutritionistsasnecessarytomeasurebiologicalimpact.Forexample,ahigh‐zincriceisbeingdevelopedforreleaseinBangladeshby2012;however,achievingtheirontargetinricemaytakelonger.IthasalsonotbeenpossibletoincreasetheprovitaminsAlevelsofriceusingconventionalbreedingtechniques;goldenriceisatransgeniccrop.Similarly,orangesweetpotatoesrichinprovitaminsAhavebeenreleasedinUganda,butitappearsnotfeasibletoappreciablyincreasethemineralcontentofthisstapleusingconventionalbreedingtechniques.Theevidenceonnutritionalefficacyisalsobuilding—thecasehasbeenmadefororangesweetpotatoes(vanJaarsveldetal,2005)andsimilarresearchisunderwayforother

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crops.AneffectivenessstudyinMozambiquehasdemonstratedthattherewasanappreciableincreaseinserumretinollevelsamongyoungchildrenasaconsequenceofconsumingorangesweetpotatoeveninacommunitysetting(Lowetal,2007).Thispaperattemptstoanswerthethirdquestiononthecosteffectivenessofbiofortification,byreviewingtheevidenceonitscostsandpotentialhealthbenefits.Itisexanteinnature,sincewithfewexceptions,biofortifiedcropsareyettobereleased.Thepaperpresentsatypologyforanalyzingthecost‐effectivenessoftheinterventionandexaminesthesensitivityoftheresultstoalternativeassumptionsoncoverageandimpact.Likefortification,biofortificationisafood‐basedapproach.Itsnicheisthatittargetsruralareas,wherealargepartofcropproductionisconsumedeitheron‐farmorlocally,andrelianceonpurchasedfoodproductsthatareprocessedcentrallyissmall.Forexample,muchofthemaizeflourinruralZambiaismilledinhammermillswithrelativelysmallcapacities.Whilefortificationatthislevelhasbeenshowntobetechnicallyfeasible,itisalsorelativelyexpensive,becauseofthemonitoringcostsinvolved(OmarDary,personalcommunication).Similarly,inruralBangladesh,riceisusuallymilledinsmall‐capacitymobileandtraditionalmills.AsFiedler(2007)notes:“ifalargeproportionofthefooditemisproducedorprocessedbysmallscaleproducers,thefoodislikelytobelessattractiveasafortificationvehicle.Insuchinstances,compliancewiththefortificationstandardsorregulationsislikelytobemorevariable,andmoredifficultandexpensivetoensure.”ItisperhapsforthisreasonthattheMicronutrientInitiativeexpectsthatthecoverageoffortifiedfoodsinruralareasmaynotexceedone‐third.Becausebiofortificationworksatthelevelofeachindividualcropplant,itcanservetoreachruralpopulationsnoteasilyservedbyotherinterventions.Buthowcosteffectiveisthisintervention?Thisreviewexaminesthekeydriversofthecostsofbiofortification,andhowtheyinfluencecosteffectiveness.Thepaperisorganizedasfollows.Section2firstpresentssomesummaryevidenceoncostsperDALYsavedfrombiofortification,andpresentsasimpleframeworkthatisusefulforunderstandinghowcostsandcost‐effectivenessdependonspecificcontexts.Itthenpresentsamoredetailedanalysisforfourcountry‐crop‐nutrientcasescenarios,eachrepresentingatypologythatcategorizestheeasewithwhichabiofortifiedstaplefoodcouldtakerootinthetargetcountry.Threeofthesecasesareforcropsthatareconventionally‐bred;thefourthexaminestheevidencefortransgenicbiofortifiedcrops.InSection3,thepaperconsidersissuesrelatedforconsumeracceptanceofanewcrop,whenthebiofortificationtranslatesintoavisiblechangeinitsappearance.ThisisthecasewithcropsthatarehighinprovitaminsAwhichareorangeincolor,andthusdistinctfromthewhitevarietiesthatareconventionallyconsumed.Section4presentsconclusions.

1 ANALYZINGTHECOST‐EFFECTIVENESSOFBIOFORTIFICATION1

Inprinciple,biofortificationisanextremelyattractiveintervention,sinceaone‐timeinvestmentinbiofortifiedcropvarietiesyieldsabenefitstreamyearafteryear.Therearevirtuallynorecurringcosts,exceptthoseinvolvedinmaintenancebreeding.Theseofcoursevary,andare

1TheunitofcurrencyusedinthispaperistheUSdollar.

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estimatedatabout$100,000peryearinBangladeshand$2millionperyearinIndia.Incomparison,bothfortificationandsupplementationinvolverecurringcosts:incrementalcostsoffortificationareestimatedat$20millionayearinBangladeshalone(Fiedler,2008).Thewell‐acceptedmetric—Disability‐AdjustedLifeYears(DALYs)—formsthebasisfordeterminingimpactandcosteffectiveness.BeforethepublicationoftheLancet(Blacketal.,2008)series,amodificationoftheDALYsframework,adaptedspecificallytoananalysisofmicronutrientmalnutrition,wasdevelopedbyHarvestPlus,andisthebasisofthefigurespresentedinthispaper.Incalculatingcost‐effectiveness,thefocusisonlyonthehealthbenefitsthataccrueasaconsequenceofbiofortification,andnotontheagronomic(yield)benefitsthatmayalsobeembodiedinabiofortifiedstaple.Whilethedetailsofthemethodologyaresetoutin(Steinetal,2005),thekeyassumptionsunderlyingtheassessmentoftheimpactandcost‐effectivenessofbiofortificationinreducingtheDALYburdeninvolvethefollowing(Meenakshietal,2007hasdetails):

• Theincrementalquantityofmicronutrientsinthegrain—asdeterminedbyplantbreeders,andbasedontheminimumtargetlevelssetbynutritionistsasnecessaryforameasurablehealthimpact.Thisisdeterminedbyexaminingthenaturalvariationinthegermplasmandistakenasfixedinthesimulationsthatfollow.

• Thequantityofthestaplefoodcropconsumedbytargetpopulations—thegreatertheconsumptionthegreatertheimpact.Anexamplemaybeillustrative:witha300gramperdayconsumption—notunreasonableforanadultwomaninmanydevelopingcountries—theadditionof4partspermillion(ppm)ofirontothestaplewouldtranslateintoanincreasedintakeof1.2mgperdayofthenutrient.Alowerlevelofconsumption,say100grams,wouldtranslateintoincreasedironintakesofonly0.4mgperday.Unfortunately,reliabledataonthequantityoffoodsconsumeddisaggregatedbygenderandagegroupisrarelyavailable;yetthisinformationiscriticaltoanalysesofpotentialimpact(Fiedleretal,2008).Forthisreason,thesimulationsbelowvarythelevelofconsumptionandexaminehowcost‐effectivenessresultschangeasaconsequence.

