How do mycotoxins fit within USAIDs priorities

USAID efforts to address mycotoxins are found in the agricultural and trade sectors - being the support for the CRSPs addressing staple commodities and the CGIAR center programs on maize and peanut. The primary justification for these investments is the importance of the mycotoxins to trade and access to the markets of Europe, Japan and North America. In contrast there is no articulated effort to address these toxins from the health, child survival, HIV and nutrition perspectives. USAID's Environmental Health program is committed to preventing suffering, the saving of lives and the creation of a brighter future for families in the developing world. This commitment includes addressing such issues as maternal and child health, reduction of infectious diseases, e.g., HIV/AIDS, malaria and tuberculosis, environmental issues associated with smoke and water and micronutrient availability. These issues are clearly important risks to health and productivity in developing countries; and the close relationship between the WHO assessment of risk and the USAID priorities is clear. What is not clear, however, is the extent of these problems that is attributable to the anti-nutritional effects of mycotoxins and how much is due to inadequate supply or other environmental factors. From an epidemiological perspective the crucial question is what proportion of these health risks can be attributed to the prima facie causal agents and what proportion can be attributed to the indirect effects of impaired immunity and lowered nutritional status from contaminated foods.

A major problem is that the model used is one for commercial large-scale food systems that can assure safe food and meet the standards for Codex Alimentarius. Unfortunately, solutions that are effective in developed countries often are impractical in developing countries, where relatively little of the food consumed passes through formal quality control systems, and where food insecurity continues to ensure that even food known to be contaminated is consumed because there are few, if any alternatives. Until the proportion of the burden of disease presently attributed to a health risk can be partitioned into that due to the mycotoxins, and into that due to the direct risk, this perception will continue. However, given the fraction of the burden of disease that is modulated by nutrition and immunity (43%) it is possible that the cost of addressing the direct risk is many times higher because neither developing countries nor donors have considered the indirect role of these toxins when making health estimates or setting health policy(ies). Many of the present investments in programs designed to deliver vitamins and drugs probably could be reduced if the myco-toxin levels in the foods were adequately managed.

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