A lesson from the past - be optimistic, but watchful
In May 2017, partners in the global effort to eliminate iodine deficiency, including WHO, IGN, GAIN, ETH and the Effective Altruism movement in Geneva, took part in an event called “Towards the Elimination of Iodine Deficiency by 2020.” The premise was that we were on the verge of eliminating iodine deficiency.
Back in 2017, things looked promising. Many countries had got their salt iodization programs up and running, and others were on track to do so. But by 2020, things had changed. In its report to the World Health Assembly in April 2022, WHO noted that “the remarkable progress made in the last decades in the elimination of iodine deficiency disorders has recently stalled with 21 countries estimated to have insufficient iodine intakes in 2020, compared to previous trends of insufficient iodine intakes in 19 countries in 2017, 25 in 2015, 32 in 2012, 47 in 2007, 54 in 2003, and 110 in 1993.”
WHO also noted that “these data are based primarily on school-age children, but the global situation of iodine nutrition status among other population groups, such as pregnant women who are particularly vulnerable to iodine deficiency, is uncertain. Countries are encouraged to continue monitoring iodine status on a regular basis, particularly when there are programmatic changes.”
To unpack this a little, there are many countries where, despite the efforts of development partners, no progress has been made or has stalled. There are also some where war or natural disasters have derailed salt iodization – Ukraine is a major example, and we have problems in Afghanistan and several others.
Because of the expense of national population surveys, much of the data is more than 10 years old. And there’s is a lack of data that would tell us that iodine is eliminated in all segments of society. In some countries, like Chad, Sudan and Burkina Faso, large parts of the population have never gained access to iodized salt. In others, iodine nutrition has worsened, placing population groups at risk. For example, while we know the situation for school age children across Europe is mostly adequate, the status of pregnant women is not adequately documented, and it's estimated that up to 50% of newborns might not reach their full cognitive potential due to insufficient iodine intake.
Studies and surveys over the past decade show sliding back does occur and that pregnant women especially are at risk, for example in Madagascar and Cambodia as well as many countries in Europe. Knowledge about the importance of iodine nutrition among senior decision-makers has declined or is inadequate, and public understanding has mostly disappeared. Policy, regulatory frameworks, monitoring and quality control are weak in many countries, and programs are less effective than they could be.
But while we can’t paint as rosy a picture now as we did back in 2017, a lot of good things are going on. In 2019, in partnership with UNICEF, a global leader in the fight against iodine deficiency, IGN began a roadmapping process that is now under way in 5 regions, identifying gaps and weaknesses in regional efforts and national programs and facilitating the creation of a five-year, evidence-based strategic direction for annual country and regional activities. Landscape analysis in more than 50 countries is leading to the creation of action plans that will address problems and ensure sustainability. Our network of regional and national coordinators proactively identify and explore issues that threaten progress.
IGN is working with many countries to mainstream salt iodization into their nutrition programming, including the contribution that could potentially be made by using iodized salt in the manufacture of foods such as bread. Looking at trade routes, supply chain, and new ways to assess program performance, as well as major advocacy efforts in Europe, South America and several African countries are some of the new actions to build program stability for the future.
IGN’s objective is to help countries develop resilient, sustainable programs that will make sure everyone knows about the importance of iodine nutrition and will bring iodized salt to people everywhere, forever. We’re not setting a time frame, but the work to do it is happening, right now.