• Nutrientlossesinfoodpreparation—thisisaparticularconcernwithprovitaminsAwhichmaydegradequicklywhenexposedtosunlightortocertainformsofprocessing,suchasfermentation.Boilingforexample,translatesintoretentionlevelsofabout80%(Bengtssonetal,2008),butretentionlevelsforotherprocessingmethodscanbemuchlower(Nascimentoetal,2007).ThesimulationsforprovitaminsAexaminethesensitivityofresultstochangesinprocessinglosses.

• Coveragerates—thegreatertheshareofacountry’sfoodsupplythatisbiofortified,thehigherthemagnitudeofimpact.Butthisdependsbothonfarmers’andconsumers’acceptanceofbiofortifiedstaplesandtheavailabilityofinfrastructurefordissemination.Clearly,thisisakeyparameterforimpact,andthecostsimulationstaketheseintoaccount.

• Costs:Thecost‐effectivenessfigureshereincludecostsofresearchanddevelopmentofthenewvarietysincethesearesignificantup‐frontcosts.Theseareapportionedtothepotentialsetoftargetcountriesusingproductionshares.Whilethesecostsincludebreedingformultiplenutrients,thecost‐effectivenessfiguresattributetotalcoststo

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eachindividualnutrient,sincethereisnoobviouswaytoapportioncostsbetweenzincandiron,forexample.Bothnutrientstendtobecorrelatedinmanycrops(PfeifferandMcClafferty,2007),sothatbreedingforhighzincoftentranslatesintohigherironlevelsinthegrainaswell.Alsoincludedarecountry‐specificcostsofadaptivebreeding,maintenancebreeding,anddisseminationandnutritioneducationcampaigns.

• Healthbenefitsandcostsarediscountedat3percentperyear,asisusualinthehealtheconomicsliterature.Thepaperalsoexaminesthesensitivityoftheresultstotheuseofahigherdiscountrateof6%.

• AlthoughthepaperfocusesonDALYs—whichareadirectmeasureofhealthbenefits—tofacilitatecomparisonswithotherinterventionsthroughthecalculationofabenefit‐costratio,DALYsaremonetizedat$1000perDALYsaved.Whilethisfigureissomewhatarbitrarilychosen,thisfigurehasbeensuggestedbyHortonetal(2008b)asbeingappropriateforlowincomecountriesinSouthAsiaandSub‐SaharanAfrica,whicharetheprimarytargetregionsformicronutrientinterventions.

TheseassumptionsarethebasisofcalculationssummarizedinTable1.Becausetheanalysisisexanteinnature,pessimisticandoptimisticscenariosareusedtocapturethesensitivityofresultstochangesinassumptions.Allthebest‐caseassumptionsareusedfortheoptimisticscenario,whilealltheworst‐caseassumptionsconstitutethepessimisticscenario.Itisclearthatnearlyalltheinterventionsareextremelycost‐effectiveeveninthepessimisticscenario,withmostcostsperDALYsavedlowerthanthe$200cut‐offoftenusedtocategorizeinterventionsas“highly”costeffective.Notunexpectedly,impactandcost‐effectivenessestimatesvarynotonlybycropandnutrient,butalsoacrosscountries.Table1.Impactandcost‐effectivenessofbiofortification(rangeofestimates)Micronutrient PercentreductioninDALYburden CostperDALYsavedCrop Pessimistic Optimistic Pessimistic OptimisticZinc: Rice 13‐20 33‐56 6‐55 1‐12Wheat 5‐9 33‐48 11‐18 1‐2Iron: Rice 4‐8 11‐21 17‐234 3‐55Beans 3‐9 16‐36 134‐439 20‐65VitaminA: Cassava 3‐5 19‐32 124‐1000 8‐127Maize 1‐8 17‐32 113‐289 11‐18Source:Meenakshi,J.V.,NancyJohnson,VictorManyong,HugoDeGroote,JoyJavelosa,DavidYanggen,FirdousiNaher,JamesGarcia,CarolinaGonzalesandErikaMeng,“Howcost‐effectiveisbiofortificationincombatingmicronutrientmalnutrition?Anexanteassessment”2007:HarvestPlusWorkingPaper2.

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Figure1.Atypologyforanalyzingcost‐effectivenessofbiofortification

Source:HarvestPlus,http://www.harvestplus.org/endusers.html,“ReachingEndUsers”RetrievedDecember9,2008.

Whatfactorshelpexplainthisvariationincost‐effectiveness?Figure1presentsasimpleframeworkforanalyzinghowcostsmayvary.Clearly,thepotentialcoverageofbiofortifiedvarieties—bothintermsoftheshareofthecropareadevotedtobiofortifiedvarieties,aswellasthepercentageofconsumerswhowouldconsumebiofortifiedstaplefoods—iskey.Thisinturndependsonwhetherthereisawell‐developeddisseminationinfrastructureforthenewcrops(onthehorizontalaxis)andwhetherconsumeracceptanceislikelytoposeahurdle(ontheverticalaxis).QuadrantAdepictsasituationwherethereisgooddisseminationinfrastructureandwherethetraitisinvisible;biofortificationislikelytobehighlycosteffectiveinthisscenario.Incontrast,costsarelikelytobehigherwheredisseminationinfrastructureisnotaswelldeveloped,andwherethetraitisinvisible(QuadrantB)andhigherstillinsituationswheretheinfrastructureisrelativelypoor,andthebiofortifiedtraitisvisible(QuadrantC).Mineral‐densecerealcropsinSouthAsiabestexemplifyQuadrantA.CerealareainSouthAsiatendstodominatedbyafewmegavarieties.ForexampleinBangladesh,thetopfivevarietiesaccountforoverhalfthericeareaintheAmanseasonandnearlytwo‐thirdsofthericecroppedareaintheBoroseason.Maximaladoptionratesforthesuccessfulvarietieswereachievedinaslittleasfiveyearsfromintroduction(JaimandHossain,2007).Byensuringthatthehigh‐zinclinesareback‐crossedintothepopularmegavarieties,andbyalsointroducingthehigh‐zinctraitintonewgenerationofvarietiesthataretobereleased,highcoverageratesmaybefeasiblewithinarelativelyshortperiodoftime.CropsinSub‐SaharanAfricaexemplify

