**3. Vitamin A deficiency in Bangladesh and the Philippines**

Bangladesh and the Philippines are so far the only two countries where regulatory applications been made to cultivate and consume GR. It is clear that progress in combatting VAD has been significant, a reduction from 23 to 34% of under-five child deaths in the 1990s to *circa* 2% in these two countries in 2013, the latest data

available [31]. The 2013 data are useful as a proxy for comparison between countries, but has limitations [32] including that the "total VAD" deaths reported are actually solely deaths where measles or diarrhea are reported on a death certificate. But these are not the only causes of death due to immune system insufficiency due to VAD, and reporting may anyway be patchy in remote, poor districts.

In any event, a 2019 publication, reporting pre-Covid-19 pandemic data, determined that large-scale food fortification against VAD could protect nearly three million children annually [19].

In July 2021, Golden Rice was approved for cultivation and, previously for consumption, in the Philippines. Golden Rice is now awaiting final approval in Bangladesh. The Bangladesh Rice Research Institute submitted an application for consumption and cultivation in Bangladesh in 2017, which has stalled in the Department of Environment [33]; hence, no regulatory decision has been taken.

It was estimated that 3.08% of children of the 14.3 million children under age 5 in Bangladesh will die in 2019 [34, 35]. Two percent of these deaths may be attributable to VAD [31], resulting in an estimated 8826 deaths in 2019. The modified version of Golden Rice was available in 2004, and regulatory delay is the main reason why only one country as of now, The Philippines, has approved Golden Rice for cultivation. Every year of delay of approval of Golden Rice may cause at least 8500 child deaths in Bangladesh. Ten years of delay will result in over 85,000 deaths, at least some of which might have been avoided.

A recent study has estimated that substituting Golden Rice for white rice could provide 57–99% and 89–113% and of the recommended vitamin A requirement for preschool children in the Philippines and Bangladesh, respectively [5]. Such a boost to dietary beta-carotene could do much to combat VAD and is highly sustainable especially when the Golden Rice is grown by the communities which need it.

Currently, Bangladesh spends annually between USD24 million and USD47 million (a 5–6 percent increase in the cost of rice at US\$480–US\$783 per metric ton), on chemically fortifying 1 million metric tonnes (4% of the country's annual rice production) with at least vitamin A and zinc [36, 37]. This is sufficient rice to feed about 7% of Bangladesh's population of 163 million people. The aim of the Bangladesh Department of Woman's Affairs is to "make fortified rice available to all" [36]. The 2020 Bangladesh rice harvest was 25 million metric tonnes. The fortification program is presumably limited by the budget available.

Large-scale food fortification with chemicals represents an unusual confluence of commercial and public health interests, with useful focus on inputs and outcomes arising [19, 36, 38]. Similar focus needs to be applied to integrate public sector developed, and free, biofortified crops—conventionally bred and genetically engineered—for the same purpose, and integrates all approaches—chemical, biological, educational and cultural—to alleviate micronutrient deficiencies in populations, for least cost and maximum coverage.

In 2013, when the Bangladesh program started, there were no alternatives to industrial fortification with chemicals. Since then, high-zinc rices have been introduced by Bangladeshi rice breeders as part of the Harvest Plus program [39]. In November 2017, Golden Rice registration was applied for by the Bangladesh Rice Research Institute (BRRI) and they have been multiplying different varieties of Golden Rice seed since then. Adoption of both high-zinc rice and Golden Rice would reward Bangladesh science investment, save foreign exchange currently being spent on importing chemical fortificants, and allow the reach of biofortified rice to a greater proportion of Bangladesh society than the currently industrial fortification alone, which depends on distributive infrastructure.

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

The above can be achieved in steps; initially, the high-zinc rice varieties could be chemically fortified with vitamin A. Subsequently, now or after registration of Golden Rice, this and the high-zinc varieties could be introgressed (bred together) in two to three rice-growing seasons by Bangladesh's public sector rice breeders. It is very curious to understand, in light of the Bangladesh regulatory data submitted for official consideration in November 2017, 47 months ago at the time of writing, why very few regulatory meetings have been called and no regulatory decision about Golden Rice has been taken. Particularly curious, in light of the recent Philippine cultivation decision (taken 10 months after data submission) when the agro-environmental conditions for rice cultivation are so similar between the two countries. (Governments have approved Golden Rice as safe for consumption in Australia, Canada, New Zealand, the Philippines and USA [40]. Cultivation permission has not been sought in these countries, except for the Philippines, where it has been granted.)

Registration of Golden Rice for cultivation in Bangladesh would allow a refocus of the huge cost of chemical fortification of rice (currently USD24–48 m annually to chemically fortify only 4% of Bangladesh's rice production) by the Department of Women's Affairs to allow a much greater proportion of Bangladesh's population to be reached than will ever be possible if dependent on industrial fortification only. The Golden Rice option has zero cost increment, compared with white rice, to governments, growers or consumers.

What could be standing in the way of the Bangladesh's National Committee on Biosafety under the Ministry of Environment, Forest, and Climate Change, meeting and taking a positive decision, to benefit hugely VAD intervention in Bangladesh?

Delay is expensive: Delay of the use of Golden Rice in India cost USD199 per annum for the decade preceding 2014 [41, 42]. Even if all 25 million metric tonnes of Bangladesh's 2020 rice production were Golden Rice, the extra beta-carotene nutrition is free, saving a large proportion of USD600 million to USD1.17 billion if the same was achieved by chemical fortification with zinc and vitamin A. In practical terms, it appears that the Bangladesh Governments objective "to make fortified rice available to all" is unobtainable without fully embracing the results of the work of the Bangladesh governments own rice breeders, in producing high zinc as well as Golden Rice varieties.
