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com
ScienceDirect
The social and economic impact of biofortification
through genetic modification
Hans De Steur1, Matty Demont2, Xavier Gellynck1 and
Alexander J Stein3
Genetic modification (GM) has been advocated as an
alternative or complement to micronutrient interventions such
as supplementation, fortification or dietary diversification.
While proof-of-concept of various GM biofortified crops looks
promising, the decision tree of policy makers is much more
complex, and requires insight on their socio-economic
impacts: Will it actually work? Is it financially sound? Will people
accept it? Can it be implemented in a globalized world?
This review shows that GM biofortification could effectively
reduce the burden of micronutrient deficiencies, in an
economically viable way, and is generally well received by
target beneficiaries, despite some resistance and uncertainty.
Practically, however, protectionist and/or unscientific
regulations in some developed countries raise the (perceived)
bar for implementation in target countries.
Addresses
1
Department of Agricultural Economics, Faculty of Bioscience
Engineering, Ghent University, Coupure Links 653, B-9000 Ghent,
Belgium
2
International Rice Research Institute (IRRI), DAPO Box 7777,
Metro Manila, Philippines
3
DG MARE, European Commission, Brussels, Belgium
Corresponding author: Demont, Matty (m.demont@irri.org)
Current Opinion in Biotechnology 2017, 44:161–168
This review comes from a themed issue on Plant biotechnology
Edited by Dominique Van Der Straeten, Hans De Steur and Teresa
B Fitzpatrick
For a complete overview see the Issue and the Editorial
Available online 21st February 2017
http://dx.doi.org/10.1016/j.copbio.2017.01.012
0958-1669/ã 2017 Elsevier Ltd. All rights reserved.
Introduction
Building upon more than two decades of related research,
the proof-of-concept and potential impact on public
health of biofortification – that is, the enhancement of
the nutrient content of crops as opposed to the addition of
nutrients to food during processing – has been established
for a variety of crops and micronutrients; in particular
this can be achieved through conventional breeding
(cross-breeding), genetic modification (GM), or the
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application of mineral fertilizer. Given the existing liter-
ature [1,2,3], here we focus on GM biofortification.
Evidence of the value of biofortification through conven-
tional breeding (and related dissemination efforts) as a
successful nutrition and public health intervention in
South-East Asia, Sub-Saharan Africa and Latin America,
is growing (for a progress report on conventional breeding
efforts for biofortification, see Ref. [3]). This has been
clearly acknowledged at the WHO/FAO Technical con-
sultation on biofortification in April 2016 [4]), and further
exemplified when the pioneers of provitamin A-enriched
orange-fleshed sweet potato (OFSP) were given the
2016 World Food Prize for their long-standing work to
deploy this staple crop to nearly two million African
households. In the future, also the large-scale deployment
of other conventionally bred varieties could increase.
When it comes to genetic engineering to increase the
nutritional value of staple crops, while an increasing
number of successful efforts have been undertaken
[5], no such crops have been introduced yet. Awaiting
the first approval and release of provitamin A-rich
‘Golden Rice’ and other genetically modified (GM) bio-
fortified crops, like multi-biofortified ‘BioCassava’ [6],
researchers have nevertheless attempted to examine their
economic value in various ways. This review focuses
on evidence and key literature on health impacts and
cost-effectiveness, willingness-to-pay (WTP) and trade
impacts of these crops. As such, this overview comple-
ments new/ongoing reviews focusing on nutritional
aspects [7].
Impact and cost-effectiveness
Biofortified crops are not ordinary consumer goods in that
they do not satisfy an obvious want but rather a hidden
health need. On the market place consumers may there-
fore not differentiate between non-biofortified and
biofortified crops, or they may not be prepared to pay a
higher price for biofortified crops. As such, biofortified
crops (i) have an added nutrition dimension, which puts
them into the realm of public health interventions; and
(ii) they target food insecure and poor population groups
in developing countries, which means their beneficiaries
may not have sufficient purchasing power to create the
demand needed for market actors to actually supply
these crops, even if they are aware of their nutrition
benefits.
Current Opinion in Biotechnology 2017, 44:161–168
Current Opinion in Biotechnology 2017, 44:161–168