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QuadrantsBandC,sincemostAfricancountrieshaverelativelypoorextensionandseedsystemsinfrastructure.Forthisreason,thepercentageofareaofmajorstaplesinSub‐SaharanAfricathatisdevotedtomodernvarietiesdoesnotapproachthelevelsfoundinSouthAsia(EvensonandGollin,2003).Farmer‐to‐farmerexchangeiscommon,andwherethevarietyishybrid,subsidiesmayoftenbenecessary.Forexample,Zambiawasabletoachieve75%coverageofmodernvarietiesaslongasseedwassubsidized,thisfigureplummetedtoaboutone‐thirdcoveragewhenthesubsidieswereremoved(Mungoma,personalcommunication).MineraldensecropsinthiscontinentthereforeareanexampleofQuadrantB.ProvitaminsAisavisibletraitthatimpartsadistinctorangecolortothegrainorroot.Becauseofthis,theremaybelowacceptancebyconsumers,evenifhighcoverageratesarefeasiblethroughagronomicsuperiority.Thecostsnecessarytoachievesubstantialimpactforcountries‐crops‐nutrientsinthesequadrants(CandD)arelikelytobemuchhigherthaninQuadrantB.Costsforatransgeniccropwithavisibletraitmayalsobehigh,evenifsuchbiofortifiedcropsaredeployedincountrieswithwelldevelopedinfrastructure(QuadrantD).Thecost‐effectivenessofbiofortificationmaybeexaminedusingthisframework,usingatypicalexamplefromeachofthequadrants.Alsohighlightedishowresultsmayvarydependingontheassumptionsused.Table2.Impactandcost‐effectivenessofzinc‐densericeinBangladesh:sensitivitytoassumptionsoncoverageandconsumptionlevels(quadrantA) PercentreductioninDALY

burdenofzincdeficiencyCostperDALYsaved(USD)

Coveragevariesfrom10to60%10 5 2620 10 1330 14 940 18 750 22 660 25 570 29 4

Consumptionlevelsamongyoungchildrenvariesfrom50to150gramspercapita

50 10 13100 18 7125 20 6150 25 5

Source:Author’scalculations,basedonMeenakshietal(2007).

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1.1 Well‐developeddisseminationinfrastructure, invisibletrait:thecaseofzinc‐densericeinBangladesh(QuadrantA)

Table2presentschangesinimpactandcost‐effectivenessresultsbasedonalternativeassumptionsoncoverageandthequantityofstaplefoodconsumed.Themaintainedassumptionsare:

• Anincrementof10ppmofzincisaddedtopolishedrice(asconsumed)atargetthatplantbreedersexpecttoachieveby2012.Becausethenutrientcontentismeasuredinpolishedrice,processinglossesarenotrelevant,sincethereisonlyaninsignificantlossofmineralduringtheboilingofrice.

• Consumptionofriceaveragesapproximately150gramseverydayamongyoungchildren,andbiofortifiedricevarietieswillaccountfor60%ofthetotalricesupplyinthecountryovera20‐yearperiod.

• Researchanddevelopmentcostsaverage$300,000peryear;adaptivebreedingcostsareapproximately$100,000peryearandlastforfiveyears;andmaintenancebreedinganddisseminationcosts(andminimalsocialmarketingcosts)addup$100,000peryearandareincurredforthelast20ofthe30yearstimeframeconsideredintheanalysis.

TheseassumptionstranslateintoreductionintheDALYburdenofzincinBangladeshofnearlyaquarter,atacostof$5perDALYsaved.Evenwitharelativelylowcoverageof10%,itisclearthathigh‐zincriceinBangladeshwillbehighlycost‐effectiveeventhoughtheimpactontheDALYburdenofzincundernutritionisarelativelymodest5%;withcoverageratescloserto70%,nearly30%oftheDALYburdenwouldbesaved,atacostof$4perDALYsaved.Thetablealsopresentsevidenceonthesensitivityoftheresultstochangesinthelevelsofconsumptionofrice,keepingcoveragefixedat60%.Inareaswhereonly50gramsofriceareeateneverydaybychildreninthisagegroup(one‐thirdofthe150gramsassumedabove),a10%reductionintheburdenofzincdeficiencycouldbeachieved.Itwouldneverthelesscontinuetobeahighlycost‐effectiveinterventionatalittleover$13perDALYsaved.Theuseofahigherdiscountratedoeslittletoaltertheconclusion:ata6%rateofdiscount,underthemaintainedassumptionsoutlinedinthebulletsabove,costswouldincreaseto$11.30perDALYsaved(Table5).Thesetranslateintoextremelyhighbenefit‐costratios:ifDALYssavedarevaluedat$1000each,thiswouldtranslateintoabenefitcostratioof198whencostsandbenefitsarediscountedat3%.Ata6%discountrate,thebenefitcostratiowoulddropto89.Towhatextentmightsimilarresultsobtainforothercrops/countriesinthisquadrant?ResultsarecomparableforEasternIndia,notsurprisinggivensimilarprevalenceofmicronutrientmalnutrition,anddietsthatarealsobasedonrice.Forotherrice‐basedeconomiesinSouthEastAsiaaswell,benefit‐costratiosarelikelytobehigh(seeforexampleJavelosa,2006).

1.2 Under‐developedinfrastructure,invisibletrait:thecaseofiron‐densebeansinRwanda(QuadrantB)

Rwandaisrepresentativeofthistypology,withhighlevelsofanemia(56%amongchildren),andwithpercapitaconsumptionofbeansbeingamongthehighestinthecontinent.Thereisnoformalseedsystemperse,andinformalseedmarketsandfarmer‐to‐farmerexchange

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predominateasthesourceofseed.Iron‐densebeansareexpectedtobereleasedinlate2010.Table3demonstratestheexpectedcosteffectivenessofbiofortificationinRwanda,anditssensitivitytochangesincoverageandconsumption.Theunderlyingassumptionsare:

• Anincrementof40ppmisaddedtobeans,atargetthatplantbreedershavealreadyachieved

• Consumptionamongchildrenisabout30gramspercapitaperday,andcoveragereaches20%over20years;therearenoprocessinglosses

• Researchanddevelopmentcostsaverage$200,000peryear;afigurearrivedatbyapportioningglobalresearchanddevelopmentcoststopotentialtargetcountriesusingproductionshares;adaptivebreedingcostsareabout$100,000peryearandlastforfiveyears,whilemaintenancebreedinganddisseminationcostsare$50,000peryearandareincurredforthelast20ofthe30yearstimeframeconsideredintheanalysis.

Table3.Impactandcost‐effectivenessofiron‐densebeansinRwanda:sensitivitytoassumptionsoncoverageandconsumptionlevels(quadrantB) PercentreductioninDALY

burdenofirondeficiencyCostperDALYsaved(USD)

Coveragevariesfrom10to60%10 2 2520 4 1330 6 940 8 750 10 560 12 470 14 4

Consumptionlevelsamongyoungchildrenvariesfrom30to70gramspercapita

30 4 1350 7 870 10 5

Source:Author’scalculations,basedonMeenakshietal(2007)TheseassumptionstranslateintoafourpercentreductioninDALYssavedannually,atacostofabout$13perDALYsaved,whichisextremelycosteffective,evenwithalowcoveragerateof20%.Ifcoverageweretoexpandto50%,Rwandacouldseea10%reductionintheburdenofirondeficiency,atacostof$5perDALYsaved.Theassumptiononthelevelofconsumptionofbeans,relativetotheotherstaplesbeingconsideredinthispaper,isrelativelyconservative.Thetablealsoexaminestheimpactofusingahigherconsumptionlevelforbeans—whichisaco‐stapleintheaverageRwandandiet.DoublingtheconsumptiontranslatesintoamorethandoublingofthereductionintheDALYburdenofirondeficiencyinRwanda,andasaconsequence,morethanhalvingthecostperDALYsaved.Nomattertheassumptionused,theinterventionappearshighlycost‐effective.

