COMMENTATOR (COMM): Previously on Life...

DR. FUCHS: You can't develop a society economically and financially if you don't have good health.

JAYATI GHOSH: There is a real danger that we are actually undermining the next generation.

CAROL BELLAMY: There are still thirty-two thousand children under the age of five dying from totally preventable causes. Totally preventable!

COMM: Blindness and eye disease have long been linked with lack of Vitamin A. Far less well known is the role it plays in children's resistance to common childhood illnesses. Without enough Vitamin A in their bodies, children can't fight off respiratory infections, diarrhoea or measles. Two million die every year as a result. In Northern Ghana, before the introduction of routine immunisation and Vitamin A distribution schemes, children regularly ended up in hospital.

DR SAMUEL BUGRI, Director of Public Health, Ghana: At one time I was keeping the children's ward and routinely -daily - we signed death certificates for children dying from measles from malaria, from diarrhoea - regularly. And I felt that, well - and, and half of the ward was full of measles cases. And we took up the challenge into going into public health and within five years of concerted effort, we were able to reduced the incidences of measles annually from twenty to thirty thousand, in the Northern Region alone, to less than five thousand a year. In public health our concern is preventing these diseases and Vitamin A provides us with that opportunity in strengthening their resistance to disease.

COMM: Since 1996, the Canadian Government has provided a billion Vitamin A capsules through a UNICEF programme. National Polio Immunisation and Child Health Days provide a vital thread in the Vitamin A distribution network which now reaches nine out of ten children in the country. In the Northern Region, volunteers distribute capsules to under fives and mothers of new born babies.

IDDI ALHASSAN, Volunteer, Jakpahi Village: You know farming depends on the rain, so once the rains start, I start work on the farm. But when it ends I can do this volunteer work.

COMM: Iddi's role is vital. While the donation of capsules is key to the Vitamin A distribution programme, its continuing success relies heavily on the good will of Iddi and volunteers like him. Esi Amoaful believes this will continue.

ESI AMOAFUL, National Vitamin A Co-ordinator, Ghana: These village volunteers were already giving health services, they were involved in the Guinea Worm eradication programme - and of course the health workers are part of the health delivery system and therefore they are already going into the communities and are in touch with these children. Teachers are also part of the Ghana education service. So these are existing structures, coupled with an intensive information, communication and education programme to ensure that our target population are also constantly reminded of the importance to go for capsules - but not only that but also eat Vitamin A-rich foods.

GHANAIAN WOMEN SINGING (TRANSLATION): 'Some food protects us from illness, And some food makes us healthy. The type of food that gives us blood is meat, eggs, peanuts! Some food protect us from illness, And some food makes us healthy.'

COMM: Vitamin A is found in a variety of sources - dairy foods, fish and liver, dark green leafy vegetables, fruits like mango and papaya, and red palm oil. But the price of some of these foods, as well as their availability, make changing traditional diets a slow process.

DR SAMUEL BUGRI: The challenge after the supplementation - the other challenge is to find out whether it can become a regular part of their diet. And that comes with change in the um the cultural habits of what they eat and how they prepare their food.

ESI (TRANSLATION): You remember the last time we came?

MOTHER (TRANSLATION): Yes.

ESI (TRANSLATION): And when we prepared porridge we added Palm Oil and we made it in the chief's house nine? This is Palm Oil and we bought some fish and meat as well.

JON (TRANSLATION): We bought some vegetables so you could use that as well.

ESI (TRANSLATION): You can chose either.

JONATHAN DAPAAH, Research Assistant, Kintampo Research Centre: We try to teach them to use foods in their cooking. And one of these was preparing porridge and then adding red palm oil. And this is a new thing to most of the mothers because under normal circumstances they think porridge goes with sugar, but because we wanted to encourage the mothers to give more of Vitamin A rich foods to their children we introduced the porridge with red palm oil to them. We try to encourage the mothers to also eat more green leafy vegetables and because we found out these leaves are available in the village - they normally dry these leaves, not eating them very fresh -so we encourage them to prepare them in their green form. Which, I mean, will help to improve upon their Vitamin A.

