**7. Conclusions**

In the 1990's, when vitamin A deficiency's importance was recognized not only as the principal cause of irreversible blindness in children, but also the principal cause of child mortality, VAD killed in excess of 2.0 million young children and mothers annually. At that time, VAD was responsible for between 23 and 34% of all deaths of young children globally (and a greater proportion in developing countries), and a greater cause of mortality globally than HIV or TB or Malaria [7].

A combination of successful community health programs, including vaccinations and vitamin A supplementation, as well as economic development resulting *inter alia*, in better access to clean water and sanitation, had reduced the death toll from 23 to 34% in the 1990s to circa 2% in 2019, of young children in Bangladesh and the Philippines.

The Covid pandemic, which started in 2020, has reversed the progress of community health programs achieved during the past three decades. Covid has also increased food insecurity. We cannot know for how long these conditions will last. There is an acute danger that they will result also in a reversal of VAD induced mortality from circa 2% toward in excess of 23–34% of child deaths in all LMICs.

In Bangladesh and the Philippines, in 2020 the first year of the pandemic, Covid killed as many people as VAD killed children only, in the previous year, 2019. Yet far greater attention was paid to Covid's arrival than children's deaths from VAD, which had been continuing for decades. It is long past time to pay more attention to alleviating VAD.

In 2021, for the first time since the 1992 UN International Conference on Nutrition, which recommended locally available food-based strategies are the first priority to combat vitamin A deficiency, such a staple food source with sufficient quantity and bioavailability of beta-carotene (a human source of vitamin A) is available: Golden Rice.

Golden Rice has been proven as safe to consume by Government regulators of four high-income countries and as safe to consume and cultivate in the Philippines. In only one other country has registration for Golden Rice on the same basis as in the Philippines been applied for, in late 2017, and with, at the time of writing5 , no regulatory decision: Bangladesh.

As the technology is in the seed, Golden Rice adoption requires no use of foreign exchange or industrial infrastructure. It is designed to be useful to resource poor rural communities that grow their own rice staple for consumption. And governments can pay growers to grow the Golden Rice supply necessary for urban use. The color of Golden Rice reduces the opportunities for "passing off" of normal white rice, as micronutrient-fortified rice. And Golden Rice introgressed with, for example, high-zinc and or high-iron rice and or folate rice, using conventional plant breeding will be a multi-micronutrient rice and a golden color.

All departments of government have a responsibility to work together, also with those supranational institutions supporting government public health programs, to use newly available Golden Rice.

<sup>5</sup> October 2021

There is a huge potential for saving lives and money—multi-millions of US dollars annually—by adopting Golden Rice, not only in the Philippines, but also Bangladesh and other countries where VAD continues to be problematic.