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Onceagain,thisconclusionisrelativelyrobusttothechoiceofdiscountrateused:increasingthediscountratefor3to6%translatesintoanincreaseincostperDALYsavedfrom$13to$18(Table5)underthemaintainedassumptionsofamaximumcoverageof20%,andconsumptionlevelsamongchildrenofabout30grams.Evaluatedat$1000perDALYsaved,thesetranslateintoextremelyhighbenefit‐costratiosof78(at3%)and56(at6%).Similarcost‐effectivenessfiguresarelikelytoobtaininneighboringregionsinBurundi,andtheKivuprovincesoftheDemocraticRepublicofCongo,allofwhichhaverelativelyhighconsumptionofbeans.IncountriessuchasKenyaandTanzaniaaswell,biofortifiedbeansarelikelytobecosteffective.

1.3 Underdeveloped infrastructure,visibletrait:thecaseofprovitaminsAmaize inKenya(QuadrantC)

Table4considersasimilarsetofcalculations,presentedthistimeformaize,andtakingintoaccountchangesinassumptionsregardingcoverage,consumptionlevels,andprocessinglosses.BecausethecoverageofmodernvarietiesinmostAfricancountriesisnotashighasthelevelsthathavebeendemonstratedinSouthAsia,thecostcalculationsassumeamaximumcoverageof50%,lowerthanthe60%consideredinBangladesh.NotethatseedsystemsinKenyaare,relativelyspeaking,betterthaninmuchofSub‐SaharanAfrica.Onceagain,themaintainedassumptionsare:

• Anincrementof15ppmisaddedtomaize,atargetthatplantbreedersexpecttoachieveby2012.

• Processinglossesaverage50%percent,consumptionamongchildrenis150gramspercapitaperday,andcoveragereaches50%over20years

• Researchanddevelopmentcostsaverage$300,000peryear;thisfigureisarrivedatbyapportioningglobalresearchanddevelopmentcoststotargetcountriesaccordingtoproductionshares;adaptivebreedingcostsapproximately$200,000peryearandlastforfiveyears;maintenancebreedinganddisseminationcostsare$100,000peryearandareincurredforthelast20ofthe30yearstimeframeconsideredintheanalysis.RelativetothecostsinBangladesh,thecostsinKenyaarehigherbothinpercapitaandperacreterms

Undertheseassumptions,Kenyacouldseea30%reductioninitsburdenofVitaminAdeficiencyatacostofunder$30perDALYsaved.Thistranslatesinto36,000DALYssavedannually.Withcoverageratesat70%,a40%reductioncouldbeachieved,withacostof$23perDALYsaved.Shouldconsumeracceptanceposeanobstacle,however,andcoverageratesdon’texceed10%evenafter10years,a7%reductionintheDALYburdencouldbeachieved,atacostof$125perDALYsaved.Turningtothesensitivityofthesefigurestochangesinconsumptionlevels,ifconsumptionlevelsamongyoungchildrenwereonlyone‐thirdthoseassumedhere,thecostsperDALYsavedwouldbecloserto$80,sincethiswouldtranslateintoonlya11percentreductionintheburdenofVitaminAdeficiency.Finally,thetablealsosetsouthowcost‐effectivenessvariesdependingonprocessinglosses.Ifprocessingmethodsinvolveprolongedexposuretosunlight,itislikelythatmuchoftheadditionalbetacaroteneinthemaizewillbelost.Inthiscase,lossesofupto70%arepossible.Thecostsinthissituationwould

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bemorethandoublethatofthescenarioconsidered,at$65perDALYsaved.Iflosseswereaslowas30%,provitaminsAmaizewouldcost$23perDALYsaved.Table4.Impactandcost‐effectivenessofprovitaminAmaizeinKenya:sensitivitytoassumptionsoncoverage,consumptionlevels,andretention(quadrantC) PercentreductioninDALY

burdenofvitaminAdeficiencyCostperDALYsaved(USD)

Coveragevariesfrom10to60%10 7 12520 14 6530 20 4540 25 3550 30 2960 35 2570 39 23

Consumptionlevelsamongyoungchildrenvariesfrom50to150gramspercapita

50 11 77100 22 41150 30 29

RetentionofprovitaminAvariesfrom30to70%30 20 2350 30 2970 39 40

Source:Author’scalculations,basedonMeenakshietal(2007).Table5showshowthecost‐effectivenessresultschangewithahigherdiscountrate:theinterventioncontinuestobehighlycost‐effectiveata6%rateofdiscountwithacostperDALYsavedof$41,andabenefitcostratioof24.HighprovitaminsAmaizeissimilarlylikelytobecost‐effectiveinothereasternandsouthernAfricancountries,whichhavepredominantlymaize‐baseddiets.Forcountrieswithlowerlevelsofmaizeconsumption,suchasthosefoundinwesternAfrica,targetincrementsnecessarytoachievebiologicalimpactwillneedtobecommensuratelygreater.ThecomparisonofBangladeshandKenyahighlightstherelativelyhighercosts—andagreatersensitivityofthecost‐effectivenessresultstounderlyingassumptions—inKenyathanisthecaseinBangladesh.Twomainfactorsdrivethis:first,thepopulationbase—andhencetheburdenofmicronutrientdeficiencyismuchhigherinBangladeshthaninKenya.440,000DALYsarelosttozincdeficiencyinBangladesheachyear,whileDALYslosttovitaminAdeficiencyinKenyaare120,000.Second,costsperperson(andperacreofcrop)arelikelytobemuchhigherinKenyathaninBangladesh.ThisisonaccountofthehighercostsofdisseminationinAfricaingeneral,andthefactthatagreatermultiplicityofvarieties—both

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Table5.Sensitivityofresultstomagnitudeofdiscountrateused;undermaintainedassumptions Zinc‐densericein

BangladeshIron‐densebeansin

RwandaProvitamin‐Amaize

inKenyaCost/DALYsaved(USD)Discountrateof3%

5 13 30

Discountrateof6%

11 18 41

Benefit‐CostRatio(Benefitsvaluedat$1000perDALYsaved)Discountrateof3%

198 78 34

Discountrateof6%

89 56 24

Source:Author’scalculations,basedonMeenakshietal(2007).openpollinatedandhybrid—arecultivatedinKenyaascomparedtoBangladesh.Also,becauseofthevisibletrait,amoreelaborateandperhapsprolongednutritioninformationcampaignislikelytobenecessaryinKenyaascomparedtothelevelofintensity(andcost)ofanutritioncampaignthatwillbenecessarywiththeinvisiblezinctraitinriceinBangladesh.

