Cracking the code on what’s poisoning millions of children

Some of the biggest players in global health have teamed up to tackle lead — a poison that kills nearly 1 million people every year, but has been largely overlooked in global health priorities.

The Partnership for a Lead-Free Future — which was launched in 2024 by the U.S. Agency for International Development and UNICEF, with financial backing from philanthropic donors such as Open Philanthropy and the Gates Foundation — aims to raise global attention, leadership, and resources to support low- and middle-income countries to end childhood lead poisoning by 2040. It currently involves 30 governments and 36 civil society organizations, foundations, multilateral and private organizations. Their plan: support country-led initiatives to phase out lead in consumer products, promote safe industrial practices, and protect communities vulnerable to lead poisoning through knowledge sharing, evidence gathering, and policy change.

USAID played a key role in the launch of the partnership, but it’s unclear how that will continue with the current aid freeze and dismantling of the agency. Devex reached out to the U.S. State Department for clarification but had not received a response at the time of publication.

A UNICEF spokesperson said the aid freeze has severely affected funding for the partnership's secretariat. Open Philanthropy, however, is working closely with UNICEF to “keep the momentum going.”

“We have advanced the timing of our previous funding commitment of $2 [million] so that they can staff the secretariat at the earliest, and are exploring providing them a longer runway in addition,” Santosh Harish, who leads Open Philanthropy’s grantmaking in the area of environmental health, with a focus on air pollution and lead exposure, told Devex.

The funding comes from the Lead Exposure Action Fund that Open Philanthropy launched last year and which has raised a total funding of $104 million. It committed $2 million to support the secretariat, while USAID had committed $3 million.

For organizations that have been fighting the battle against lead poisoning for decades, it’s a relief that this fight is finally getting much-needed global attention. But that’s not without some inspiration.

Harish thinks the current momentum in tackling lead exposure globally is driven in large part by the successes in places such as Bangladesh and Georgia.

“These examples basically demonstrated that, sure, there is this big problem, but then there is a way to actually actively address it and see progress in a matter of just a few years. And so I think they underlined the tractability case for working on lead exposure,” he told Devex.

In Georgia, years of collaboration between the government, donors, international health and environmental organizations, and research institutes led to a better understanding of the scale of the problem, and they’re now working to institutionalize a system for surveillance and prevention of lead exposure.

Lead is not entirely eradicated in Georgia, but the data shows that what the country has done to date is working. In Adjara and Imereti, two of its western regions, the prevalence of elevated blood lead levels among children has seen a decline from more than 60%-80% to 20% within five years, according to Nino Dzotsenidze, environmental health officer at UNICEF Georgia, one of the international organizations addressing lead exposure in children in the country.

A study published this January also found that between 2020 and 2023, the average blood lead levels in pregnant women in Georgia’s Adjara region fell by 59%. Those with blood lead levels at or more than 5 micrograms per deciliter also dropped from 73.5% in 2020 to 20.4% in 2023.

How did they do it? Through multicountry and multipartner collaborations. New York City health officials doubling as lead poisoning detectives also played an important role in this success story.

A spicy discovery

Lead is a toxic metal that can have serious health consequences for humans, with children being particularly vulnerable. Research has shown that no amount of lead is safe for children. Yet, up to 800 million children globally are estimated to have dangerously high levels in their blood.

High levels of lead in the blood have been associated with irreversible neurological and cognitive developmental impairments in children. As exposure increases, the effects become more severe, leading to high blood pressure, anemia, and even death. Increased blood lead levels in women during pregnancy can also cause bleeding, miscarriage, and stillbirth.

The impact is huge for governments. The World Bank estimated that the global cost of lead exposure stood at $6 trillion in 2019.

New York City has a robust system for monitoring lead poisoning among its residents. Children ages 1 to 2 years old are required to get a blood lead test, and assessed for risk until they are 6 years old. Individuals found to have elevated lead levels in their blood are interviewed to assess how they were exposed to it, and the health department offers to test the products suspected to contain the toxic metal. They also do undercover work collecting samples of products in stores.

It is through this system — which combines product monitoring and blood lead surveillance data — that the NYC health department found adults and children of Georgian ancestry were at an increased risk of elevated lead levels in their blood. A key source was spices, which contained “extremely high levels of lead,” according to Paromita Hore, director of environmental exposure assessment and education at the NYC Department of Health and Mental Hygiene.

It also found that the spices with really high lead levels were coming from Georgia, brought into the U.S. by people traveling from the country.

Armed with the information, the department started reporting its findings to Georgian authorities, including the Georgian consulate in NYC between 2011 and 2017, according to Hore.

