NEW HEALTH TECHNOLOGIES TO SAVE LIVES

SPEEDY HEALTH TECHNOLOGIES

New technologies hold promise to save lives

In the near future, new technologies for global health—vaccines, drugs, microbicides, diagnostics, and devices—could reduce suffering and save millions of lives worldwide:

• A vaccine against malaria could protect against a disease that threatens half the world’s population.

• New drugs could change the lives of the more than 1 billion people who suffer from neglected tropical diseases.

• A microbicide that could effectively block HIV and other sexually transmitted infections could give women the power to protect themselves with or without their partners’ cooperation.

• A rapid test for tuberculosis (TB) could speed up treatment and improve chances of survival for patients living with both TB and HIV.

• New, effective contraceptive devices could help families in developing countries avoid pregnancies that are ill-timed or unwanted, which account for an estimated 25 percent of all pregnancies.

Finding the next generation of tools

Investments in health technologies have already led to tremendous advancements in global health. Smallpox, a disease that once decimated populations across continents, has been eradicated. Millions of people have been spared from diseases such as polio and measles, allowing them to live longer, more productive lives.

Existing technologies have made this progress possible. Now, we need to expand access to these tools and develop the next generation of technologies that will prevent, diagnose, and treat global health threats:

• Through a proven, cost-effective treatment, millions have been cured of TB. However, this treatment regimen is long and difficult for patients to sustain. Moreover, drug-resistant TB cases are rising. In China and India, the two countries with the highest TB burden, the World Health Organization estimates that 8 percent and 5 percent of cases will not respond to current treatment, signaling an urgent need for new drugs.

• Deaths from diarrheal disease among children less than five years old have been cut nearly in half since the 1980s, but 1.8 million children still die from diarrhea each year. A vaccine against diarrheal disease could help save them.

• Life expectancy in the world’s poorest countries could increase more than 20 percent by 2050 if recent advancements against HIV/AIDS, TB, malaria, and other infectious diseases continue.

Cooperation and collaboration are key

Solving these and other challenges requires the cooperation and collaboration of every sector—private and public, governmental and nongovernmental. The United States, which has historically been the leader in health research and development, plays an especially vital role. New research from the Bill & Melinda Gates Foundation shows that US investment in global health is working. As the largest funder of global health research, the United States can and should maintain its leadership in the advancement of new global health technologies to benefit the health of people around the world.

The challenges ahead of us are great, but they are not insurmountable. With adequate investment in the discovery, development, and delivery of global health technologies, we can stop the spread of disease, effectively treat once-devastating conditions, and save lives.

ULTRA RICE TECHNOLOGY

 ULTRA RICE CONCEPT

     Program for Appropriate Technology in Health (PATH) is an international, nonprofit, nongovernmental organization dedicated to improving health, especially the health of women and children, PATH identifies, develops, and applies appropriate and innovative solutions to public health problems in areas such as reproductive health, communicable disease prevention, and nutrition.  Since 1996, PATH has worked to promote the Ultra Rice fortification technology.  The purpose of this item is to introduce the Ultra Rice premix, a produce that holds great promise for alleviating micro nutrient deficiencies.

WHAT IS ULTRA RICE PREMIX?

      Ultra Rice p0remix is a micronutrient-fortified, manufactured rice product that was developed to address nutritional deficiencies in populations where rice is a staple food.  The Ultra Rice premix is blended with local rice in ratios approximating 1:100.  For example, one kilogram of Ultra Rice premix yields 1,000 fortified servings.  When cooked, the taste and texture of the fortified rice blend are nearly identical to those of unfortified rice.  Ultra Rice premix resembles natural milled rice grains in size and shape and does not break down during the typical washing and cooking stages of rice preparation.

     The unique advantage of the Ultra Rice technology is its ability to protect micronutrients within the manufactured grain-a feature that is especially effective in areas where traditional preparation includes washing the rice prior to cooking.  The Ultra Rice formula develops a structure that helps to shield sensitive micronutrients from ultraviolet light, oxidation, and leaching during food preparation.

     The original Ultra Rice premix formula was designed as a vehicle for vitamin A.  Other formulas, currently under development, will carry iron, zinc, thiamin, and folate.  Additional nutrient combinations may be custom-designed to address specific dietary deficiencies in a targeted area.