162 Plant biotechnology

Table 1

Potential impact and cost-effectiveness of GM biofortified crops (and alternative interventions or benchmarks reported in different studies)

Biofortified crop (country) Impact Cost-effectiveness Profitability

Dawe et al. [16] Provitamin A ‘Golden’ Rice, 1st
generation (Philippines)
Zimmermann and Provitamin A ‘Golden’ Rice, 1st
Qaim [10] generation (Philippines)
Stein et al. [11] Provitamin A ‘Golden’ Rice, 2nd
Stein et al. [17] generation (India)
De Moura et al. [18] Provitamin A ‘Golden’ Rice, 2nd
generation (Bangladesh,
Indonesia, Philippines)
Changat and Protein-rich potato (‘protato’)
Krishna [19] (India)
Krishna and Qaim [20] Bt eggplant (India) b
De Steur et al. [21] Folate-enriched rice (China)
De Steur et al. [22] Folate-enriched rice (China)
Chow et al. [23] Provitamin A ‘Golden Mustard’
(India, rural areas of 16 (out of 29)
states and 8 urban areas)
Henley et al. [24] Transgenic biofortified sorghum
(Sub-Saharan Africa)
Nguema et al. [25] Multi-biofortified ‘BioCassava’
(Nigeria, Kenya)
De Steur et al. [26] Multi-biofortified rice (China)
Fiedler et al. [12] High-provitamin A and high-iron
banana (Uganda)
VA intake increases by 2–8% of current US$ 4–7 per million RAE provided (VA
intake supplementation = US$ 30–73 per
million RAE)
Burden of VAD decreases by 6–32%; 15 000–85 000 DALYs saved per year a 66–133% rate of return on R&D
investments
Burden of VAD decreases by 9–59%; US$ 3–19 per DALY saved (other VA 29–93% rate of return (international
204 000–1 382 000 DALYs saved per year interventions = US$ 84–1860 per DALY agricultural R&D investments =
saved) 17–35%)
Impact: prevalence of VAD decreases by 71–78% in Bangladesh and by 30–60% in Indonesia and the Philippines
Impact: protein content increases by up to a third, and levels of essential amino acids increase significantly; protein intake should
increase and reduce the prevalence of PEM
Impact: consumers benefit from a technology-induced decrease in eggplant prices; since eggplant is an important vegetable in low-
income households in India, this price decrease is pro-poor as positive nutritional effects can be expected from concomitant
increases in vegetable consumption
Impact: burden of folate deficiency decreases by 37–82%
Burden of folate deficiency decreases by US$ 21–64 per DALY saved
20–60%
905 000–1 685 000 DALYs saved per year US$ 92–171 per DALY savedc 21–42% rate of return
(expanding supplementation = 635 000– (supplementation when fixed costs of (supplementation = 68–104%,
1 380 000 DALYs saved) expanding services are ignored = US industrial fortification = 6–22%)
$23–50 per DALY saved)
Impact: PDCAAS doubles, while iron, zinc and provitamin A levels are expected to increase; young children should be able to meet
most of their protein requirements from biofortified sorghum porridge
Burden of VAD and iron deficiency US$ 4–5 and US$ 56–87 per DALY saved in Nigeria and Kenya, respectively (other
decreases by 6% and 3% in Nigeria and VA interventions in Africa = US$ 41–52 per DALY)
Kenya, respectively
Burden of VA, zinc, iron and folate US$ 2–10 per DALY saved
deficiency decreases by 11–46%
Burden of VAD and IDA decreases by 3– US$ 50–77 per DALY saved (World 29–34% rate of return
5%; 8600–12 900 DALYs saved per year Bank benchmark = US$260 per DALY,
WHO benchmark = US$1380 per DALY
saved)

