The editorial staff of World Hunger Education Service recently sat down and interviewed Peter Morris for his insights about progress in international aid, hunger, nutrition and pandemics. Mr. Morris has served in numerous crises around the world, leading USAID teams, including epidemic response to Ebola in Guinea. A nutrition expert, he has been involved in critical funding decisions by the US Government for funding new approaches to treating malnutrition in the hardest hit countries.
Question: We’re doing this interview in the middle of the Covid-19 epidemic; what do you think the public should know about how Covid-19 is increasing hunger and malnutrition?
Peter: I think Covid-19 is increasing malnutrition beyond just when people get sick from the virus. It has disrupted the food systems so much, such as diminished transport of food to markets. People living with a narrow economic margin in countries have to change their strategies of how they use their money. It’s almost like a famine because of the inability of people to access food. The World Food Programme is now asking for around $5 billion more for all the places that need food assistance, necessary as COVID-19 is affecting every country.
Q: While working for the United States Agency for International Development (USAID), you, like Ron Waldman, dealt with disease outbreaks, both those within conflict and displacements, but not epidemics that were themselves emergencies. What did you learn about how aid agencies can better prepare for these emergencies and how they should respond?
Peter: Responding to an outbreak as an emergency has never been in USAID’s wheelhouse. The Centers for Disease Control and Prevention (CDC) would send teams out to countries and work with Ministries of Health to recommend epidemiologic approaches for what that country could do. Examples of this are measles, diphtheria, encephalitis or cholera. USAID has never responded to an outbreak per se until Ebola took place. Having said that, the Office of U.S. Foreign Disaster Assistance (OFDA) and USAID’s Bureau for Global Health created a management operations center for the H1N1 crisis. However, that outbreak was not as virulent as people thought it might be. From what we know the optimal way for USAID to deal with outbreaks of pandemic potential is through prediction and prevention. USAID’s Emerging Infection group created the PREDICT project which is designed to identify outbreaks in advance and to prepare trainings and provision of Personal Protective Equipment (PPE), etc. They funded training in countries where people live in close proximity to zoonotic vectors, or where people eat wild-caught meat, or have many small holder poultry and water fowl farms. USAID worked with local veterinary groups. But with a country like China, a very large country, our contribution was a “drop in the bucket.”
As we in the Humanitarian Sector looking at it, there are two kinds of outbreaks. There is the kind where a person has to have direct physical contact for transmission. There is the other kind where it is airborne. Covid-19 is a classic case of this second one, where it broke out of a localized area. If you don’t contain it in the first ten days, it’s too late. I’m surprised this Covid-19 outbreak occurred so soon. It’s just fortunate that it wasn’t as virulent as it could have been.
In your experience, what are some of the most effective or pivotal anti-hunger programs you’ve seen?
In my opinion, School feeding has been really successful. The United States Department of Agriculture (USDA) supports this. Where they provide a meal that incentivizes vulnerable children to go to school as well as providing a nutritious meal. The other programs were providing cash for families to buy food in the market which supports the family “pot” while supporting local food systems.
While working for USAID, what were pivotal issues you were involved in?
I was in charge of the technical assistance for OFDA, which included many sectors. OFDA originally was focused on natural disasters and, later complex protracted emergencies. After Ebola, we created a unit to deal with pandemic diseases because we realized we’d have to be in it in a response way. As a result, OFDA has now set up an operations center team for COVID-19.
How did you get interested originally in hunger and nutrition issues?
I’m originally from Detroit, where my initial work was in a hematology lab working on sickle cell deficiency diseases (SCD). We saw a lot of patients with profiles that were similar to young people with severe zinc deficiencies. We wanted to see if zinc deficiency was a contributing factor to the severity of SCD, and if supplemental zinc would help.