THE ROLE OF ULTYRA RICE TECHNOLOGY IN ALLEVIATING 
MICRONUTRIENT DEFICIENCIES

THE PROBLEM

     Micronutrient deficiency is recognized as a serious threat to the health, development, and productivity of millions of people worldwide.  A major cause of micronutrient deficiency is undernutrition, a condition present in much of the developing world.  Undernutrition is the result of a prolonged, low level of food intake and/or poor absorption of the food consumed.  Manifestations include wasting, stunting or underweight, reduced cognitive abilities, and low productivity.  The Food and Agriculture Organization of the United Nations estimates that about 800 million people in the developing world are chronically hungry and undernourished (FAO, 1999).  Two-thirds of these undernourished people live in Asia and the Pacific, which is home to 70 percent of the total population of the developing world.  Women land children are especially vulnerable to micronutrient deficiencies become of their additional requirements for reproduction and growth, respectively (UNICEF, 1998).  Severe micronutrient deficiencies can lead to blindness, impaired cognitive function,l life threatening infections, and, in millions of cases, death.  Even mild to moderate deficiencies have serious health effects, increasing susceptibility to disease and increasing the likelihood of premature death.

THE ULTRA RICE TECHNOLOGY - A PROMISING SOLUTION

     Several options for alleviating micro-nutrient deficiencies exist.  These include direct supplementation (eg., tablets and capsules), food fortification and dietary modification and diversification.  However, nutritionists have realized there is no one "magic bullet" to eliminate micronutrient deficiencies and in fact, various approaches are often combined to better cover at-risk populations.

     Rice is the staple food for more than half of the world's population.  Worldwide, rice provides 23 percent of human energy intake and 16 percent of protein intake (International Rice Research Institute, 1997).  Total consumption of rice continues to increase in close correlation with population growth.  by 2025, more than 5 billion of the world's anticipated 10 billion people are expected to depend on rice as their principal food (IRRI, 1997).  Micronutrient deficiency is especially common where rice is the primary source of calories.  In these areas sufficient nutrient-rich foods do not always accompany rice.

     Milled rice is low in micronutrients because its nutrient-rich outside layer is removed during typical rice milling and polishing operations.  This makes the grain better tasting and more visually appealing, but less nutritious.  As a fortification vehicle, the Ultra Rice premix can replace micronutrient lost during the rice milling process and can help compensate for dietary in sufficiencies.  Fortifying a staple food such as rice has the added advantage of not requiring modifications to consumer purchasing or eating habits.

PATH'S ULTRA RICE PROGRAM

 MISSION AND GOALS

     The mission of PATH's Ultra Rice program is to improve the nutritional status of vulnerable, rice-consuming populations by introducing, commercializing, and encouraging sustained availability of the Ultra Rice technology.  Given the size of rice-eating populations worldwide, Ultra Rice technology could play a major role over the next decade in alleviating micronutrient deficiencies.

     The Micronutrient Initiative of Canada, the Australian Agency for International Development, and the United States Agency for International Development (through the opportunities for Micronutrient Interventions Project) provided initial financial assistance for Ultra Rice activities.  With support from the Bill and Melinda Gates Foundation, PATH is now working to:

• develop an iron-bearing and multiple fortificant Ultra Rice premix formula, evaluating bioavailability and consumer acceptance;
• create commercially sustainable sources of appropriately fortified versions of Ultra Rice premix, and make these available to affected populations in developing countries; and
• demonstrate the effectiveness of Ultra Rice technology in alleviating micronutrient deficiencies in affected populations.

     The Ultra Rice team is collaborating with nutrient experts, donors, and technical specialists to gain the advice and support of the international community for the advancement of this promising technology.  PATH is committed to working closely with interested collaborators, including ministries of health,l other government and regulatory agencies, private companies, and non governmental organizations, to identify opportunities for the introduction of Ultra Rice premix.

INTRODUCTION STRATEGY AND TECHNOLOGY TRANSFER

INTRODUCTION STRATEGY

     To introduce Ultra Rice premix, PATH will focus on countries where:

• micronutrient deficiencies are documented,
• rice is a staple food,
• PATH can develop advocacy and in-country support for Ultra Rice premix as a micronutrient vehicle, and
• appropriate manufacturing technology is available.

     A combination of various approaches will make the Ultra Rice Program sustainable.  Ultra Rice premix distribution systems may include government-sponsored nutritional programs, food aid programs, or private commercialization ventures.  PATH recognizes the necessity to demonstrate a viable market before attracting commercial partners and subsequently transferring the manufacturing technology.  PATH will provide technical assistance in produce manufacturing, training, demand creating, and marketing.