1.4 Well‐developed dissemination infrastructure, visible trait and transgenic: the case ofgoldenriceinAsia(QuadrantD)

Whilethepaperthusfarhasfocusedexclusivelyonconventionally‐bredcrops,afewwordsontransgeniccropsareinorder,asthepotentialforabiofortifiedmaize,forexample,thathasgenesthatimpartdroughttolerance,oraprovitaminsAricethathassubmergencetolerancegenescanbeimmense.Biofortificationcouldthenrideonamuch‐prizedagronomictraittohighlevelsofcoverage.Transgeniccropsalsoofferthepotentialforsignificantlyincreasingtheamountofthemicronutrientthatisavailable,andofferthepossibilitythatmorethanonemicronutrientcanbeincorporatedintothestaplefood.Buttotheextentthattransgeniccropsalsofaceobstaclesintermsofpublicconcernsastotheirsafety,achievingwidecoveragemaynotbefeasible,placingsuchcropsintheupperleftquadrantoftheschematicdepictedinFigure1.Underthegrandchallengesinhealthprograms,researchiscurrentlyunderwaytoexaminethefeasibilityofintroducingmicroandmacronutrientsintocassava,sorghum,bananaandrice.Withtheexceptionofgoldenrice,therearerelativelyfewstudiesthatexaminethecost‐effectivenessoftransgenicbiofortifiedcrops.Steinetal’s(2008)resultsareparticularlyinstructive,sincetheyarebasedonthesamemethodologythatunderliestheothercostestimatespresentedinthispaper,thisenablesdirectcomparisons.Steinetal’sresultssuggestthatgoldenriceishighlycosteffectiveinIndia,atalittleunder$20perDALYsaved,evenunderalowimpactscenario.Thelowimpactscenarioassumesacoveragerateofbetween15to20percent,andincludesregulatorycostsofover$2million,totalresearchanddevelopmentcostsof$8.5million,andsocialmarketingcostsofapproximately$15million.Theyfindthatthis

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resultisrobusttochangesinassumptionaboutcoverageratesandcosts,ineachcasebeinglowerthanthecostperDALYsavedofthenextcheapestintervention.EarlierworkbyDaweetal(2002)andZimmermanandQaim(2004)inthecontextofotherAsiancountrieshasqualitativelysimilarresults.Sinceregulatorymechanismsfortheintroductionoftransgeniccropsarestilltobeinputinplaceinmanydevelopingcountries,thepotentialreachofatransgenicbiofortifiedcropinthenextfivetotenyearsappearslimitedtoafewcountries,includingthePhilippines,India,andSouthAfrica.

2 HOWWILLCONSUMERSREACTTOAVISIBLY‐DIFFERENTSTAPLEFOODCROP?

Thecoverageratesthatbiofortifiedcropsreachdependnotonlyonproduceracceptance,butalsoonacceptancebyconsumerswhomayresistastaplefoodthatisvisiblydifferentinappearanceandperhapstaste.Whatarethegroundsforoptimismaboutconsumeracceptanceofanorangecoloredmaize,oragoldenrice?InafascinatingaccountoftheintroductionofmaizevarietiesintotheAfricancontinent,anditsspreadtodisplacethetraditionallycultivatedsorghumandmillets,JamesMcCann(2005)devotesanentirechaptertitled“HowAfrica’sMaizeturnedWhite”.Henotesthat:

“DespitetherecentevidencethatAfricanconsumersarenowratherfirmlyentrenchedintheirpreferenceforwhitemaize,earlierAfricans’aestheticsensibilitiesregardingfoodandsymbolcausedconsumerstoselectcoloredmaize,rangingfromcrimsontoblue,tocolorfulmosaicsofred,blue,yellowandorange,eitherondifferentears,orallmixedonasingleear.Historically,manylocalconsumersinAfricaexpressedstrongpreferencesforredorblueororangeoryellowkernels,orforvariegatedmixesofalloftheabove.Intheearly1960s,thepresencecoloredmaizeonAfricanmarketsbegantorecede,asnationaltrendsfavoringwhitemaizeovertookolderlocaltraditions.”(McCann,2005,pp.113‐114).

Theswitchtowhitemaize,then,appearstohavestartedlessthanfiftyyearsago,dictatedlargelybycommercialcompulsionsandtrade.Ofcourse,thedistributionofyellowmaizebredprimarilyforfeedasfoodaidhasimpartedanegativeconnotation,bothonaccountofpoorsensorycharacteristicssuchasaromaandtaste,andtheassociationwithtimesofhardship.Inmorerecentyears,economistshavefocusedattentiononwhetherabiofortifiedmaizewillbeacceptedinAfrica.DeGrooteandKimenju(2008)comparingwhiteandyellowmaizes(butnotanorangebiofortifiedmaize),notethatonaverage,consumersneededasubstantial37%discounttoswitchfromwhitetoyellowmaize.Whiletherewasapremiumforcommercially‐fortifiedmaize,itwasonlyabout6to7%inmagnitude.However,themagnitudeofthediscounttoinduceaswitchwasmuchlowerforpoorerconsumers.AstudyconductedinZimbabweaboutconsumers’perceptionsaboutyellowmaizesuggestedthatnutritioneducationwasthesinglemostimportantfactorininfluencingacceptanceofyellowmaize,andthatpoorerconsumersweremorelikelytoacceptyellowmaizethanricherconsumers(Muzhingietal,2008).

