5) Description of health product/service offering: This Project will work to assure that nearly everyone in the world has access to vitamin and mineral supplements costing about a penny per pill per person. The project will save and improve millions of lives, working with with companies, governments, charities, nongovernmental organizations, and social entrepreneurs.

Many populations and sub populations still lack vital vitamins and minerals, and thus suffer simple but severely damaging vitamin and mineral deficiencies, cancer, mental retardation, and other diseases.

The Project will use various innovations and initiatives to decrease the cost and increase the effectiveness of the manufacturing, advertising, and distribution of the pills, including auction bidding for participation by many entities in the Project.

Even if full subsidy were required for half the world’s 6.5 billion people, the cost of the pills would be in the neighborhood of $12 billion per year [$.01 x 365 x 3,250,000,000 = $11.86 Billion], an achievable sum.

6) Description of innovation: The Project will be a great enlargement of activities similar to those of the Micronutrient Initiative of the Canadian International Development Agency and UNICEF. Despite the Micronutrient Initiative success, the Canadian International Development Agency reported “in 2004-5, a small number of programs disbursed more slowly than anticipated,” including the Micronutrient Initiative.

There is much unmet need. One "coverage round" of Vitamin A is helpful, but Vitamin A should be available routinely, not just after a flood. Supplements are helpful, and should be provided even when they cost more than $.001 per person per day. Providing to children is vital, and many adults lack nutrients also. $24 million spent by the Micronutrient Intiative in 2003 and 2004 is a start, but expenditures of 100 times as much, would still have benefits that dwarf the cost.

The Canadian Micronutrient Initiative (MI) spent about $24 million in each of 2003 and 2004. The 2005 annual report of the MI project undertaken also with UNICEF shows severe and debilitating vitamin and mineral deficiencies in many countries, and we quote extensively:

Malnutrition, including vitamin and mineral deficiency, underlies over 50% of [millions of] child deaths, according to the World Health Organization (WHO).

Every year 18 million babies are born with inadequate protection from mental impairment caused by iodine deficiency.

Early results suggest that 39 countries managed to deliver two high coverage rounds in 2004 and 56 managed one high coverage round. We helped provide supplements to over 200 million children and save the lives of 300,000 children.

7) Operational model: The Project will have one person in charge and responsible to do the following.

Many companies will benefit by their participation. Set up competitive programs among them, so they provide their products and services at minimal costs, or maximum benefits to the Project.

Use a medical school, e.g. Harvard, Yale or Johns Hopkins, to plan for different contents of the pills and other water and dietary supplements for different people and for different areas. Where selenium or zinc is lacking in an area, provide higher doses. Some people may need non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin to help prevent heart disease, high blood pressure, or Alzheimer's disease, and others not. Children and old people need different amounts and mixes of vitamins and minerals. Yet, too many choices may confuse consumers.

Recruit key people at many levels. Bill Clinton’s recent agreement with beverage companies not to sell high fructose drinks to school children is important, and he should extend it to reduce the sales of high fructose drinks to adults, and reduce the use of that additive, working with Coca-Cola, Pepsi, and ADM. Other political leaders also need to be recruited, from the Canadian CIDA, from UNICEF, US AID, the World Bank, and others. James P. Grant, head of UNICEF following 1980, is an ideal model. Bornstein's "How to Change the World," says he saved 25 million children, and 4 million per year by Oral Rehydration therapy, glucose and salts to prevent deaths from diarrhea. The EPA, FDA, CDC, and Surgeon General should have a taskforce to help implement the Project through legislation and regulation. State and local politicians and regulators can require not only chlorination and fluoridation of water, but consider other controls.

Research institutes such as the Linus Pauling Institute on Micronutrient Research, and the Webb Waring Institute on Aging Cancer and Antioxidants should help.

8) Human resources: The Project will work with certain companies that are key, including those providing salt, water and drinks, and staples. North American Salt, Morton, and other companies iodize salt, but various of the 10,000 small producers in India, the fourth largest producer, do not. Salt companies should make more Lite Salt and alternatives to straight sodium chloride with some iodide, including adding potassium to reduce blood pressure, calcium to reduce osteoporosis, other micronutrients such as zinc, iron, magnesium, and chromium. North American’s livestock salt that contains zinc, manganese, cobalt, copper, iodine, and iron is probably healthier for human consumption than the company's human "food grade" salt. The company can do better.

Water providers, whether international and private like Vivendi Environnement, Suez Lyonnaise des Eaux, Thames Water, national like Aqua America, governmental, municipal, providing bottled water, vitamin water, or other beverages like Evian, Disani, Coca-Cola, Pepsico, Anheuser-Busch, SABMiller, Interbrew, or Heineken can benefit from providing more varied and healthy drinks with supplements.

9) Key operational partnerships: Have a competition among pill manufacturers, preventive medicine specialists, medical schools and others to plan the contents of pills in different areas, probably having several choices of pills for different areas.

Have manufacturers compete to manufacture pills. Wal-Mart might offer, as a charitable contribution, to run that competition. It is known for pushing its suppliers to achieve efficiencies. Manufacturers, particularly if given rights to add their name to the Ashoka brand of pills (e.g. Ashoka-Pfizer for the US) might produce pills very inexpensively, or might bid to pay for that right. Another company might be able to provide the pills for free for Costa Rica, and another might charge a modest amount to provide pills for a Chinese province.

