The global total prevention of folic acid preventable-spina bifida and anencephaly (FAP SBA) is long overdue. It has been 24 years since the publication of findings from the randomized clinical trial by the Medical Research Council proving unequivocally that folic acid taken shortly before and during early pregnancy will prevent a large proportion of spina bifida and anencephaly.1 Within this same time period, vaccine programs have assured that almost every child in the world is receiving newly developed conjugate vaccines, leading to remarkable global improvements in associated child mortality and child health. Unlike the expansive global support achieved for preventing vaccine-preventable diseases, no country or donor organizations has provided sufficient resources to build the global program for the total prevention of FAP SBA. Due to lack of support, the current level of global prevention for FAP SBA has stalled at approximately 25%.2 The bottom line is that we are collectively failing children globally by letting FAP SBA to occur, which is associated with high risk of death and disability, including orthopedic, motor, neurologic, and learning and developmental deficits.