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Iforangemaizeisbelievedequivalenttoyellowmaize,thesestudiesindicatethatthetaskofexpandingcoverageunderapro‐VitaminsAmaizeisindeedanuphillone.However,astudyconductedbyStevensandWinter‐Nelson(2008)inurbanMaputo,Mozambique,focusedonadeeporangebiofortifiedmaize,andcomparedittoanisogenicwhitemaize.Theirresultssuggestthat“existingpreferencesforwhitemaizemaynotprecludeacceptanceoforangebiofortifiedmaize.”Also,amorerecentsurveyinZambiathatincludedbothsensoryevaluationandwillingnesstopaycomponents,andcomparedwhite,yellowandorangevarieties,concludedthatconsumersdidnotconfuseorangeforyellowvarieties,andfoundorangemaizetobeasacceptableormoreacceptablethanwhitemaize;whileyellowmaizehad,onaverage,thelowestacceptabilityscores.Infact,orangemaizeappearedtosellatapremiumrelativetowhitemaize(HarvestPlus,ongoingresearch).ThisisalsocorroboratedbyasimilarstudyoforangesweetpotatoesinUganda(Chowdhuryetal,2008).Clearlymoreresearchisneededtoaddresswhetherinfacttheorangenessofthebiofortifiedvarietieswillproveasellingpoint,orwhetherthenegativeperceptionsaboutyellowmaizewillcarryovertothesevarieties.Whatifanorangecoloredbiofortifiedcropisalsotransgenic?If,inadditiontobeinganunfamiliarcolor,thecropisalsogeneticallymodified(GM),thismayposeanadditionalhurdletoovercomeforachievingwidecoverage.Therehavealsobeensomestudiesontheconsumeracceptanceofabiofortifiedtransgeniccrop,allofthemusingmethodsofelicitationthatrelyonhypothetical(butincentive‐compatible)scenarios,sinceatransgenicbiofortifiedcrophasnotyetbeenreleased.TheresultssuggestthatincontrasttoEuropewheretheoppositiontotransgenicfoodsappearsentrenched,inthedevelopingcountriesthatarethetargetofbiofortification,consumerattitudesarenotsonegative,especiallywhengiveninformationaboutthenutritivevalueofthefoods.Afewexamplesareillustrative:acomprehensivesurveyoffarmers,urbanconsumersandruralconsumerswasundertakeninthePhilippinestoassesstheacceptabilityofa3‐in‐1GMrice,withenhancedprovitaminsA,resistancetotungro,andresistancetobacterialleafblight.Morethantwo‐thirdsoftherespondentsindicatedthattheywouldacceptabiofortified(golden)GMrice,anequalnumberindicatedthattheywouldplantit,orbuyandconsumeit.Aquarterwouldplant/consumeitundercertainconditions,thatrelatedlargelytoconcernsabouttheperceivedadverseeffectsofGMfoodsonhealth.AskediftheywouldbewillingtopayhigherpriceforaGMricethatmet50%oftherecommendeddietaryallowanceforvitaminA,about30%indicatedthattheywouldnotdoso,whileabouthalftheconsumersindicatetheirwillingnesstopaybetween1and10percentmore.Thesemagnitudeswerecomparabletothosefortheagronomictraitofpestandinsectresistance(Gonzalesetal,2008a).ResultssuggestingthataGMbiofortifiedcropmayfindacceptancealsoappearfromBrazil,fromthePhDresearchofCarolinaGonzales,whofocusedonabiofortifiedcassavainthepoorerNorth‐EastregionofBrazilwitharelativelyhighprevalenceofVitaminAdeficiency.Herresults(Gonzalesetal,2008b)suggestthatconsumersmightbewillingtopayahighpremiumforabiofortifiedcassavathatcouldhelpalleviateVAD,implyingthepotentialforimprovementsinhealthfaroutweighanynegativeperceptionsthatBrazilianconsumershaveaboutGMfoods.Finally,astudyconductedbytheIndianInstituteofManagementalsofindssupportforthelackofwidespreadconsumeroppositiongoldenriceinIndia(Deodharetal,2007).

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Studiesaboutpublicperceptionsdonot,ofcourse,translateintoasmoothsailingregulatoryprocess.Indiahasseenalargenumberof“publicinterestlitigations”seekingtoblockalltransgenicfoodsbeingarguedintheSupremeCourt.TheapprovalofanyonecropmayenablethequickerreleaseofbiofortifiedGMfoodsthatappeartobewaitingontheshelf(ahighironricebackcrossedintoapopularmegavarietyinBangladeshisagoodexample).

3 DISCUSSIONANDCONCLUSIONS

Thepaperhasreviewedthecost‐effectivenessofbiofortificationforfourcasestudiesthatrepresentarangeofscenariosthatarelikelytoberealizedasbiofortifiedcropsaredeployed.Theabilityofbiofortificationtomakeasubstantialimpactonthemagnitudeofmicronutrientmalnutritionvariesconsiderably,dependingoncoverage,whichinturndependsonwhetherthereiswell‐developedinfrastructuretosupportseeddissemination,andwhetherthetraitisvisibleornot.Aswithanyexanteanalysis,examiningthesensitivityoftheresultstochangesinassumptionsusedtoderivecost‐effectivenessfiguresandbenefit‐costratiosisnecessary.Tables2to4highlightthecontext‐specificityoftheimpactofbiofortificationandofitscost‐effectiveness;mineral‐densecropsinSouthAsiaenjoyaconsiderablecostadvantageoverprovitaminsAcropsinSub‐SaharanAfrica,eventhoughintermsofpercentagereductioninDALYsthecaseforaprovitaminsAmaizeisstrongerthanfortheothercrop‐nutrients.Inmostcases,biofortificationcontinuestobehighlycost‐effectiveevenwithrelativelylowcoveragelevelsandcorrespondingimpactonthemagnitudeofmalnutrition.Theseconclusionsremainlargelyrobusttothechoiceofahigherdiscountrateof6%,eventhoughasexpected,withahigherdiscountrate,costsarehigher(andbenefit‐costratioslower)ascomparedtothecasewherea3%discountrateisused.TheimplicationsofusingdifferentdiscountratesarenicelyillustratedandsummarizedintheChallengepaperbyHorton,AldermanandRivera(2008a).Atfirstglance,thesebenefit‐costratiosmayseemtoohightobecredible,particularlyinQuadrantAforcountriessuchasBangladesh.Notehoweverthatbenefit‐costratiosof100:1havebeenreportedforvitaminAsupplementsinEthiopia,attributedtothehighmortalityratesthere(Hortonetal,2008b).However,thereareseveralreasonsfortheseapparently‘high’benefit‐costratios.First,SouthAsiancountrieshavelargepopulations,implyingthatforagivenprevalenceratemoreDALYsarelost—andcanbesavedthroughbiofortification—inSouthAsiancountriesthaninmostAfricancountries.Second,theinvisibletraitmakesforeasieracceptancebyfarmersandconsumers.Third,thepredominanceofafewmegavarietiesincroppingpatternsmeansthatlargenumberscanbereachedwiththesameinvestment.Fourth,relativelymodestcoverageratesthathavebeenassumedof60%inSouthAsia,20%isSub‐SaharanAfrica.Ascoverageexpands,thebenefit‐costratioislikelytofall.Butingeneral,benefit‐costratiosforbiofortificationareintrinsicallyhigh,becausethelargeresearchanddevelopmentcostsareincurredup‐frontandtherearerelativelysmallrecurringcosts,especiallyinQuadrantsAandB.Thereforealargeone‐timeinvestmentyieldsacontinuousstreamofbenefits,unlikethecase,say,withsupplementation,whererecurringcostsofdistributionmustbeincurredyearafteryear.

