To address the needs of malnourished children in malnutrition hotspots, there will not only be a need for a massive scale up of the production of existing products, but also a need for experimental and operational research to develop additional varieties and formulations of RUF.

If today's UN recommendation of treating severe acute malnutrition with therapeutic RUF is to be realised, there is a need for 258,000 tons of product. Production capacity in 2007 is estimated to be less than 19,000 tons, with orders placed projected to be for only 8,500 tons.

Therefore only 3% of severely malnourished children are likely to have access to treatment this year. This enormous production gap does not even take into consideration the requirements for a potential extension of RUF use for moderately malnourished children or as a supplement to populations of vulnerable children.

The market is currently dominated by a single milk and peanut-based product, with few other options available. MSF has been advocating for Nutriset, the patent holder, to offer favourable licensing terms to other producers.

At a current cost of ââ?š¬3 per kilo, total product cost would amount to ââ?š¬750 million to treat the 20 million children that WHO estimates have severe acute malnutrition. However, considering that raw materials account for at least 50% of locally produced product and that the most significant cost is powdered milk, the future cost will be higher.

The price of milk powder increased dramatically in 2006, rising from ââ?š¬2,000 to ââ?š¬4,000 per metric ton. Today there is a worldwide shortage of milk. In June 2007, the average cost to treat one child with therapeutic RUF amounted to ââ?š¬34.2. In January 2008, it is predicted that this figure will rise to ââ?š¬38.7 per treatment. This is still a low cost to save a child's life.

To address the needs of malnourished children in malnutrition hotspots, there will not only be a need for a massive scale up of the production of existing products, but also a need for experimental and operational research to develop additional varieties and formulations of RUF.

There is an urgent need to increase choices and diversify supply of high value nutritional products, and to adapt their use to a variety of clinical situations ranging from the treatment of the most severe forms of malnutrition, to supplementing the diets of vulnerable populations of children subsisting on highly restricted and deficient diets.