COMM: In another part of the world, in Guatemala, they've come up with a different solution. They use sugar to deliver synthetic Vitamin A. It was the fight to save children's eyes that drove doctors to embark on the rocky road to government legislation - and get the sugar industry to agree.

DR FERNANDO BELTRANENA, Ophthalmologist, Guatemala City: It came to points sometimes - like, some guy came to me and said 'Listen, how many cases you have now? OK. How much does it cost to get corneas and to get transportation? Ok, how much?' 'Right now, what, two hundred and sixty thousand dollars?' - I mean quetzales which was at that time dollars, I mean, anyway - he says, 'OK, I want to give it to you - but stop trying to fortify sugar, it's much more expensive!' Something like that. People came to that point in, in fighting back. One single and cheap measure of public health and er of course you know what we did was just announce it! Because it was terrible and it was a change that Guatemala was going to be a pioneer.

COMM: Although fortification of sugar started in 1974, it was sporadic. It wasn't until the mid-1990s that the sugar industry heads finally accepted that they, too, had a responsibility for public health across the country.

DR OSCAR PINEDA, Food Fortification Specialist: I went to all the sugar mills and I took samples of the children that lived there, and I showed them the result; with their own children - it was like, the children in their family, you know? And they knew it was right and they knew they were improving on that. And then there was a big fight after that, because money was concerned, you know? And at that time we were talking about three million dollars worth of Vitamin A - it was a large amount of money. And, just by chance I saw the figures of how much they were selling in Guatemala: it was a huge amount of money. And we told them, 'Look, if you sell this much, this is nothing for you -it's a fraction of one per cent of what you want to spend and the benefit would be so large that you may as well be nice enough and do it!' And they bought the idea.

DR FERNANDO BELTRANENA: I never thought that there was going to be so much impact even though I believed in fortification and I thought that the eyes were going be the ones that really would get healthier. But to know - to see the statistics in child survival. And fortunately we see now also around the world where it has been used that this is the main goal that we get from vitamin A. These preventive measurements which can reach a very large population of children definitely will save money. Because, because when you see a child like just looking into blindness, a child that goes blind; how much does it cost to the State if they are going to have forty, forty-five, sixty years of life? That would be really very expensive for the society.

COMM: There is some Western criticism of sugar as a Vitamin A carrier. But Guatemalans claim fortifying sugar's the best way of reaching the maximum number of people because it's such a basic part of the national diet. COMM: But it doesn't reach everyone. With such a scattered population, in rural areas in particular, one in five Guatemalans miss out - and they're usually those living in the poorest conditions.

DR ALMA GURADO, Mezquital Health Clinic, Guatemala City (TRANSLATION): The most usual problems we have with the children here are respiratory problems, diarrhoea and intestinal parasitic infections - these are the most frequent problems we see.

DR OSCAR PINEDA: The longer term goal is food - just improve the quality of food of the people to improve their diet. With a good diet, they shouldn't have any problems or anything. But this is a big order. Eventually it may happen, but it is a big, big order because you may go to places where you see that people are so poor that they cannot do much. And the conditions of the soil are so extremely poor that there are only very few things that they can grow. Still, if they could improve on that, they could do to it!

COMM: The charity, Action Aid, works with many people in developing countries and it agrees that food is the long term solution to vitamin A deficiency.

SALIL SHETTY, Chief Executive, Action Aid: No single micro-nutrient deficiency exists in isolation. Most of the people who suffer from vitamin A deficiency also suffer from all other types of deficiencies: zinc, iodine etc. So a food-based strategy is a much more integrated way of tackling the problem. In addition, I think if you're talking about food-based strategies you are talking about locally available foods and you can make it appropriate to local dietary habits and patterns. Bangladesh is a celebrated example where this is working at a fairly large scale, almost three million people covered with small-scale kitchen gardens. And not just for people with land but even for landless people, using embankments, you know common land - as well as poultry, for example.