I later went to grad school, starting out in biochemistry, which I found interesting. I joined a lab group who were looking into trans-fatty acids and as we found a correlation between diet and fat-related cancers. I did my research on trans-fatty acids and cytochrome p-450, an enzyme system in the liver that hydroxylates compounds to get them out of the body. As it happens, virtually all naturally occurring fats in food are cis fats and trans fats only occur when you process foods to allow them to be more solid at room temperature. If you eat a lot of processed foods, then the idea was they become incorporated into your cell membranes and change the fluidity of the membrane and perhaps activity the cytochrome p-450. Our idea was that if the cytochrome t450 protein is more or less active, and its purpose is to get rid of compounds that could be carcinogens.
Back in 1979 I decided to change my major from strict biochemistry to nutritional biochemistry. I got a masters and went overseas.
Earlier, when I was in grad school, I was involved in a local church and set up a program to help resettle refugees in the United States. In this program we sponsored refugees, most of whom were from Cambodia, Laos, Eritrea and Afghanistan.
I had a cousin working for an NGO in India who said come on over to work when you get out of school. When the Cambodian family heard I was going to India they gave me a fifty-dollar bill to give to their orphaned grandson on the Thai/Cambodian border. I heard about the Khao- I- Dang refugee camp of Khmer fleeing from the war between the Khmer Rouge and Vietnamese into Thailand.
As it happened, I flew to Thailand, found the camp, and actually found the little boy who was living with another family. When I was in Khao-I-Dang, I was offered a job by CARE International, an American NGO.
I started working for CARE’s supplementary feeding program, which was high-energy milk, and soup kitchens for moms. In those early days, I relied on the famous UN nutrition guidelines for emergencies booklet by John Seaman and Claude de Ville de Goyet. I liked everything about the work. It fit into my world view and faith about helping people.
I met my now wife, Margie, there at a nutrition meeting. We were married in 1984 and in 1985 we went to Agadez, Niger to work in Red Cross drought feeding centers with Tuareg people.
Later, in 1994 I worked in the Democratic Republic of Congo (DRC) – Congo (then Zaire), as their refugee nutrition coordinator for UN High Commissioner for Refugees (UNHCR), where we did sampling in all of the camps. Then I moved to Washington DC and started working for USAID.
Over the course of your career do you see progress made in reducing malnutrition and hunger?
I see progress in understanding malnutrition better, and in improving the methods to treat malnutrition. For example: the transition from many years of our promoting the use of “high energy milk”, made in a big oil drum with dried milk, oil, sugar, water and vitamins, to the pre-packaged F-75 and F-100 milk formula was important, and then the transition to “Ready to Use Therapeutic Food” (RUTF) along with innovations such as The Community-Based Management of Acute Malnutrition (CMAM) was a great improvement over high energy milk and therapeutic feeding centers in emergencies. I feel we are a bit like firefighters keeping a growing blaze at bay. Yes, methods and practices have improved, but populations have increased, and disparities have increased, and resources and food security have been shrinking for much of the world’s populations.
In what ways have you witnessed the United States Government (USG) demonstrating distinctive leadership in addressing food shortages and hunger around the world?
USAID, during Andrew Natsios time as its administrator, began looking at using cash as an alternative to in-kind food aid – I saw this personally in Afghanistan, when I was involved in assessing the food crisis.
I am very proud of the role the USG has played in providing leadership in both food security and nutrition. USAID was leading the research funding for CMAM use and micro-nutrient fortification. Now CMAM is Standard Operating Procedure for malnutrition since 2001. CMAM is the marriage of RUTF (a.k.a. Plumpy’Nut) and a development model using positive deviance in a community call the hearth model.
How in your view can the CMAM-type treatment/recovery outreach scale up to reach the 95% of malnourished children who are currently not reached?
USAID funded most of the original research for this. As the research began showing how well it worked, many of the leading NGOs such as Concern, Save the Children, and Action Contra la Faim began changing all their programs, and this lead the rest of the world to also adopt CMAM as the optimal approach to fighting severe malnutrition. With CMAM you can have a much larger reach into a community.
Have you seen examples — worth noting/sharing — of Americans, civilians, or American voluntary organizations making important progress in any hunger zones? (besides what we already discussed), i.e. from your work at OFDA?
