Deputy Administrator Isobel Coleman at USAID’s Wasting Research Consultation Event

DEPUTY ADMINISTRATOR ISOBEL COLEMAN: Thank you, Dina [Aburmishan], for that introduction. Thank you to my USAID colleagues who have made this consultation possible, and thank you to all of our partners in the research community who have contributed to the growing body of evidence we are exploring at this convening. Your work could not be more timely and important.

Since I joined USAID as Deputy Administrator in 2021, I have been seized with how we can better address the scourge of malnutrition through prevention, treatment, research, and evidence generation. Child wasting is a priority issue for USAID. Last year, we released a paper on wasting which outlines how USAID supports our partners to treat malnutrition using proven best practices, including through implementing the bold changes outlined in the recently updated WHO guidelines.

It also emphasizes our commitment to working with partners to strengthen our approaches to prevention. It is imperative that we continue building out additional evidence that enables us to fight malnutrition more effectively.

In June of 2023, I traveled to Sindh Province in Pakistan, one year after the devastating floods of 2022. I was shocked by the harrowing devastation that was still gripping the country: at every turn, an astounding number of lactating mothers and children - disproportionately girls - were malnourished.

A full year after the catastrophe - which exacerbated already existing food insecurity - and despite nearly half of the $215 million in U.S. assistance funding for flood response and recovery going towards malnutrition, parents were facing impossible choices - which child to feed, which meal to skip, and what asset to sell off next.

I walked away from that experience really anguished by the devastating circumstances, and resolved to shift the way we deploy our resources for nutrition in emergencies.

We must be able to reach more children in need - helping treat more of those who have reached a state of acute malnutrition, or indeed preventing them from reaching such a dire condition in the first place.

At USAID, we are continually confronting the stark reality that while global needs are reaching record levels - and continuing to rise - development and humanitarian resources are not. There is a staggering gap between the level of need and the resources available to meet those needs.

And looking at the sheer number of conflicts and crises around the world, we know the pressure on USAID's budget is poised to increase.

This forces us to squeeze more out of every dollar entrusted to us. It is our responsibility to steward our investments as wisely and effectively as possible, and to do everything in our power to achieve the greatest impact per dollar.

We know that following the evidence sometimes forces us to redirect our investments, shifting them away from activities that are demonstrably "good", because the evidence shows we could make even more progress toward the same objectives through other approaches that deliver more impactful results.

It's hard to change a program that is doing some good, but that's exactly what we need to do when we know we could achieve even more by working in a different way.

But this kind of evidence-driven adaptation is an important step toward determining and implementing the most cost effective malnutrition programming - which we at USAID view as a paramount priority, and a moral obligation as we seek to get the greatest impact possible with each dollar we spend.

Put simply, if we do not continue to innovate in this space, and to implement those changes as policy and practice, we will continue to see parents and children suffering the harrowing experience of acute hunger, being robbed of the ability to live, think, create, and thrive because of lack of access to basic, life-sustaining nutrition.

I know that this community takes that imperative - to learn about and improve cost-effectiveness - very seriously.

In terms of malnutrition treatment, we are seeing some incredible research helping us progress.

Your contributions are continuing to bolster this robust body of evidence which is helping us bring down per capita costs and reach more kids with lifesaving treatment.

This past October, I traveled to Italy for the G7 Development Ministerial and hosted an event on malnutrition at the US Mission to the UN. In my speech, I recognized the one year anniversary of WHO's release of its updated protocol on treating malnutrition, which is already creating opportunities for us to reach more malnourished individuals with programming that meets their needs.

Accelerating efforts to have more national governments implement these simplified protocols will also save lives.

This welcomed revision to the protocol was made possible because of researchers like you who contributed to the evidence driving these decisions over the course of more than a decade.

That revision also came 10 years after the last revision. So my challenge to you all today is this: let's not wait another 10 years for another revision with the power to save more lives.

Let's keep incorporating research into practice, capitalizing on new insights and approaches, and implementing new solutions to malnutrition that allow us to improve our practices and reach more people in need, as the evidence becomes available.

Because even with the advancements we've made, including this updated protocol, we know that we are still only able to reach roughly 25 percent of kids with wasting.

That's three out of four children left to fend for themselves, which means way too often wasting away. No one in this room, knowing so well the devastating human impacts of malnourishment, can be satisfied with these numbers.

We are of course familiar with the innovative, lifesaving impacts of ready-to-use therapeutic food, or RUTF. I want to recognize Andre Briend, one of the original developers of RUTF, who is here with us today.

This innovative product allowed treatment for uncomplicated cases of SAM to be shifted to outpatient settings, paving the way for community management of acute malnutrition, which marked a revolutionary step toward saving more lives.

We need to remain unwavering in our commitment to continual learning, intellectual humility, and adapting our approaches when we have new information.

All of our efforts, commitments, and investments need to be in service of improved and lasting outcomes for children.

We have to start from what we know is optimal, including RUTF use and other effective solutions for children experiencing wasting who have a lower risk of mortality.

The variety of options being discussed over these two days, and the ongoing research to understand different dosages and products for different groups, should ultimately allow us to reduce the pressure on stressed global RUTF pipelines and reach more children.

But even as we work to develop the capacity to treat more children more efficiently, we cannot neglect to recognize the importance of prevention.

Because we know that another way to save more children from dying from hunger is to prevent children from reaching the point of acute malnutrition in the first place.

This is an area that is ripe for greater attention.

If we could devote the same attention and apply the same rigor we've dedicated to treatment research to the issue of scalable solutions for wasting prevention, the results could be staggering.

We could save so many lives.

We recognize that this is a part of the spectrum of malnutrition that can be particularly challenging to research.

Getting quantifiable, hard data in this area means measuring outcomes for children who have not yet reached the point of acute malnutrition, and who may never enter a clinic to have their anthropometrics recorded.

While they may be harder to count and measure, these children are no less important.

So even as we recognize that this kind of research is incredibly hard, I'd challenge this group to take on that hard challenge - one that, with the right breakthroughs, has the potential to save so many lives, and prevent so many children from suffering the harrowing experience of enduring malnutrition.

It's gratifying to see the breadth of work that is being covered across these two days.

This is an impressive group of experts.

So many of you have already played a pivotal role in developing this field, and getting us to where we are with our ability to reach children with a highly effective, cost-efficient treatment to prevent children from dying from wasting.

I am glad to see this community is not resting on its laurels, but continuing the work of innovation and evaluation with urgency, to shape the future of this important work.

Thank you for your leadership and your many contributions.

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