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The gold standard in supplementation

The Gold Standard in Supplementation

Words by Alexander Gelfand • Illustration by Davide Bonazzi

When Alfred Sommer was completing his training as an ophthalmologist in the mid-1970s, doctors already knew that vitamin A deficiency in children led to eye problems ranging from night blindness to corneal ulcers.

But it was Sommer who discovered that the deficiency also increased a child’s risk of dying—a connection he made while analyzing data from studies he ran in Indonesia with support from USAID, channeled through Helen Keller International, the same organization whose supplementation efforts Amanda Palmer would support nearly 30 years later.

Sommer first demonstrated high oral doses of retinol could cure children of not only the deficiency but also its attendant eye problems. Shortly thereafter, he noticed something else: The more severe a child’s vitamin A–related eye problems, the more likely they were to die. In fact, their risk of mortality increased even before they began showing eye symptoms.

Sommer had Keith West, who had just completed his DrPH degree, supervise an intervention study in Indonesia’s Aceh province. The results were striking: Giving children oral vitamin A supplements in capsule form twice a year not only decreased their risk of eye problems but also reduced child mortality by a whopping 34 percent—a number so high that it was greeted with skepticism. “No one believed that at all,” Sommer recalls. “How could two cents’ worth of vitamin A decrease child mortality by a third?”

Yet Sommer, West and others replicated these findings in India, Nepal and sub-Saharan Africa during the 1980s and ’90s, and Sommer further established that giving children with severe measles vitamin A supplements cut their case fatality rate in half. Scientists now also better understand how vitamin A works to strengthen the immune system, making common illnesses like measles, diarrhea and other feverish infections far less likely to kill.

Those findings led UNICEF and the WHO to launch global vitamin A supplementation programs in 1998—programs that have since saved the lives of more than 250,000 children every year, leading the World Bank to declare vitamin A supplementation the most cost-effective strategy for improving child survival in existence.

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