“The Power of Us”

Micronutrient Forum Connected 2020

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Connecting the nutrition community

An important milestone in the evolution of the Micronutrient Forum, and in the growth of the global nutrition community as a whole, took place in November 2020. Four years after its previous very successful conference, which took place in Cancun, Mexico, the Micronutrient Forum (MNF) held its fifth global conference, MNF CONNECTED.

For five days, people from all over the world came together online to explore the conference theme of ‘Building New Evidence and Alliances for Improving Nutrition.’ This was a bold experiment – a strong act of recovery from the disappointment of having to cancel the 5th MNF global conference in its originally planned form in Bangkok during March of this year as a result of the COVID-19 pandemic.

A huge effort went into planning the original conference; an ever greater effort went into planning and delivering this innovative virtual alternative. In its own words, “The Micronutrient Forum serves as a global catalyst and convener for sharing expertise, insights and experience relevant to micronutrients in all aspects of health promotion and disease prevention, with special emphasis on the integration with relevant sectors.” This mission was very effectively fulfilled during MNF CONNECTED.

Structure and content

The online conference was structured in five tracks:
Track 1: Micronutrient Biology and Status Assessment
Track 2: Efficacy and Safety of Micronutrient Interventions
Track 3: Program Effectiveness
Track 4: Designing an Enabling Environment for Micronutrients
Track 5: Food Systems

Conferences always provide a wealth of information and a host of opportunities to exchange research findings and opinions. MNF CONNECTED 2020 was no exception. Making a virtue of necessity, the conference organizers created a dedicated website that was strongly branded and easy to navigate, giving visitors the sense of entering a special space full of information and action.

Launched in advance of the conference, this website functioned as a place of meeting, information and sharing for all participants, providing the opportunity to conveniently review and select elements from the extensive conference program. The content included sessions that were livestreamed each day along with a large amount of pre-recorded contributions that could be viewed on demand.

A significant advantage of this format was that conference delegates had the opportunity to watch sessions that might otherwise have been running simultaneously, and to follow contributions from all of the tracks – an important consideration in the context of an event whose aim is to be a “global catalyst and convener for sharing expertise, insights and experience.” This facilitating role is also being expanded beyond what would have been possible in the context on a traditional conference, for the entire conference content will remain online and be accessible to delegates for the coming year.

The enforced choice of online delivery had the additional benefit of reducing attendance costs considerably and eliminating travel costs completely, making this event accessible as never before. Delegate numbers exceeded 3,500, with an unprecedentedly high level of participation on the part of colleagues from low- and middle-income countries. Certain of these, however, reported that the broadband coverage in their location was insufficient to cope with the requirements of streaming – an issue that will certainly be addressed if a similar conference is held again.

High expectations

First established in 2006 as the successor to the International Vitamin A Consultative Group (IVACG) and the International Nutritional Anemia Consultative Group (INACG), the Micronutrient Forum convened international conferences in Istanbul in 2007, Beijing in 2009, Addis Ababa, Ethiopia in 2014, and Cancun, Mexico in 2016. It was chaired by Alfred Sommer  (professor and former dean of Johns Hopkins Bloomberg School of Public Health, and the former Chair of IVACG) from its inception until 2010, when it lapsed due to USAID’s decision to discontinue support. A group of interested organizations, including Sight and Life, brought it back to life after brief hiatus and in 2014 convened the Addis conference. From 2010 to 2017 Lynnette Neufeld (Director, Knowledge Leadership at GAIN) was Chair of the Steering Committee of the Micronutrient Forum.

Saskia Osendarp

Since staging its 2016 conference, the Micronutrient Forum has become a legal entity and non-profit organization under the leadership of Executive Director Saskia Osendarp and MNF Board Chair Howdy Bouis, entering a new level of organizational maturity.

Expectations of the 5th global conference were therefore high – and additionally so because of the impact of the COVID-19 pandemic on many of the world’s poorest and most vulnerable populations. As Princess Bajrakitiyabha Narendira Debyavati, the Princess Rajasarinisiribajra of Thailand, observed when formally opening the conference on 9 November, the global nutrition community can still connect and collaborate in the face of COVID-19, working harmoniously to combat micronutrient deficiencies around the world.

Joel C. Spicer

Joel Spicer, President and CEO of Nutrition International, and responsible for hosting the Micronutrient Forum for six years, put it more bluntly during the second day of the conference: “It’s time to ring the alarm bell for nutrition,” he said: “if nutrition doesn’t get attention now, it will slip through the cracks.” (Watch the full session: How to keep micronutrients as a priority with shifting global, national and donor priorities?)