PART TWO

COMM: Plant biotechnologist, Ingo Potrykus, doesn't believe the existing programmes are enough. He has devoted the last ten years of his professional career to developing a genetically modified rice that contains vitamin A. In 1999 he grew the first successful golden rice. PROFESSOR POTRYKUS: The beauty of genetic engineering is that the entire technology is built into the seed and if the farmer gets one seed he can grow up the seed. One plant produces about a thousand seeds and he can grow a thousand plants then he can produce fields and fields and fields with this technology without paying anybody any licences or being responsible to anybody.

COMM: To date the technology has cost $2.6 million. The Rockefeller Foundation, which funds many sustainable agriculture programmes in developing countries also funded the initial research into golden rice.

GORDON CONWAY, Chief Executive, Rockefeller Foundation: I don't necessarily think it's the best way - it's one of a whole range of things that we have to do. We have to supplement, as I've said already, we have to increase the range of foods that people eat. Those are the kinds of things we have to do but I think that the vitamin A rice will in particular get to poor families in more remote places.

INTERVIEWER : How will that happen?

GORDON CONWAY: Well, they'll either grow it themselves or they'll be able to purchase it. But er in the most remote places we would expect that they would - the rice that they grow would be the vitamin A rice - that at any rate, they would grow that rice for their children.

SALIL SHETTY: Our biggest concern is the extent to which people themselves are involved in the process of deciding whether or not it should go ahead. We are also dealing with a great deal of uncertainty about the health, social and environmental effects of golden rice, we don't really know enough about it. And of course there is the very practical question of, you know as to whether people would be - particularly, you know, in Asia and Southeast Asia which are the big rice consuming belts - as to whether people want to go in for a yellow tinted rice when there very used to dealing with, you know, polished rice which is very white in colour as you know. PROFESSOR POTRYKUS: My possibilities do not go beyond offering for free these organisations what we have produced. If some people decide that they want blind children and white rice it's their decision. I'm offering the possibility of yellow rice and no blind children. But the decision what people want to eat is theirs.

COMM: Seventy patents owned by some thirty-two companies and institutions have been used in developing golden rice. But Ingo Potrykus is confident - after a difficult year of negotiations - that farmers won't have to pay for this technology.

PROFESSOR POTRYKUS: Now as we have reached a state where we have virtually the agreement of all important patent holders to give free licences to this purpose, I am absolutely certain that the farmers will get this material free of charge and free of any other obligations or any dependencies from anybody. That's clear.

GORDON CONWAY: Astra Zeneca is going to do all the bio-safety testing and get the patents sorted out. And it has promised that the vitamin A rice and technology will be available for plant breeding institutes in developing countries - in the Philippines and India and Bangladesh, and so on. And I believe it'll do that, if that's what it said it'll do - but of course we have to keep the pressure on. There should be a spotlight shone on those companies and that's where, I think, activists have a particularly important role to play. It's to make sure that multinationals live up to their promises.

SALIL SHETTY: Ultimately the whole debate on GM and vitamin A rice is not any difference in that sense. It's a debate about control and dependency and, you know, for example we understand a lot of the rice which has been earmarked for vitamin A , sort of modification are ones that are dependent on agrochemicals and irrigation. So the whole - you know, the problem of shifting control from poor farmers to larger corporations and forces beyond their control is a big concern. And, er, it's, it's almost like a vertical chain of dependency that's created every time a whole new technology is introduced. I want to say that we are not at all against technology in an absolute sense - obviously not, I mean, technology's brought many benefits - but at the same time, you know, we are very concerned as to, you know, where poor farmers will keep losing control over time.

COMM: To include poor farmers themselves in the global debate on genetically modified crops, Action Aid set up an unprecedented meeting in Southern India this year. Scientists, government officials, NGOs and biotech corporations sat down with the farmers to discuss a full range of issues on food security.