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Byandlarge,theassumptionsonthecostsareconservative:forexampleasmentionedearlier,whereanincreaseinthecontentofmorethanonemicronutrientiseffective,thecostsarenotapportionedbymicronutrient(andarethereforedoublethosethatwouldhaveobtainedhadtheybeenapportioned).Totheextenthoweverthatthevisibletraitprovestobeabarriertoacceptance,leadingtolowercoverageratesthanthoseusedhere,actualcostsmaybehigher.Asnotedintheintroductorysection,thepaperissilentonvaluingthenon‐healthbenefitsthatmayaccruefromtheadoptionofabiofortifiedcrop.Thisisonlyappropriategiventhatitisthemarginalcostsandbenefitsfrombiofortificationthatarethefocusofthispaper.Buttotheextentthatthebiofortifiedtraitistobepiggy‐backedonagronomicallysuperiorlines,thebenefitstothefarmerfromabiofortifiedvarietyareclearlyhigher.Whilequantificationoftheagronomicbenefitsofvarietiesintowhichthebiofortifiedtraitwillbemainstreamedisbeyondthescopeofthepaper,EvensonandGollin(2003)provideacomprehensivereviewofthebenefitsandcostsofmodernvarietydevelopmentindevelopingcountries.Forexample,Johnsonetal(2003)estimatethattherateofreturntogeneticimprovementincassavawasintherangeof9to22%withaboutone‐fifthofthecassavaareainAfricabeingplantedtomaterialdevelopedintheinternationalagriculturalresearchsystem.EstimatesforSub‐SaharanAfricatendtobelowerthanthoseinAsia.Theagronomicbenefitsfromtransgeniccropsalsoappearsubstantial:inthePhilippines,thestudyreferredtoaboveestimatesthattheinternalratesofreturnforthe3‐in‐1GMricerangefrom31to42percent,evenunderconservativescenarios(Gonzalesetal,2008a).Withmorewidespreadadoptionofmodernvarieties,theseratesofreturnandbenefit‐costratiosarelikelytofallasyieldgrowthtapersoff,ashashappenedwiththemajorcerealsinIndia.Nevertheless,independentofanyagronomicbenefitsthatbiofortifiedvarietiesmayconfer,thehealthbenefitsaresubstantial.Whatisalsoimportantisthatbiofortificationfitsaruralniche,inawaythatisnoteasilymetbyotherinterventions.Thenextstepistodocumentcostsandcost‐effectivenessusingexpostcostfigurestoreplacetheexantenumbersdiscussedhere.Thiswillhappenasbiofortifiedvarietiesaredisseminated;thereareongoingeffortstodocumentcostswithorangesweetpotatoinUgandaandMozambiquesothattheassumptionscanbevalidatedusingfielddata.Itisimportanttoguardagainsttheriskofoverinterpretationoftheresultsfromtheexantecostanalysis.TheschematicpresentedinFigure1isusefulforunderstandingthepotentialrangeincost‐effectivenessandtheprimarydriversofeffectiveness.Itsuggeststhatthelargestbenefitsatlowestcostsareobtainedincountriesandcrops‐nutrientsthatfallinQuadrantA.However,ifthisargumentistakentoitslogicalconclusion,itwouldbeverydifficulttojustifyinvestmentsoutsideSouthAsia,andinparticularSub‐SaharanAfricawherepopulationdensitiesarelower,andtheavailabilityinfrastructurepoorerthaninAsia;clearlythiswouldbeaninappropriateinference.Whatiskeyisthatallthebenefit‐costratiosexceedunitybyasubstantialmargin.Forthemostpart,thesecost‐effectivenessfigurescomparefavorablytothoseoffortification(Horton,AldermanandRivera,2008a)andarerobusttochangesinkeyassumptions,althoughthereareexceptions.AsnotedinMeenakshietal(2007),therearesomecaseswhere

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biofortificationdoesnotenjoyacomparativeadvantagerelativetofortification,notablyinLatinAmerica.Moreresearchisnecessary,however,beforesuchcomparisonscanbemadedefinitively.First,thereisneedforcountry‐specificitytothefortificationcostsaswell,sincethereisawidevariationacrosscountriesinthesecosts(asdocumentedinFiedler,2007,whoreviewssomereasonsforthese).Second,comparisonsmustbemadeonacommonmethodologicalbase,whichisnotpossibleatpresent.Takingintoaccountboththesefactorswillenablethedevelopmentofacountry‐specificplanforanoptimalmixofinterventions—thatincludesbiofortification,fortificationandsupplementation,forexample—thatwillachievethegreatestreductioninmicronutrientmalnutritionforagivenlevelofresources.

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REFERENCESBengtsson,A.,A.Namutebi,M.LarssonAlminger,U.Svanberg(2008),“Effectsofvarioustraditionalprocessingmethodsontheall‐trans‐β‐carotenecontentoforange‐fleshedsweetpotato,”JournalofFoodCompositionandAnalysis,vol.21,pp.134‐143.Black,R.E.,L.Allen,Z.Bhutta,L.Caulfield,M.deOnis,M.Ezzati,C.MathersandJ.Rivera(2008),“MaternalandChildUndernutrition:GlobalandRegionalExposuresandHealthConsequences”Lancet.CopenhagenConsensusCenter,2008.“CopenhagenConsensus2008‐Results.”Chowdhury,Shyamal,J.V.Meenakshi,ConstanceOworiandKeithTomlins(2008),”AreConsumersWilling‐to‐PayMoreforBiofortifiedFoods?EvidencefromaFieldExperiment”HarvestPlusWorkingPaper3.Dawe,David,R.RobertsonandL.Unnevehr(2002):GoldenRice:WhatRolecoulditplayinalleviationofVitaminADeficiency?”FoodPolicy27:541‐560.DeGroote,HugoandSimonChegeKimenju(2008)“Comparingconsumerpreferencesforcolorandnutritionalqualityinmaize:Applicationofasemi‐double‐boundlogisticmodelonurbanconsumersinKenya”FoodPolicy,vol.33,pp.362‐70.Deodhar,Satish,SankarGaneshandWenChern(2007),“EmergingMarketsforIndianFoods:AnIndianPerspectiveonConsumerUnderstandingandWillingnesstoPay”(IndianInstituteofManagementWorkingPaper2007‐06‐08),Evenson,RobertandD.Gollin(2003),CropVarietyImprovementanditseffectonProductivity:TheImpactofInternationalAgriculturalResearch(CabiPublishers).Fiedler,JohnL,TinaG.SanghviandMaureenSaunders(2008),“Areviewofthemicronutrientinterventioncostliterature:programdesignandpolicylessons”InternationalJournalofHealthPlanningandManagement.Fiedler,JohnL(2007),“EstimatingtheGlobalCostsofCombatingMalnutrition:AJointWorldBank‐USAID/A2ZProjectStudy,”mimeo.Gonzales,Leonardo,FlordelizaBordley,VidaAlpuerto,AlphonsusGonzales,CenonElca,RoniloBeronia(2008),“ExAnteImpactAssessmentof3‐in‐1rice”(DepartmentofAgriculture,BiotechnologyProgram,PhilRiceandSTRIVEfoundation).Gonzales,Carolina,MatinQaimandNancyJohnson(2008),“ConsumerAcceptanceofSecondGenerationGMFoods:ThecaseofBiofortifiedCassavainNorth‐EastBrazil”mimeo.HortonSue,HaroldAldermanandJuanRivera(2008a),“HungerandMalnutrition:CopenhagenConsensusChallengePaper2008.”Draft,May11.Horton,Sue,FranceBegin,AlisonGreigandAnandLakshman(2008b),“BestPracticePaper:MicronutrientSupplementsforChildSurvival(VitaminAandZinc)”CopenhagenConsensusCenterWorkingPaperOctober2008.Javelosa,Joy(2006),MeasuringthePotentialPayoffsfromBiofortification:TheCaseofHigh‐IronRiceinthePhilippines(unpublishedPhDdissertation,UniversityofFlorida).Jaim,W.M.H.andMahabubHossain(2007),“VarietalDiversificationofRiceandtheProcessofAdoptionofModernRiceVarietiesinBangladesh:SummaryPaper”mimeo.