Sense of urgency

Lawrence Haddad

This sense of urgency was likewise conveyed by Lawrence Haddad, Executive Director of GAIN, who gave the keynote speech during the opening of the conference. Looking forward to next year’s United Nations Food Systems Summit, with its stated aim to “launch bold new actions to deliver progress on all 17 SDGs”, as well as to the Nutrition for Growth (N4G) Summit to be held in December 2021, Lawrence stated that “our global food system is on the wrong track, and we have to find the levers to get it onto the right track,” emphasizing that “2021 is the best opportunity for positive change we will have in the next ten years.” (Watch the full session: How to meet global micronutrient needs within sustainable food systems)

This, then, was the setting for the work of the five conference tracks – not just to present the findings of self-contained research studies and implementation programs but to seek the connections between these lines of endeavor. Time and again, the interrelated themes of connection and collaboration were revisited by conference speakers and also delegates, who had the opportunity to correspond with presenters via a live chat facility and also to connect with them online before or after their live sessions.

Micronutrient biology, the subject of conference Track 1, is something that can be influenced by designing and delivering appropriate interventions on the basis of scientific evidence. The enabling environment, the subject of Track 4, can likewise be shaped by targeted policy interventions. Delivering effective programs (Track 3) based on efficacious and safe micronutrient interventions (Track 2) can help address micronutrient deficiencies. 

The challenge of inadequate food systems

However, the 2020 edition of the State of Food Security and Nutrition in the World, jointly prepared by FAO, IFAD, UNICEF, WFP and WHO and published by FAO in July, estimates that almost 690 million people went hungry in 2019 – up by 10 million from 2018, and by nearly 60 million in five years. One reason for this is the world’s inadequate food systems, which fail to deliver many of the elements essential for a healthy, balanced diet, and which also do not meet the nutritional requirements of the world’s most vulnerable populations. The very concept of ‘food systems’ is a relatively new one, however – there was no conference track dedicated to it when the Micronutrient Forum last convened, in 2016 – and although inadequate food systems might be easy to diagnose and describe, they are much less easy to fix.

David Nabarro

This conundrum was eloquently and memorably expressed by David Nabarro, the founding coordinator of the UN Scaling Up Nutrition (SUN) Movement, who is currently advising the Director General of WHO on its response to the COVID-19 pandemic. In his concluding observations on 13 November, he observed that, “A malnourished child does not have an alarm light on its head to flash ‘nutrition emergency’. The emergency is invisible – and it leads to lifelong disadvantages that are mental, emotional, and physical, as well as economic. This magnificent MNF CONNECTED has realized that malnutrition is a sign that things are not right. Acting to change this is complex, however.” Quoting Saskia Osendarp, and thanking her for her leadership in delivering this conference, David continued, “We need to step out of our own shadow and work together as never before.” (Watch the full session: Look up, don’t look down: how to redesign the future for nutrition post-COVID19)

“The power of us”

This was the key take-away from a remarkable event that was a milestone in every sense of the word. Saskia Osendarp re-emphasized David Nabarro’s point in her concluding remarks: “We all want to meet up again physically, but this conference has shown how connected we can all be. There are no magic bullets, and we must work much more closely across sectors to address micronutrient deficiencies – using the power of us.”

Klaus Kraemer
Klaus Kraemer

Klaus Kraemer, Chair of the Micronutrient Forum Conference Committee, and Managing Director of Sight and Life Foundation, observed in this context that, “As a global nutrition community, we need to speak in a clear and coordinated voice.” For, as he continued, “If we want to change policy, we need to speak the language of policy.” This will be a major challenge for the nutrition community – to speak clearly in a concerted voice that external decision-makers can understand.

Too important to be left to nutritionists?

Eileen Kennedy, professor and former dean of the Friedman School of Nutrition Science and Policy at Tufts University, perhaps had this in mind when she quoted a nutritionist of days gone by as saying that nutrition was too important to be left to the nutritionists. (Watch the panel discussion: How to keep micronutrients as a priority with shifting global, national and donor priorities?) The remark had been made not in this century but in the previous one, by Howard A. Schneider, Director of the Institute of Nutrition at the University of North Carolina, at the Nutrition-related Oversight Review, Hearings Before the Subcommittee on Domestic and International Scientific Planning, Analysis, and Cooperation of the Committee on Science and Technology, U.S. House of Representatives, Ninety-fifth Congress, First Session, in 1977.

“The nourishment of human beings is a complex affair that taps a multitude of the components and agencies of both our public and private lives,” said Schneider. “Like Clemenceau’s aphorism that war is too important to be left to the generals, I sometimes am persuaded that human nutrition is too important to be left to nutritionists.”

From “The power of us” to “Speech to power”

Francesco Branca

The achievements of MNF CONNECTED were great. For them to be translated into action, intensified cross-sectoral collaboration is necessary. But so is speech to power. As Francesco Branca, Director of the Department of Nutrition for Health and Development at WHO put it: “We can’t have a world with three billion left out.” (Watch the full session: How to meet global micronutrient needs within sustainable food systems)
 
MNF CONNECTED will be the subject of a Sight and Life Special Report that is scheduled for publication on 1 February 2021. Watch this website for further information. 

A Tale of Two Conferences, One Ultimate Goal

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The 2019 summer conference season opened in an intense way for me. With barely one intervening week, I had the privilege of attending two fascinating conferences that differed in most aspects but converged on the complementary pathways towards the common and ultimate goal of a better-nourished and healthier world.