During the beginning of the Somali crisis (early 1990s), in one of the first daring innovations, the late Fred Cuny came up with a very clever system to get food aid into Somalia using private markets. USAID’s Food for Peace (FFP) and the Africa Bureau have worked effectively with the Government of Ethiopia to create a system of food security safety net programs in Ethiopia which have made a big difference in their seasonal food crises. In fact, USAID has created a Bureau for Food Security (BFS) – now called the Resiliency and Food Security Bureau (RFS) – realizing that emergency funding is not the long-term answer – this has been an important step. The International Rescue Committee (IRC) is working on a simplified protocol for CMAM combining Moderate and Acute Malnutrition protocols to increase the reach make the use of RUTF more sustainable (The jury is still out on this, but I hope that they continue to look at it).
What do you think the public should know about the best ways to combat hunger?
I believe that if we look at the definition of food security: a combination of “Access, Utilization, and Availability” – a common thread that facilitates these three aspects is Good Governance (both Public and Private sector). Good Governance has to work hand in hand with technology (preventing post-harvest loss, better sustainable food production etc. equitable market systems, and intermediate financial institutions), use of good child feeding practices, education on both nutrition and agronomy, and adequate infrastructure (roads, transport) to open markets to people. To me this means we need an integrated way of addressing hunger. I am interested in the whole systems approaches that David Nabarro was promoting, who is currently the World Health Organization (WHO) Special Envoy for Covid-19, but previously was the Coordinator for Scaling Up Nutrition. David is now leading an organization called 4SD (Skills, Systems and Synergies for Sustainable Development) which looks at a whole systems approach to development.
Are there particular parts of the world today where hunger or disasters are being missed by the media, but which deserve more of our attention?
Syria, Bangladesh, and Yemen where you have really difficult problems but we’re seeing donor fatigue. In northern Sahel, you have the whole political issues and vulnerability to droughts, 1975, 1985, and repeating, most recently in 2006. Now the Sahel has increased conflict with ISIS, it has effected the food systems.
We don’t know yet all of the effects of global warming. Where it used to rain it now floods. Where it used to flood, it now doesn’t rain at all. Many of the poor in the world are subsistence farmers who live on the margins and can’t afford a crop failure.
What books about hunger or pandemics do you recommend to others?
I recommend people read Amartya Sen’s Poverty and Famines (1983). More recently I’ve been reading Michael Osterholm’s “Deadliest Enemy: Our War Against Killer Germs”, with Mark Olshaker (2020).
Now that you are, as of 2020, the new Chairman of the Board of World Hunger Education Service (WHES), what vision or directions do you have for this non-profit?
WHES has a great legacy but it’s not in the forefront of food issues as much as it used to be. It’s a volunteer Board. It would be good for us to do something no one has done before. I think we really want to get a first-hand look at opinion leaders in the world on food security and nutrition and let more people know what they’re doing.
Note: Peter Morris was recently elected Chairman of the Board of World Hunger Education Service, the publisher of this site.
Mr. Morris spent over 23 years with the USAID Office of US Foreign Disaster Assistance (OFDA), most of the time as technical lead as well as nutritionist and contingency planner. He led the technical staff specializing in nutrition, health, water, agriculture, shelter, livestock and evaluation involved in roughly $2 billion/year of humanitarian assistance. For several years, also, he was seconded by USAID as a director of health HNTS at the World Health Organization. During the Rwanda crisis of 1994-95 he served as a health officer in Bukavu, DR Congo (then, Zaire) helping to manage refugees. He earned an MS from the University of Maryland, College Park, and MPS in International Development from Cornell. Peter and his wife Margie, who also served on the board of the World Hunger Education Service have two sons and a daughter.
* Reference made to two interviews conducted by Mr. Morris with Ron Waldman and David Nabarro:
An Interview with David Nabarro
Pandemics, Crisis and Hunger: An Interview with Dr. Ron Waldman Part 1