PHM-Exch> Vitamin A Wars: the Downsides of Donor-driven Aid

[Ted Greiner]

Press Release: Critics Savage Global Vitamin Supplementation as Harmful and Wasteful International Aid.
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>>“Donor-driven development assistance is not just ineffective, it does harm” - Prof. Ted Greiner.
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>>Many millions of preschool age children, in more than 100 countries world-wide, receive mega-dose Vitamin A capsules (VAC) twice every year, even though most don’t need them. The annual cost of this aid program totals hundreds of millions of dollars (1). This pharmaceutical-style approach to reducing malnutrition has for twenty years been financed by US and Canadian donors. But, as evidence has mounted that these mega-doses may harm some children and donors continue to fail to publish evaluations showing whether VAC works or not, the program has increasingly been criticised by international and local experts.
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>>These attacks on the capsule approach culminated in The Great Vitamin A Fiasco written by Prof. Michael Latham of Cornell University in 2010 (2). Now, another senior figure in development nutrition has joined the criticism. On Sept. 24th, Prof. Ted Greiner, former nutrition advisor to Sida (3), publishes a new critique of VAC
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>>Vitamin A Wars: the Downsides of Donor-driven Aid 
>>at (http://www.independentsciencenews.org/)
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>>on the science website Independent Science News (4). The article will be available online on Monday, 24th Sept.
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>>Vitamin A Capsules (VAC) are provided to young children in all or part of over 100 countries. This approach is based on twenty year old clinical trials which suggested this might reduce death rates. Prof. Greiner argues that these programs were imposed by certain international donors, who have then failed to publish scientific evaluations of their effectiveness. Furthermore, says Prof. Greiner, the VAC approach burdens developing countries who have to distribute the vitamins. But he also argues that, through both active and passive mechanisms, the VAC approach blocks the initiation of food-based interventions that would reach everyone, not just young children, could often have an income generating effect for the poor, and would be more sustainable.
>>Since these programs appear to benefit only the companies who supply the capsules, they are increasingly resented in host countries. In this article, Prof Greiner highlights the many problems with VAC supplementation and calls for an exit strategy.
>>The evidence: Though preliminary clinical trials suggested VAC might reduce mortality rates, evaluations of the effectiveness of VAC programs in real life situations, if ever conducted, have never been published. Indeed recently,  the by far largest independent clinical trial ever done found no impact on mortality (5). 
>>The downsides of VAC: The serious disadvantages of semi-annual mega-dose Vitamin A capsules, rarely acknowledged by donors:
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>>1) The extremely high doses of vitamin A used may be teratogenic (cause birth defects). Therefore, they cannot be given to women or girls of reproductive age. This requires the use of relatively expensive approaches for storing and distributing them to keep them from being generally available.
>>2) VAC programs are intended to be universal, but consequently, especially for children who already receive adequate Vitamin A through diet, supplementation may lead to overdoses. While this results in only minor and temporary side effects, some studies suggest this may also have effects on the immune system that can lead to higher levels of respiratory tract diseases.
>>3) Donor programs rarely pay the full intervention costs of VAC supplementation programs. Consequently, host governments have to allocate the time and resources of precious medical and administrative staff for the capsules’ transportation, storage, distribution, record-keeping, reporting to the donors, etc..
>>4) The most serious disadvantage of the universal VAC supplementation approach is that “It distracts from and sometimes blocks sustainable food-based approaches” says Prof Greiner, inhibiting progress within host countries towards solving a range of nutritional deficiencies. These alternative solutions include nutrition education combined with small scale farming. In addition, some donors and the international experts beholden to them have actively worked to inhibit food-based solutions at the international level.
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>>Completing this analysis, Prof Greiner, calls for the development of a strategy to cautiously phase out and replace VAC with whichever option is most appropriate to each setting. Says Prof Greiner: “Even many proponents call for phasing it out, but no one is yet working on achieving this.”

 
Ted Greiner, PhD
Professor of Nutrition
Hanyang University
Seoul Korea
skype name: tedgreiner
http://www.tedgreiner.info
http://twitter.com/_breastfeeding
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