Have advertising companies compete to provide public service announcements, and cable, satellite, and broadcast TV stations compete to show them, arriving at net contributions to the Project. Have public relations companies donate time, and have national, provincial, and local health departments donate efforts to educate populations to take the pills.

Have transportation and logistics companies donate for the right to be sponsors and distribute the pills. Have grocery chains and convenience stores throughout the world donate space and stock the pills.

10) Financial Sustainability

          • Fees charged to clients?: Yes

          • How do you assure affordability?: Have a two or three tier pricing scheme for different areas. People able to pay should pay a full price, though with the Project’s massive manufacturing and distribution should make the pills less expensive than current grocery store generic brands.

People with any governmental proof of poverty (e.g. food stamps) should be given the pills by stores who would get any needed payment through the Project’s distribution chain or from government payments. Depending on the cost and donations from governments and others, probably a third tier in the middle would pay some intermediate price. Staples providers, whether rice, wheat, cereal (General Mills), barley, sorghum, potatoes, or cassava can and should enrich and supplement their products, such as under the Flour Fortification Initiative.

          • Earned incomes as a percentage of operating costs: 50

          • Other funding sources: Profit making companies perform vital economic functions. Purely charitable, and governmental programs, are different and also perform vital economic functions. This Project could help develop mixes of those functions and payment methods. Companies could charge less and make in-kind charitable contributions. Charitable groups could charge some for their products and services. Governmental groups could seek targeted contributions to get the job done. Auctions could be set up for products and services that would normally cost the Project money, and the results of the auction could be that the Project would pay less than normal, or nothing, or receive contributions to the Project if the winner of the auction saw economic, social, or public relations benefits that outweighed the cost.

          • Strategy for long-term sustainability: Because many of these initiatives can reduce budgets, the budgets should be reachable. In recent years, various sources have given extremely generously to health initiatives. Science Magazine reported in January 2006, “Over the past 7 years, a cadre of deep-pocketed, impassioned players has committed more than $35 billion to fight the diseases of the world's poor. At the forefront of these efforts is the Bill and Melinda Gates Foundation, which since 1999 has pledged $6 billion--roughly the budget of the World Health Organization (WHO) during the same time--to battling HIV/AIDS, malaria, tuberculosis, and other long-underfunded diseases.”

Thus there is now a huge amount of money available, that has been directed to disease. This article does not say it has been directed to vitamin

          • Percentage of low-income clients: 80

          • Overall "market": UNICEF’s Vitamin and Mineral Deficiency: A Global Progress Report says: Iodine deficiency is estimated to have lowered the intellectual capacity of almost all of the [80 developing] nations reviewed by as much as 10 to 15 percentage points. Iron deficiency in the 6-to-24 month age group is impairing the mental development of approximately 40% to 60% of the developing world’s children. Vitamin A deficiency is compromising the immune systems of approximately 40% of the developing world’s under-fives and leading to the deaths of approximately 1 million young children each year. Iodine deficiency in pregnancy is causing almost 18 million babies a year to be born mentally impaired. Folate deficiency is responsible for approximately 200,000 severe birth defects every year in the 80 countries for which Damage Assessment Reports have been issued (and perhaps as many as 50,000 more in the rest of the world). The deficiency is also associated with approximately 1 in every 10 deaths from heart disease in adults. Severe iron deficiency anaemia is also causing the deaths of more than 60,000 young women a year in pregnancy and childbirth.

12) Scaling up strategy

          • Stage of the initiative: Start Up stage.

          • Expansion plan: Finishing the description of the demand, UNICEF’s Vitamin and Mineral Deficiency: A Global Progress Report says: Iron deficiency in adults is so widespread as to lower the energies of nations and the productivity of workforces – with estimated losses of up to 2% of GDP in the worst affected countries. Vitamin and mineral deficiencies overlap and interact. Half of children with VM deficiency suffer from multiple deficiencies. “Although there are few national surveys to draw upon, best estimates suggest that a third of world’s population live in countries at high risk of zinc deficiency.” “Analysis of several community-based trials has suggested that zinc supplementation can reduce the prevalence of diarrhoeal disease by 20% and of pneumonia by as much as 40%. These two diseases are responsible for approximately 40% of all child deaths in the world each year.”

Tables in that Progress report at P 37-41 list the countries, the numbers, and percentage of people affected with many of these micronutrient deficiencies in 80 developing countries, directing the priorities for action.

13) Policy change: Have US AID fund the Project. A report on the FY 2006 USAID budget says, "Child survival and maternal health programs ($326.5 million) reduce the number of deaths in children under five and save the lives of women during childbirth. Programs address immunizations, pneumonia and diarrhea prevention and treatment, oral rehydration, polio eradication, micronutrient deficiencies, antenatal care and safe birthing, nutrition, breastfeeding, and the USG contribution to the Vaccine Fund." That is down from $411 million in FY2003. Full funding would cost a similar amount as the HIV/AIDs initiative. Because that is unlikely to happen, get a leader and small team working with the various governments, foundations, donors, manufacturers, distributors, companies and others to build the Project.

14) Origin of the initiative: I'm a friend of Bill Drayton's, so when I got the notice of the contest, on a subject I've cared about for many years, I wrote this.

Contact Information:
Howard  Holme
President
Bandwidth Market, Ltd.
(business)
5833 Montview Blvd.
United States
Tel: 303 355 0179
Fax: 415 329 1651
Email: HHolme@BandwidthMarket.com
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