Bt, Bacillus thuringiensis; VA, vitamin A (retinol); US$, United States dollar; RAE, retinol activity equivalents; VAD, VA deficiency; R&D, research and development; DALY, disability-adjusted life year;
PEM, protein-energy malnutrition; PDCAAS, protein digestibility corrected amino acid score; IDA, iron deficiency anemia; WHO, World Health Organization.
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a
DALYs is a common metric used in public health research to quantify the burden of a disease, illness or injury in terms of life years that are lost due to premature mortality as well as to morbidity (in
which case the severity of the condition is taken into account and the time spent with it is expressed as fractions of life years) [27,28,29].
b
Bt eggplant is a pest-resistant, first generation GM crop that is not a biofortified crop in the true sense, but it was included to show that other GM crops can have positive nutrition effects.
c
The authors only report incremental cost-effectiveness, but for better comparability across the studies, we calculated the stand-alone cost-effectiveness of Golden Mustard.
 The social and economic impact of biofortification through genetic modification De Steur et al. 163
Therefore impact assessments are needed to capture the
nutrition benefit that may not be fully priced in a market
setting [8]. Cost-effectiveness analyses (CEAs) are
required to compare the outcomes of biofortification with
the costs for the development and dissemination of the
crops. By juxtaposing benefits and costs in a consistent
way, CEAs help policy-makers prioritize interventions
for implementation while taking into account financial
constraints. Cost-benefit analyses, which are less common
in this context, express both benefits and costs in mone-
tary terms and indicate the overall profitability of an
investment.
Overall, CEAs indicate that GM biofortified crops are
interventions that offer good value for money and are
often more cost-effective than alternative or complemen-
tary interventions (Table 1). These results are in line with
conventional breeding efforts [9], and are also robust
when key assumptions are varied in sensitivity analyses
[10,11,12]. GM biofortified crops therefore represent
sensible investments that increase public health and
welfare. This can be explained with the rationale of
biofortified crops [1,2]: While other micronutrient
interventions incur recurrent costs (e.g., for supplements,
fortificants or distribution), biofortification requires a big
upfront investment into the breeding programs, but once
the germplasm has been developed, benefits can be
reaped year-on-year and across countries with only lim-
ited ancillary costs as biofortified seeds can ‘piggy-back’
on the normal seed distribution systems and be re-used by
farmers (In the case of crops that are biofortified with
provitamin A and therefore possibly change color, more
intense education campaigns may be required. On the
other hand, because of economies of scale, multi-biofor-
tified crops will be more cost-effective).
Moreover, other micronutrient interventions have their
own limitations – for example, supplementation requires
that beneficiaries are reached by public health services,
and only commercial foodstuffs are fortified – this means
poor people in remote rural areas are hardly covered by
common micronutrient interventions. Even buying
enough fruit and vegetables to meet nutrition guidelines
requires a higher percentage of income in rural areas than
in urban areas [13]. In contrast, biofortification is self-
targeting in that crops are grown in rural areas, and staples
are eaten in large quantities by poor people. It is therefore
economies of scale as well as their wider coverage that set
breeding approaches apart.
The impact of biofortified crops depends also on how
much of a given micronutrient can be engineered into a
crop, how much of the crop is eaten by the target
population, how bioavailable the micronutrients are,
and how many individuals suffer from the underlying
deficiency. For instance, this can explain why the impact
of Golden Rice in the Philippines was projected to be
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lower than in India (Table 2). In India there are more
individuals suffering from vitamin A deficiency than in
the Philippines, and the Indian study assumed higher
provitamin A-levels in the rice because by then a second
generation of Golden Rice had been bred already. Con-
sequently, the projected impact in terms of disability-
adjusted life years (DALYs) saved in India is higher
(DALYs are a metric for the burden of disease that takes
into account the severity and duration of a condition to
express how many ‘healthy’ life years are lost—in this
case due to vitamin A deficiency). Additional differences
can also arise because for cost-benefit analyses, the impact
of biofortification cannot be expressed in DALYs, which
are the same across countries, but these have to be
converted into monetary terms. This can lead to biases,
for example, if different national per-capita incomes are
used for this conversion [14,15].
Willingness-to-pay (WTP)
Foods genetically engineered to provide nutritional ben-
efits hold great promise for those seeking alternative
strategies to tackle malnutrition. Consumer studies on
foods with nutritional benefits [30] and/or GM foods
[31,32] have shown a wide variety of concepts that can
be measured to determine consumer reactions, for exam-
ple, attitude, perceptions, beliefs, (sensory) acceptance,
purchase intentions, willingness-to-accept (WTA) or
WTP, of which the latter is commonly used in bioforti-
fication studies. Regardless of the WTP method applied
(such as experimental auctions), consumers’ WTP reflects
the premium a consumer is prepared to pay for GM
biofortified crops. In other words, it measures the amount
(%) consumers are willing-to-pay more for GM bioforti-
fied crops as compared to non-biofortified crops.
Table 2 summarizes evidence from 10 WTP studies.
Overall, consumer studies indicate a high WTP for
GM biofortified foods. When information on vitamin
levels or benefits is provided, consumers are prepared
to pay a premium of 20% or more in nearly all studies.
While this corresponds with WTP studies on biofortifica-
tion through conventional breeding [33], as well as
on other potential GM crops with health benefits, it gener-
ally contradicts research on GM crops with farmer benefits
[34], for which consumers generally demand a discount of
29% (relative to non-GM crops) [35]. In other words,
consumers reactions toward GM crops are much more
positive when direct consumer benefits are involved.
These positive findings, however, refer to cases where no
specific information on the applied GM technology (i.e.,
positive, negative and/or objective statements) is pro-
vided. While WTP for GM biofortified foods is still
relatively high when consumers receive one-sided, posi-
tive information on GM technology, the provision of
negative information results in lower premiums or nega-
tive values (i.e., discounts), even in the case of dual
Current Opinion in Biotechnology 2017, 44:161–168
164 Plant biotechnology