CAPTION: 'Citizens' Jury, Karnataka'

JURY MEMBER: So what we are saying is probably by selecting the very élite plants and multiplying by these kind of matter of tissue culture, maybe you the farmer can have plantation which are a better quality. So this our experimentation shows there is a great potential in this technology.

2ND JURY MEMBER (TRANSLATION): I'm the keeper of traditional seeds in my village and when people need them they come to me because I have varieties of seed no-one else has - in the future I want to conserve even more varieties of seed.

SPEAKER: Now a stage has been reached when the farmers will have either to spray or they will have to pray so we have reached such as situation today. Now it is during this situation that the transgenic technology seems to have come to the rescue of the farmers.

3RD JURY MEMBER (TRANSLATION): When the Green Revolution you said it was a safe technology. But soon we had a lot of problems with the pollution. Now you say biotechnology is best. How can we be sure that after ten years it will not backfire in a similar way and we will again be the victims?

4TH JURY MEMBER: We're not people who are saying, 'Let's go back to nature, let's not use modern technology!' We are saying, use technology very carefully in line with principles which maintain the ecology of the region and also technology in control of the people.

JURY MEMBER (LAKSHMAMMA) (TRANSLATION): Most of the jury wanted a stop put to GM crops until extensive field trials have been carried out for at least five or ten years. Since we have the real practical knowledge, farmers like me should be made active participants in these trials - not only in yield assessments but in safety and environmental and other aspects.

SALIL SHETTY: We think that in relation to vitamin A rice it's very important we go through these kinds of processes at a reasonably large scale, where people can themselves can give their views on it. And that's why increasing the awareness of people of their own rights I mean, in this context, I mean, the rights we are talking about are, for example: the right to have a choice. A real choice, not monopolies in agricultural markets is a real right which gradually people are losing out on. A right to have self-reliance, you know, to depend on themselves rather than depending on other people. A right to access to land. These are the types of rights that people have to be aware of and start claiming - there's no shortcut, I don't think.

Another very key factor in relation to vitamin A deficiency as you know, is the whole question of water sanitation and hygiene. Because if we introduce vitamin A and people are unable to absorb it because of poor water sanitation and diarrhoeal conditions there cannot be a solution which is in isolation.

GORDON CONWAY: We are going to have to do the right kinds of tests: health tests and environmental tests. And that's what will now be done to ensure that this is going to be as safe as one can make it. I think it will come out pretty safe - from what I can make out.

INTERVIEWER: Do you have any concerns about the uptake of vitamin A by people who are living on meagre diets?

GORDON CONWAY: I'm not sure about that - I think that's the kind of health tests that will have to be made. But er the health experts who have looked at it at the moment don't seem to be concerned but we - we need to look at that more.

COMM: Ingo Potrykus is aiming to distribute the golden rice to plant breeders and farmers in the next three years - and he is not content with just rice.

PROFESSOR POTRYKUS: We got a patent on producing pro-vitamin A containing co-plants - not only rice. We are involved in helping to transfer the same character into wheat, into African white maize, banana, sweet potato, cassava, other crops. In ten years from now there maybe all the major staple crops improve with regard to vitamin A supply.

SALIL SHETTY: If we are talking about, let's say the next five to ten years, we are very concerned that the other technologies for dealing with Vitamin A deficiency - for dealing with nutritional deficiency generally - are not lost in the meantime. And that adequate investments which are made in the whole question of sustainable agriculture, public health, water and sanitation - you know, all of which affect the nutritional status of poor households.

COMMENTARY Gordon Conway agrees there's no magic solution. All avenues, he believes, have to be explored.

GORDON CONWAY: Vitamin A is by far the most important of the deficiencies. We're talking about millions of children dying because of Vitamin A deficiency. It's not just the fact that many of them go blind. It's the fact they die because they don't have resistance to diseases. What we discovered - and we discovered this only about 10 years ago - is that children who get diarrhoeal infections tend to die if they don't get a good supply of Vitamin A, and that was the discovery that made everyone concentrate on Vitamin A.

END