**2. Vitamin A deficiency and other nutritional deficiencies**

The latest figures available estimate that of the world's population about 2 billion people are macronutrient deficient, and about 800 million people suffer from "hidden hunger" another name for micronutrient deficiency [18]. Iron, vitamin A and zinc deficiencies are the most common micronutrient deficiencies. Folate deficiencies are also widespread. Where all these deficiencies occur is strongly correlated with the global burden of poverty and disease [19], and so the distribution of them is remarkably similar to the vitamin A deficiency map (**Figure 1**).

For many years, VAD was principally associated with childhood blindness. During the early 1970s, programs of vitamin A supplementation were started in India, Indonesia and Bangladesh. In Indonesia, a development specialist with Helen Keller International noted that the true public health weight of the problem is obscured because its victims often die before they can be reported as blind [21]. Indonesian data analysis demonstrated that children with "mild" vitamin A deficiency were at a high risk of dying [22]. Subsequently, a series of seminal studies demonstrated that a universal source of vitamin A would save 23–34% of global under 5 years, child mortality [23, 24] and also, later, [2, 25–27].

These findings [23, 24] gave huge impetus to expanding vitamin A supplementation programs from the 1990s [28], which involved significant costs [29] and at the time was highly controversial [21]. The Millennium and Sustainable Development Goals made significant progress from the base year of 1990, including in combatting VAD, and with major advances in vitamin A supplementation, as well as

<sup>1</sup> Many transformation events were produced once in ~2004 from which event GR2E has been selected on the basis of molecular structure and insertion in the rice genome, together with agronomic performance when introduced to different rice varieties. It is the basis of the regulatory data generated and is the only form of Golden Rice, which is offered for approval and use.

#### *Golden Rice, VAD, Covid and Public Health: Saving Lives and Money DOI: http://dx.doi.org/10.5772/intechopen.101535*

vaccination programs against measles and other diseases, and improved sanitation and clean water access, in turn reducing diarrhea incidence.

Thus, from 1990 simultaneous progress was made in reducing VAD, thereby improving the immunity of populations of vulnerable children to common diseases, and at the same time reducing the incidence of those diseases.

Nevertheless, macronutrient deficiency is being reduced at a faster rate than micronutrient deficiency (**Figure 2**).

If greater attention is not paid to reducing micronutrient deficiencies, they will have a bigger impact on productive human life than macronutrient deficiencies [7].

**Figure 1.** *Public health importance for vitamin A deficiency, by country. Source [20]. Redrawn by & courtesy of Banson.*

**Figure 2.**

*DALYs lost due to chronic hunger and hidden hunger between 1990 and 2010 (part of Figure 2 from [30]).*