PATH'S ROLE

     PATH aims to make the Ultra Rice premix locally available by transferring Ultra Rice premix production from the development center in Washington State, U.S.A., to major rice-consuming countries around the world.

     For more than 20 years, PATH has been involved in the research, development, technology transfer, and manufacture of health technologies in the developing world.  PATH draws upon in-house skills in pharmaceuticals, food processing, quality control, and business development to determine the feasibility of technology transfer and the type of technical assistance required.  This experience base will help PATH identify manufacturing partners for the local production of Ultra Rice premix.  PATH intends to license the production rights for the premix to these selected partners.  A formal licensing agreement between PATH and each local partner will help to ensure product quality and to encourage its distribution to at-risk populations.  The transfer will also include a comprehensive set of standard operating procedures.

MANUFACTURING PARTNERS' ROLES

     Because Ultra Rice premix incorporates an extrusion step in its process, potential manufacturing partners would include local pasta or noodle makers, whose existing manufacturing technology should easily support Ultra Rice premix production.  These manufacturing partners should also be able and willing to invest in additional production and quality monitoring equipment, where necessary.  A second production stage, the dry-blending of Ultra Rice premix with local rice to produce the consumable blend, may be completed by the Ultra Rice premix manufacturer, local rice millers, or rice packers.

ULTRA RICE PREMIX INITIATIVES UNDERWAY

     Groups from several geographic areas have expressed interest in the Ultra Rice premix technology and are currently the focus of evaluation or initial introduction activities.

BRAZIL:  In pernambuco State, widespread vitamin A deficiency has been identified.  To address this problem, PATH Canada, under contract from PATH, is working with government officials, nutritionists, and rice packers in the region to introduce vitamin A fortified Ultra Rice premix into local school lunch programs.  PATH plans to extend this program into other areas of Brazil as well.

INDONESIA:  PATH is working with large employers to fortify rice provided to employees through onsite meal programs.  Factory management intends to blend the Ultra Rice premix with local rice to serve to workers on a daily basis.  Initial volumes are expected to amount to approximately 10000 to 15000 meals per day.  PATH's objective is to demonstrate a potential market so that interested local, commercial producers of the premix might be identified.

PHILLIPPINES:   After carefully evaluating other rice fortification methods, health officials have expressed strong interest in the Ultra Rice premix technology.  PATH has had initial discussions with local authorities involved in rice fortification research.  In November 1999, the Department of Health approved a fortification strategic plan, and there is keen interest in the development of an Ultra Rice formula with iron for testing and trials in the Phillippines.  The Phillippine government is expected to fortify at least 10 percent of the rice distributed by the agency charged with rice market stabilization.

THE ULTRA RICE PRODUCTION TECHNOLOGY

THE PREMIX

• The Ultra Rice premix is made from dough consisting of rice flour, selected micronutrients, blinders, antioxidants, lipids, and other nutrient-protecting materials.  No genetically modified materials are included.
• From the different forms of nutrient compounds available, PATH has chosen those which demonstrate the optimal nutritional, organoleptic (taste and odor), color, texture, and density characteristics, while maintaining affordable costs.
• No animal products (eg., animal facts) are included in the ingredients.  All incorporated components are included in the United States Food and Drug Administration's GRAS list, a list of food additives that are "generally recognized as safe."

THE PROCESS

• After the dough is formed, it is extruded through a special die, cut into rice-sized kernels, and dried.  The final Ultra Rice premix resembles natural milled rice grains in size and shape.

• After production the Ultra Rice premix is flushed with nitrogen to maintain shelf life, bagged, sealed, and stored in moisture-proof, opaque containers.

THE BLEND

• Close to the time of consumption, the storage container is opened, and the Ultra Rice premix is blended with local rice.  It may either be cooked on the premises or repackaged for further distribution.

• The blend ratio (premix to natural rice) is approximately 1 to 100.  Depending upon the precise potency level of the premix and the desired level of micronutrient fortification, this ratio may be varied within definable limits.

• Techniques and protocols for the dry-blending step are straightforward and the specifics best developed through direct consultation with the packer.

EQUIPMENT REQUIRED

• Most of the equipment used in the production of the Ultra Rice premix would be typical in a pasta or noodle factory and includes simple mixing and blending equipment, a de-aerator an extruder, cutting blade, and dryer.

• Specialized equipment needed for premix production includes the extrusion die, an in-process moisture measuring device, and a rotating treatment drum.

• Subsequent dry-blending of the premix and rice may be accomplished on either a batch or a continuous basis.  Metering, measuring, and assaying equipment for this step are not specialized.