Reflections from Baltimore

The first conference was Nutrition 2019, the annual meeting of the American Society for Nutrition, hosted in Baltimore, home to Johns Hopkins University, one of the leading nutrition research institutions in the world. Five intense days with hundreds of lectures, presentations, panels and posters organized in themes ranging from cellular and physiological metabolism to global and public health nutrition. As expected, great learning and networking, accompanied by the recurring wish one could multiply oneself so as not to miss one or more exciting parallel sessions. Nearly 3,500 participants from scores of countries, albeit with diminished participation from Africa and Asia compared to last year’s edition. I had the opportunity to present a poster on complementary food safety and quality in Rwanda (poster shown below), the detailed content of which was recently published in Maternal & Child Nutrition.

A few topics stood out. Perhaps the most emergent was the microbiome, a theme that has now migrated from the margins to the center of clinical and translational nutrition. The most thought-provoking microbiome presentation in my view was by Dan Knights from the University of Minnesota. In a panel titled “You Are What Your Microbes Eat” exploring the interplay between diets and the gut microbiome, he borrowed from physics the metaphor of dark matter to describe the countless compounds present in foods that are not captured on any nutrition label yet strongly influence microbiome composition and metabolism. Intriguingly, responses of specific gut microbes to the same foods are often different from person to person, pointing to the need for a personalized approach to the microbiome and nutrition and mirroring the emergence of nutrigenomics and personalized nutrition, another salient topic in the conference.

Sustainability was another theme on the move towards the mainstream of nutrition, certainly influenced by the EAT-Lancet Food in the Anthropocene report[i]. The challenges of nudging consumers and food systems towards healthy diets and sustainability, and the multiple tradeoffs involved, were highlighted in several sessions, including a dense panel discussion moderated by Klaus Kraemer, Managing Director of Sight and Life, and Eileen Kennedy, Dean of the Friedman School of Nutrition Science and Policy at Tufts University.

A special event, rich in historical perspective and fond memories, was the Kellogg Prize for Lifetime Achievements in International Nutrition Lectureship. Marie Ruel, Director of IFPRI’s Poverty, Health, and Nutrition Division, was this year’s prize recipient, recognized for her outstanding work of more than 25 years on policies and programs to alleviate poverty, food insecurity and malnutrition in developing countries. What made the ceremony particularly touching was the presence of many other leaders in the field who were mentors, colleagues, or mentees of Marie’s, a testimony to the expanse and depth of her contributions.

My overall perception of the field, partly from having attended both the 2018 and 2019 editions of ASN, is that it is currently in a stage of incremental and relatively modest advances; areas such as the microbiome and personalized nutrition show tantalizing promise, yet they involve complex science in its early stages, which likely implies a translational pathway a few years long, not to mention translational challenges to low-resource contexts.

Impressions from Hyderabad

The second conference was the Agriculture, Nutrition & Health (ANH) Academy Week 2019. Held in Hyderabad, the bustling and sprawling high tech hub of Southern India, this was a much smaller and more intimate event of about 400 participants from a broad array of food system-related disciplines. It was the Academy Week’s fourth edition, the previous ones having been held in Addis Ababa, Kathmandu and Accra. The first two days were dedicated to learning labs, followed by a three-day research conference. Overall, a superb interdisciplinary and cross-sectoral gathering that stretched participants’ world views and thinking across boundaries.

Srujith Lingala of Sight and Life participating during ANH.

And it was the progress in the interdisciplinary dialogue on food systems that impressed me the most. We have been talking about ag-nutrition integration for a few years now, but the road has been bumpy and uphill, with dissonances ranging from language to priorities and expectations. It felt so much smoother and fluid at this Academy Week. To me, this gathering was one among a number of signals that we are now reaching an upland in which we can switch gears towards more integrative thinking and holistic approaches to the food system. These refined approaches incorporate not just nutrition and health but also sustainability – now inextricably linked with agriculture –, equity and socioeconomic development, while acknowledging the need for inclusive governance to co-create win-wins and negotiate inevitable tradeoffs with fairness. The good research presented at the conference included innovative tools (such as Agrifood) to facilitate the complex and consequential decision-making involved.

ANH, Acedemic Week, India, Nutrition, Agriculture
Group photo from Agriculture, Nutrition & Health (ANH) Academy Week 2019 held in Hyderabad, India.

Final Thoughts

I thus stepped into the second half of 2019 with renewed optimism from these two conferences and the complementary and increasingly convergent learning agendas they represent. Health system-based approaches and the first thousand-day focus remain vital, but are insufficient to address the multiple burdens of malnutrition. Food system-based approaches can benefit the whole population from cradle to grave, spanning the food insecurity-malnutrition spectrum and addressing other dimensions also relevant to nutrition outcomes. With these two wings in tandem, we will be able rise faster towards a better-nourished, healthier, fairer, and more sustainable world.

For additional pictures from ASN visit here and for ANH visit here

[i] Willet et al., “Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems”. Lancet 2019; 393: 447–92.