In 2019, the Georgian government asked Pure Earth, a global environmental health organization working to reduce lead and mercury poisoning in more than 10 low- and middle-income countries, to help investigate where the lead was coming from and how it was reaching children. It found that some of the large spice importers and wholesale sellers were adding lead chromate, an inorganic compound with a bright yellow pigment, to enhance the spices’ color and weight.

“The government enforcement officials then came out [and] stopped that,” Carol Sumkin, vice president of development at Pure Earth, told Devex. That led to a reduction of adulterated spices in Georgia’s marketplaces, and two years later, when Pure Earth went back to check on the spices in the market, Sumkin said there was almost zero percent lead in spices.

Hore said fixing the problem in the country of origin — which in this case was Georgia — was the “ideal model."

A wake-up call

The NYC health department’s findings on high lead levels in spices created a “hullabaloo” in Georgia, UNICEF’s Dzotsenidze told Devex.

But to understand how widespread the problem was in the country, UNICEF’s local office urged the government to integrate blood lead level monitoring into the Multiple Indicator Cluster Surveys, or MICS, a major global household survey developed by UNICEF to generate internationally comparable and representative data on the well-being of children and their families and help inform government policies and programs. The goal was to provide a more accurate measure of lead prevalence among children in Georgia.

The advocacy worked. In 2018, the government agreed for the U.N. agency, which has been supporting the country since 1993, to include blood lead level monitoring in MICS. The survey was conducted by the National Statistics Office of Georgia, with technical and financial support from UNICEF and Georgia’s National Center for Disease Control and Public Health, or NCDC, as well as financial support from a wide range of bilateral donors and U.N. agencies.

It would be the first time that blood lead monitoring was included in the survey globally, but it proved to be cost-effective. Dzotsenidze, who has been at the forefront of UNICEF’s efforts to address lead poisoning in the country, said it saved time, resources, and money, as it would have been more expensive to commission a separate survey. The Italian National Institute of Health, one of the leading public health institutions in Europe, tested the blood samples for free.

The result of the survey served as a wake-up call to the government and other stakeholders in Georgia.

Forty-one percent of children in the country had elevated lead levels in their blood at or above the World Health Organization’s threshold of 5 micrograms per deciliter, and 16% of children had blood lead levels at or higher than 10 micrograms per deciliter. Prevalence was higher in the western side of the country, with more than 80% of children in Adjara having elevated blood lead levels above 5 micrograms per deciliter and 50% having levels at or more than 10 micrograms per deciliter. The survey also found lead levels at or higher than 10 micrograms per deciliter were highest in the poorest households.

The government, with technical support from UNICEF, created a working group consisting of different ministries and agencies to develop a plan to combat lead poisoning and established a state health program that provided free medical consultations, follow-up blood testing, and supplements such as iron and calcium for families whose children had elevated lead levels, as well as pregnant women.

Prior to the results of the survey, UNICEF and NCDC also started sharing information on social media and other channels on the harmful impact of lead and its potential sources. When the results came out, they provided affected families with recommendations on how to reduce their risk of exposure, such as keeping children away from landfill areas and construction sites and cleaning their homes via wet mopping.

Over time, the government expanded the state health program to include testing children and their family members, up to 18 years old, for lead and to provide medical services for those with elevated levels. UNICEF procured laboratory equipment that would allow the country to test for toxic metal content and conduct the necessary analysis to help determine sources of lead exposure. Researchers from several donor countries, such as Norway, Canada, Israel, and the United Kingdom, have also provided technical support for capacity building of the laboratory staff, Dzotsenidze said.

Key ingredients of success

Data played a major role in the efforts to combat lead poisoning in Georgia. It was vital to showcase the problem and get the government to take action, experts said.

“When you can show the data that indeed this problem exists, and that there are protocol and very specific interventions that you can do, then that really does result in activation — and that was certainly the case in Georgia,” Pure Earth’s Sumkin said.

Georgia isn’t the only place where data has been central to efforts to combat lead poisoning.

In the Philippines, Pure Earth was able to convince the government to incorporate blood lead level testing in children aged 6 to 9 years old in its national nutrition survey — which is conducted every three years — to gain a better understanding of how many children are at risk of lead poisoning.

They found that of the nearly 3,000 children who were tested, the average was 1.96 micrograms per deciliter of blood — significantly lower than the WHO threshold, although still concerning given that no level of lead is safe for children. Based on the survey result, the organization estimated that 1 million children ages 6 to 9 years old are potentially at risk of lead poisoning.

Pure Earth’s Philippines country director, Larah Ibañez, said presenting the data to the country’s environmental health committee led the government to consider how to integrate lead detection, treatment, and management in its clinical practice guidelines, and look into the cost-effectiveness of scaling up blood lead surveillance nationwide.