Table 2

Consumers’ willingness-to-pay for GM biofortified crops according to provided information, in % premium for GM biofortified food

Biofortified crop (country)

Nutrition GM technology information g
information f
Vitamin Benefits Positive Negative Dual Dual + Objective
a
Transgenic biofortification
Lusk [37] b Provitamin A ‘Golden’ Rice (US) 20
Lusk and Rozan [38] b Provitamin A ‘Golden’ Rice (US) 38
Deodhar et al. [39] b Provitamin A ‘Golden’ Rice (India) 20 h
Kajale and Becker [40]b,d Provitamin A ‘Golden’ Rice (India) 4
Corrigan et al. [41]c,d Provitamin A ‘Golden’ Rice (Philippines) 33 53 7 20
Depositario et al. [42] b Provitamin A ‘Golden’ Rice (Philippines) 40 60
13 27
Gonzalez et al. [45] b Provitamin A Cassava (Brazil) 64/70
De Steur et al. [43] b B9 ‘Folate’ Rice (China) 34
De Steur et al. [44]c,e B9 ‘Folate’ Rice (China) 33 31 10 26(17h) 17 i
Colson et al. [49] c Vitamin C Potato (US) 62 14 0
22 20
Vitamin C Broccoli (US 33 38 12
12 6
Vitamin C Tomato (US) 25 28
21 3 15
Kassardjian et al. [46] c Vitamin C Apple (New Zealand) 48
Intragenic biofortification a
Colson et al. [49] c Vitamin C Potato (US) 61 50 13 2
12
Vitamin C Broccoli (US) 35 94 27 13
12
Vitamin C Tomato (US) 40 77 18 17
11

GM, genetic modification; US, United States.

Note: The values (in %) refers to the amount (i.e., premium) consumers are willing to pay more for a GM biofortified crop as compared to the non-
biofortified crop. Depending on the study, consumers received different types of information about the GM biofortified crop. When an information
treatment is not provided to consumers, an empty cell is shown.
a
Intragenic and transgenic biofortification refer to the use of GM techniques by which genes from, respectively, closely related species and species
not capable of sexual hybridization are transferred into the targeted crop.
b
Premium values are derived from a survey (i.e., open or closed-ended WTP questions) (see Supp. Table 3 in [5] for detailed information).
c
Premium values are derived from an experiment (auction or choice experiments) (see Supp. Table 3 in [5] for detailed information).
d
Based on a student sample.
e
Based on a sample of women of childbearing age; data also based on Ref. [50]).
f
Participants received information on the increased vitamin level, either alone (Vitamin) or together with its health benefits due to (Benefits).
g
Consumers received information about positive, negative and/or objective (science-based verifiable) statements related to GM technology (for detailed
information, see individual studies). Dual information refers to the provision of positive statements, followed by negative statements on GM technology.
h
Here, % premium levels are provided by consumers who first received negative information, followed by positive information about GM technology.
i
When only objective information is provided (not presented here), the premium consumers are willing to pay is higher (25% as compared to 17%,
i.e., when also dual information is given).