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Johnson,N.,V.M.Manyong,A.G.O.DixonandD.Pachico(2003),“TheImpactofIARCGeneticImprovementProgrammesonCassava”inEvensonandGollin,op.cit.Low,J.,M.Arimond,N.Ousman,B.Cunguara,F.ZanoandD.Tschirley(2007),“AFood‐BasedApproachIntroducingOrangeSweetPotatoesIncreasedVitaminAIntakeandSerumRetinolConcentrationsinYoungChildreninRuralMozambique”JournalofNutrition,vol.137,pp.1320‐1327.McCann,JamesC(2005),MaizeandGrace:Africa’sEncounterwithaNewWorldCrop1500‐2000(HarvardUniversityPress).Meenakshi,J.V.,NancyJohnson,VictorManyong,HugoDeGroote,JoyJavelosa,DavidYanggen,FirdousiNaher,JamesGarcia,CarolinaGonzalesandErikaMeng(2007),“Howcost‐effectiveisbiofortificationincombatingmicronutrientmalnutrition?Anexanteassessment”HarvestPlusWorkingPaper2.Muzhingi,Tawanda,AugustineLangyintuo,LucieMalabaandMarianneBanzinger(2008),“ConsumerAcceptabilityofYellowMaizeProductsinZimbabwe”FoodPolicy,vol.33,pp.352‐361.Nascimento,P.,N.S.Fernades,M.A.Mauro,andM.Kimura(2006),“Effectofdryingonthebeta‐carotenecontentofcassavaandsweetpotato”In BookofAbstractsofVIBrazilianMeetingonChemistryofFoodandBeverage,November. Pfeiffer,WolfgangandBonnieMcClafferty,“Biofortification:BreedingMicronutrient‐DenseCrops”Chapter3inManjitKangandP.M.Priyadarshan,BreedingMajorFoodStables(Blackwell,2007).Stein,AlexanderJ,MatinQaimandH.P.S.Sachdev(2008),“GeneticEngineeringforthePoor:GoldenRiceandPublicHealthinIndia”WorldDevelopment,vol.36,pp.144‐158.Stein,A.,J.V.Meenakshi,M.Qaim,P.Nestel,H.P.S.SachdevandZ.Bhutta(2005),“AnalyzingthehealthbenefitsofbiofortifiedstaplecropsbymeansoftheDisability‐AdjustedLifeYearsApproach:AHandbookFocusingonIron,ZincandVitaminA,”HarvestPlusTechnicalMonograph4.Stevens,RobinandAlexWinter‐Nelson(2008),“ConsumerAcceptanceofProvitamin‐ABiofortifiedMaizeinMaputo,MozambiqueFoodPolicy,vol33,pp.341‐351.VanJaarsveld,P.,D.Marais,E.Hamse,P.Nestel,D.B.Rodriguez‐Amaya(2006),“Retentionofβ‐caroteneinboiled,mashedorange‐fleshedsweetpotato”JournalofFoodCompositionAnalysis,vo.19,pp.321‐329.VanJaarsveld,P.J.,F.Mieke,S.A.Tanumihardjo,P.Nestel,C.J.Lombard,andA.J.S.Benade(2005).“β‐carotene‐richOrangeSweetpotatoImprovestheVitaminAStatusofPrimarySchoolChildrenAssessedwithModified‐relative‐dose‐responseTest.”AmericanJournalofClinicalNutrition81:1080‐1087Zimmerman,RandMatinQaim(2004):“PotentialHealthBenefitsofGoldenRice:APhilippineCaseStudy”FoodPolicy,29,147‐168.

Copenhagen Consensus 2008Each day, decisions are made about global political priorities. Unfortunately, political decisions seldom take into account a comprehensive view of the costs and benefits of implementing one solution and not the other or solv-ing one problem instead of another.

In the Copenhagen Consensus 2008, an expert panel of eight outstand-ing economists, including 5 Nobel Laureates, delivered a ranked list of the most promising solutions to the ten of the most pressing challenges facing the world today: Global Warming, Terrorism, Hunger and Malnutrition, Water and Sanitation, Air Pollution, Women and Development, Conflicts, Subsidies and Trade Barriers, Education and Diseases. Around 55 of the world’s lead-ing economists and specialists in the ten challenges compiled up-to-date analysis of the best solutions to ensure the best possible foundation for the prioritization of the solutions.

An overview of how to implement the top solutions from the Copenhagen Consensus 2008Five best practice papers have now been written on the top-solutions on the economists’ list from the Copenhagen Consensus 2008. These papers provide clear and focused empirical recommendations on the best practice and the costs and benefits of the solutions helpful for governments, inter-national organizations, NGO’s and philanthropists in both developed and developing countries.

The Copenhagen Consensus Center analyzes the world’s greatest chal-lenges and identifies cost efficient solutions to meeting these challenges. The Center works with multilateral organizations, governments and other entities concerned with mitigating the consequences of the challenges which the world is facing. With the process of prioritization, the center aims to establish a framework in which solutions to problems are prioritized according to efficiency based upon economic and scientific analysis of distinct subjects.

The Copenhagen Consensus Center is headed by Bjørn Lomborg

Copenhagen Consensus Center Copenhagen Business School • Solbjerg Plads 3 • DK-2000 Frederiksberg • Denmark

Phone +45 3815 2254 • info.ccc@cbs.dk • www.copenhagenconsensus.com