Data from the NYC health department — which also found lead in spices used by Bangladeshi households in New York — and researchers from Stanford University and Dhaka-based icddr,b, formerly the International Centre for Diarrheal Disease Research, was also instrumental in getting the Bangladesh government to take action against lead poisoning. When government authorities learned that farmers were putting lead chromate in turmeric, an essential spice and important cash crop in Bangladesh, to make it more appealing to consumers, they put up notices and warned the public against buying brightly colored turmeric roots. They also conducted workshops with farmers and mill owners on the dangers of adding lead to the food they’re selling and imposed hefty fines on those found to be selling adulterated turmeric, according to a report by NPR.

Georgia faces some looming challenges, however. It is an upper-middle-income country and is getting less aid from external sources, Dzotsenidze said. The U.S. and European Union also froze aid to the country in July 2024 over the passage of a law that designated civil society groups that receive more than 20% of their funding from abroad as foreign agents — although it’s unclear if and how that affects efforts to combat lead poisoning.

And while the government remains committed to addressing the problem, leadership changes create uncertainties.

“If the government commitment … does not remain the same, it could be a challenge,” Dzotsenidze said. There have been several government changes in Georgia over the years. Georgia’s health minister has changed four times since the conduct of the MICS survey in 2018.

Taking it global

Georgia’s success to date highlighted the importance of country-led ownership of a problem, but also the usefulness of ad hoc efforts — such as the testing of spices in New York — to raise awareness of the existence of the problem and its potential sources, Open Philanthropy’s Harish said.

Abheet Solomon, senior adviser for the environment at UNICEF in New York, told Devex that the lessons from Georgia have been reflected in the design of the Partnership for a Lead-Free Future, for which UNICEF serves as the secretariat. It also underpinned UNICEF’s approach to ending childhood lead poisoning in the 36 countries where it is implementing programs.

In 2024, for example, UNICEF supported the Ministry of Health in Bhutan to conduct its first national blood lead level survey in children and pregnant or breastfeeding women. The result? They found that over half of Bhutanese children ages 1 to 6 years old had more than 5 micrograms per deciliter of lead in their blood, and 76% had more than 3.5 micrograms per deciliter of lead in their blood. In addition, 3 out of 5 pregnant or breastfeeding women had blood lead levels at or more than 3.5 micrograms per deciliter. Solomon said the agency has plans to conduct similar surveys in Bangladesh, Cambodia, and Nepal.

As for Georgia, Solomon said UNICEF is committed to supporting the government “over the next few years to help expand the surveillance system nationwide and to identify and tackle every last source of the lead exposure,” hoping that more donors will join the partnership and commit support to the efforts in Georgia for every child to have a lead-free future.

But replicating or adapting the lessons from Georgia in other countries comes with challenges, he said. Countries are facing many competing priorities, and there’s a lack of donors to fund country-led efforts. The U.S. aid freeze has had a significant impact on resources for the partnership’s secretariat and UNICEF’s support to countries tackling the issue, according to a UNICEF spokesperson. The U.N. agency for example has been unable to test the status of childhood lead poisoning in some South Asian countries and what’s contributing to it.

However, UNICEF remains committed to the goals of the partnership — a lead-free future for every child — and it has had engagements with over 50 countries to move forward with the agenda, with multiple technical exchanges, the spokesperson said. The U.N. agency is now working with philanthropic donors to help fill the gap in funding and leadership for the initiative.

There are also gaps in enforcing regulations in low- and middle-income countries and a lack of safeguards to ensure proper management and recycling of used lead-containing batteries. The health sector may also not have the same capacity to confront the impact of pollution on children as they do when it comes to infectious diseases, and it can be difficult to get different sectors of government to work together to end childhood lead poisoning.

In many places, the major sources of lead exposure and how they can be mitigated are still unknown. In a large country such as India, for example, that would require lots of coordination with different players in government, Harish said.

“You need this large surveillance work to understand the extent of lead poisoning in any given geography. Are there hot spots? What are the likely sources? Then one needs to test the sources. One needs to sort of test different potential interventions to figure out what a playbook could even look like,” he said.

Editor’s note: This story is part of a Devex series on what’s working in global health, supported with funding from the Gates Foundation. Through this reporting, Devex will cover global health successes, exploring how these responses worked, what challenges they encountered, as well as key lessons and insights. Devex retains full editorial independence. To get in touch about the series, including pitches for us to consider, email editor@devex.com.

Photos by: Pure Earth, UNICEF Georgia, and Guduru Ajay Bhargav

Cracking the code on what’s poisoning millions of children

A spicy discovery

A wake-up call

Key ingredients of success

Taking it global

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