information, that is, when also positive information is
given. The power of negatively framed information,
which is inherent to the current reality of negative GM
campaigning, is no surprise given the adverse effect of
risk communication on GMOs (genetically modified
organisms) [36], regardless of whether the information
is scientifically underpinned.
A comparison of GM biofortification studies targeting
different crops, vitamins and regions should be done with
scrutiny. Nevertheless, the positive findings that can be
drawn from studies looking at consumers in poor, devel-
oping regions lend support for the introduction of GM
biofortified crops where related micronutrient malnutrition
is prevalent. This is particularly the case for already exist-
ing applications, like Golden Rice and folate (Vitamin B9)
biofortified rice. Regarding the former, potential consumer
demand was assessed in the United States [37,38], India
[39,40] and the Philippines [41,42], each by two different
studies. Without giving specific information about GM
technology, consumers are prepared to pay between
20% and 40% more for Golden Rice than its regular
counterpart (except for the latest Indian study). Similar
premium levels (34%) were reported for folate rice in a
folate deficient region of China [43,44]. The large con-
sumer interest in high-risk regions was further demon-
strated for vitamin A cassava in North-East Brazil, where
WTP values up to 70% were reported [45].

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 The social and economic impact of biofortification through genetic modification De Steur et al. 165
Furthermore, regarding the type of breeding approach,
one study shows that consumers are willing to pay more
for GM biofortified crops when genes are transferred from
closely related species (intragenic breeding) rather than
from non-closely related species (transgenic breeding)
[46]. Given consumers’ different reactions toward the
applied breeding approach, future research should deter-
mine how novel, more precise genome-editing tools like
CRISPR/CAS9 [47], which most likely will influence the
GMO debate [48], will affect consumers reactions.
Even though a certain segment of the population may be
still reluctant toward such GM crops, the high premiums
consumers are on average willing to pay for GM bioforti-
fied crops provide an important indication of their market
potential. Therefore, it will be crucial for decision-makers
to use these findings as a means to prioritize GM biofor-
tification as a health intervention, in order to ensure that
GM biofortified crops are consumed as widely as possible
within the target populations.
Trade and regulations
First-generation GM technologies mainly targeted farm-
ers through increased production efficiency (increased
yields and reduced costs), and benefited consumers indi-
rectly through lower prices [51], while second-generation
GM technologies such as biofortified crops aim at benefit-
ing consumers more directly through nutrition and health
benefits [52]. Being developed by private companies for
the biggest seed markets, first-generation GM crops were
major, internationally traded commodities (e.g., soybean,
maize, cotton, and canola) [53]. As a result, benefits were
shared internationally [54]. Trade studies are particularly
relevant for these crops because impacts could be
affected by trade-related regulations specific to GM crops
and derived products [54], restrictions of trade due to
heterogeneity and asynchronicity in approval [55], and
heterogeneity in food labeling policies [56], GM-free
private standards [57], and market acceptance [58].
Potential trade restrictions are a major impediment to
the approval of GM technologies, although studies show
that the economic argument is overstated in many cases.
Gruère et al. [53] reviewed the literature on global trade
effects of first-generation GM crop adoption and came to
three general conclusions. First, in the absence of GM
crop-specific trade regulations, countries that adopt GM
crops and countries that import these crops will typically
gain, while exporting countries that do not adopt GM
crops may lose. Secondly, the introduction of GM crop-
specific trade regulations reduces welfare gains, espe-
cially for non-adopters. Finally, importers’ regulations
can reduce gains for exporting adopters, but these losses
are usually dwarfed by the large domestic gains from
adopting GM crops. This argument is even stronger in the
case of biofortified GM crops, as they target domestic
consumers and are generally not intended for trade. For
those crops, domestic welfare gains far exceed the
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domestic gains from current GM crops with farmer ben-
efits [52].
However, the trade argument has received limited atten-
tion in the literature on second-generation GM bioforti-
fied crops. On the one hand, while first-generation GM
crops mainly targeted non-food (feed and fiber) markets,
second-generation GM biofortified crops mainly target
