WHO and UNICEF call on Vietnamese authorities to enforce food fortification regulations

The decree is in line with global recommendations to prevent and control micronutrient deficiency and it highlights the Government’s commitment to improve the health of its population.  

WHO and UNICEF note that the decree has not been implemented after more than five years since its adoption. This is despite the fact that food fortification, including use of fortified food ingredients in processed foods, is already the global norm, with no detrimental impacts on the final food product or business profitability and sales. Food fortification contributes to a smart and healthy population, which benefits society and national development.

Iodine deficiency is a significant cause of mental retardation in children, and stillbirth and miscarriage in women. Iron deficiency increases the risk of maternal death and poor fetal development and impairs motoric and cognitive development in children and productivity among adults. Zinc deficiency increases the incidence of diarrhea, the risk of acute respiratory infection and child mortality. 

According to 2021 Iodine Global Network report, Viet Nam is amongst the group of 26 countries remaining in the world with iodine deficiency. The 2019 General Nutrition Survey (GNS) conducted by the National Institute of Nutrition of the Ministry of Health (MOH)  showed that median  urinary iodine concentration among pregnant women dropped from 122 µg/L in 2006 to 83 µg/L in 2009, and remained at the very low level of 83.4 µg/L in 2019, which is far below the global standard of 150 µg/L.  In addition, the 2019 GNS revealed that only 30% of households in Viet Nam were consuming adequate iodized salt, which is alarming.  

Moreover, the GNS 2019 demonstrated that zinc deficiency among pregnant women and under 5 children is a significant public health problem, especially among pregnant women (63%) and under 5 children (58%). Iron deficiency anaemia among under 5 children was 53.2% and 50,3% among pregnant women. 

WHO recommends that fortification of all food-grade salt, used in household and food processing, with iodine is a safe and effective strategy for the prevention and control of iodine deficiency disorders. Fortification of widely consumed staple foods and condiments, such as salt, vegetable and wheat flour, is a globally recognised and highly cost-effective strategy for increasing nutrient intakes without the requirement to change eating behaviours or substantial government budget.. There is internationally-proven evidence that the use of iodized salt has no negative impact on the final product’s colour, taste and smell. 

Based on WHO recommendations, fortification of salt, wheat flour and vegetable oil are mandatory in 126, 90 and 33 countries respectively. 114 of the 126 countries that currently have mandatory legislation for edible salt iodization have included the requirement to use iodized salt in processed foods. In Asia, 17 countries have legislation for mandatory fortification of wheat flour; 7 countries for mandatory fortification of oil and 35 for mandatory fortification of salt, of which 29 countries require salt used in food processing to be fortified. 

Evidence shows that every dollar spent on salt iodization and flour fortification would result in a return on that investment of more than US$10 .  Fortification is not free, but all competitors will face the same costs of fortification. Making fortification mandatory is fair for both businesses and consumers. The same standards should be required of all relevant food products that are imported into Viet Nam. 

WHO and UNICEF strongly recommend the Government to fully implement Decree 09, including ensuring processed foods are made with iodized salt and fortified wheat flour, and companies are supported favourably and positively to ensure their compliance. Food producers and distributors can be supported by clear guiding regulations on compliance requirements and use of fortified ingredients recognising that in Viet Nam, the main source of dietary salt and wheat flour is processed foods and meals consumed outside households.  

This will strengthen the human capital of Viet Nam and is in line with the UN Decade of Action on Nutrition. We as part of the UN, recommit ourselves in supporting the Government’s drive toward attainment of national development priorities, including food fortification./.