food markets for which approval, labeling, private-sector
standards, and market acceptance would matter even
more. On the other hand, second-generation GM biofor-
tified crops are tailored to subsistence farmers and con-
sumers, and most of the currently developed crops are not
major traded commodities in the targeted countries
(Tables 1 and 2; [2]; Supp. Table 2 in [5]). This
means opposition to the approval of GM (biofortified)
crops is mainly due to either external lobbying by inter-
national NGOs or due to the particular political economy
in the target country, where beneficiaries of biofortified
crops are poor and dispersed, whereas the potential losers
from trade problems that might arise from GMOs (e.g.,
through adventitious presence and the rejection of ship-
ments by importing countries) are well-organized and
politically influential, even if the overall loss of social
welfare would be minor.
Finally, GM biofortified crops are typically developed by
public institutes in the context of humanitarian projects,
where the actual concern is to deliver the technology in
the hands of the targeted populations. The success of the
latter crucially hinges on (i) the presence of well-devel-
oped seed sectors and seed markets for dissemination,
and (ii) the development of value chains that are able to
segregate, label and differentiate these crops from con-
ventional crops, change consumer behavior (e.g., in the
case of visible traits such as Golden Rice and orange sweet
potato), and inform consumers about the benefits of GM
biofortified crops [2]. Since many of the current GM
biofortified crops are targeted to traditional food value
chains in developing countries, the success of GM bio-
fortified crops will crucially hinge on value chain upgrad-
ing, development of standards and vertical coordination
in order to efficiently govern quality and identity of GM
biofortified crops from seed to plate.
Challenges and research needs
The case of GM biofortification demonstrates the impor-
tance of socio-economic analysis as a means to estimate
future impacts and barriers of commercialization, while
providing a basis for decision-making of key stakeholders
and health planners in particular. Researchers can and
should advance the aforementioned research domains in
several ways, for example, by incorporating other micro-
nutrient strategies [59], evaluating combinations of
farmer and consumer-oriented traits [60], assessing
multi-biofortification [26] or food basket approaches
(delivering a variety of biofortified crops together) [3],
Current Opinion in Biotechnology 2017, 44:161–168
166 Plant biotechnology
or targeting other supply chain actors. In addition, socio-
economic analyses should further examine and improve
the currently applied methodologies to obtain indications
of overt behavior, for example, as illustrated in analyses of
consumers’ WTP for GM foods [61] with nutritional
benefits [62,63].
Future research also needs to confirm the impact and
cost-effectiveness of GM biofortified crops in ex post
analyses, and in particular for cost-benefit analyses the
consideration of costs and the conversion of benefits
should follow a consistent approach to increase compara-
bility of the results. More research on the investments in
value chain upgrading will be needed in order to prepare
seed and food value chains for successful delivery of this
technology to beneficiaries and differentiating and pre-
serving the identity of the end-product throughout the
chain, without causing major trade disruptions with trad-
ing partners.
Despite its cost-effectiveness and positive impacts on
nutrition, public health and overall social welfare, nega-
tive information on GMOs can still cause uncertainty at
the consumer level. Notwithstanding ongoing efforts to
inform about GM crops and to implement and reap the
benefits of agricultural biotechnology (e.g., open letter of
107 Nobel Laureates [64]), a combination of further
improving breeding efforts and demonstrating their effi-
cacy/effectiveness, information campaigns and regulatory
changes [65], but also of socio-economic research (e.g.,
stakeholder level analysis) will be needed to support the
successful reports of biofortification and convince policy-
makers in the fields of agriculture, nutrition and public
health as well as consumers of the potential merits and
very tangible benefits of biofortification and genetic engi-
neering in this context.
Acknowledgements
HDS conceived the overall manuscript and contributed the section on
willingness-to-pay and the general sections, MD contributed the section on
trade and revised the manuscript, XG reviewed the final manuscript, AJS
contributed the section on cost-effectiveness and the graphical abstract and
revised the manuscript.
We did not receive any financial support for this work.
The views expressed are purely those of the author and may not in any
circumstances be regarded as stating an official position of the European
Commission.
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