Drones save the day in Yellow Fever vaccine campaign in DRC

Drones were used by the Democratic Republic of Congo government, WHO, UNICEF along with VillageReach and its technology partner Swoop Aero and other donors in achieving a mass Yellow Fever immunization campaign across Equateur province in north-east DRC. Olivier Defawe, the Director of Health Systems at non-profit VillageReach spoke to Lakshmi Ajay, Logistics Update Africa on the exercise

What is the Yellow Fever vaccination campaign and its objective? What is the size and scale of this initiative?
The Yellow Fever vaccination campaign was almost a month-long campaign in Oct-Nov 2021 organized by the DRC Ministry of Health (Expanded Programme on Immunization (EPI)) with support from WHO and UNICEF. To accomplish the campaign target of vaccinating 90% of the population (ages 1-60) in Equateur province, the provincial government reached out to VillageReach to seek help reaching remote and hard-to-reach villages using the existing drone delivery network.

What has been VillageReach's role and of other stakeholders involved in this initiative?
Since the end of 2020, Equateur province, in the northeastern part of DRC, is home to a two-way delivery network using Swoop Aero drone technology. The Provincial Ministry of Health, with technical assistance from VillageReach and financial support from donors coming together, including GAVI the Vaccine Alliance, and the Bill & Melinda Gates Foundation, established flight operations to address health product delivery needs given the challenging terrain in the Equatorial region.

Using drones, the provincial authorities have been distributing vaccines and other immunization and health products (e.g. personal protective equipment PPE, lab samples including Covid-19, and medicines) for the last year, on a monthly or on-demand basis for children and women in 38 hard-to-reach health areas, via 22 drone landing sites. VillageReach acts as a fourth party logistics (4PL), while the drone service provider Swoop Aero plays the role of third-party logistics partner (3PL), with public health facilities being the actual clients.

What are some outcomes achieved in the initiative?
VillageReach in collaboration with external evaluators from Kinshasa School of Public Health and the University of California, Los Angeles have an ongoing evaluation of the Equateur drone programme. Midterm evaluation results after 3-5 months of drone integration into the health supply chain include:
• Vaccine availability at the health centers where the drone lands improved over the prior 3 months from 78% at baseline (before drones) to 102% after 5 months of drone deliveries, exceeding targets.
• Stockouts for all routine vaccines had been reduced to 0% for the prior 3 months (except for the BCG vaccine which was experiencing national shortages).
• Health workers from the 6 most remote health centers saved 2 days of travel time each month thanks to the drone bringing the vaccines to them, and health workers from another 4 health centers saved up to 1 day of travel time each month - allowing more time for clinicians to spend with their patients.
• The proportion of patient Polio samples that arrived in a timely manner at the laboratory in the capital of Equateur improved from 10% to 52% (drones pick up lab samples from the health centers only when they drop off vaccines).
• There was an increase in the percentage of health facilities that were 'stocked according to plan' (with 5 weeks of routine vaccines, diluents, and syringes) from 34% to 86%.
• There was also an increase in the percentage of advanced (mobile) vaccination sessions in the communities, plausibly linked to improved availability of products flown by drones.

What health workers like most about drones:
• Speed of transport/deliveries, consistency of deliveries each month, no more stockouts/better availability of immunization products, speed of transport for lab samples and reports, less out of pocket costs for health workers who otherwise would have to travel and spend money to go collect the vaccines each month at the district health office (which can be quite far from the health facility and sometimes involves an overnight stay there).

How was the initiative undertaken? How were issues like maintaining a cold chain, epidemiologic surveillance, and unexpected issues managed better by the use of drones?

Specifically for the Yellow Fever campaign, a fleet of six drones flew over 7,300 km in total in 21 days serving 5 health centers where Yellow Fever vaccines were administered. The six drones transported 32,460 doses of Yellow Fever vaccines, 19,520 diluents, and 15,000 vaccination cards – a total of 142kg (747 liters). The drones enabled the vaccination of 27,788 people (1-60 years old) living in a very remote and hard-to-reach region of Equateur province. The use of drones saved a significant amount of time on all 5 routes served during the Yellow Fever campaign. The most remote 2 health facilities received the products in 1 hour by drone (it would have taken 14-15 hours by ground) and 2 health facilities that were closer, but still hard-to-reach, received the products in under half-hour (vs. up to 4 hours by ground).

In addition, drones also allowed for just-in-time delivery of Yellow Fever vaccines on the day of the vaccination at one of the health facilities where the refrigerator wasn't working, and thus they couldn't store the vaccines from one day to another. Finally, the vaccination campaign also led to increased epidemiologic surveillance activities, and the drones allowed for quick transport of 38 lab samples from the remote health facilities to the provincial-level lab and EPI for processing (21 of these were Yellow Fever samples, the others were samples of other infectious diseases).

What were the medical aid delivery timelines that were achieved during this initiative?
Here are a few examples of the same:
1. Maanga health center (fridge was broken at this health facility, so it received Yellow Fever vaccines every day during the campaign) which takes 15 hrs by ground transport vs. 1 hr by drone transport
2. Nkake health center: 14 hrs by ground transport vs. 1 hr by drone transport
3. Ekele health center: 1 hr by ground vs. 8 min by drone
4. Ipombo health center: 4 hrs by ground vs. 29 min by drone

Since the transport time is reduced to under 1 hour (and for health facilities that are closer to Mbandaka where the main drone port is, to under half-hour), maintaining the vaccines and lab samples between 2-8 degrees Celsius did not pose problems and only required the use of chilled ice packs which EPI provides. Note that temperature during transport is being monitored using a small digital thermometer. Drones presented an opportunity to leapfrog cold chain challenges during transport and at the destination, due to their faster speed than ground transport.

How have drones aided the community during the pandemic?
The Coronavirus reached Equateur in 2020, but it hasn't affected this part of DRC to the extent that the capital Kinshasa or other countries were affected. In 2021, health workers sent 5 Covid samples by drone to be tested by EPI (but the drones carried 113 samples of various infectious diseases in total: Polio, Measles, Yellow Fever, Ebola, Monkeypox, HIV, TB, and Covid). Therefore so far the provincial government hasn't expressed a need to transport Covid vaccines by drone to remote areas of Equateur province (which are the areas that have been prioritized for drone transport).

However, in Malawi where VillageReach and Swoop Aero are partnering with the Ministry of Health, the drone delivery network has transported over 12,000 Covid vaccine doses between May-Dec 2021. In Malawi, we have utilized the drone networks to transport a wide range of health products: medicines, vaccines, PPE and other medical supplies, HIV and TB lab samples, test kits and test results, and medical, pharmacy, and lab reports, to and from hard-to-reach facilities.

VillageReach supports the health priorities of each local community that it serves. So while Covid may not have been a big problem in the Equateur province of DRC, the province did have an Ebola outbreak in 2020. We have received funds from USAID via UNICEF to sustain and extend the drone network in order to better prepare drones to collect Ebola samples in the future in order to prevent the next outbreak.

What are some other areas in healthcare access and delivery that drones are being used in recent years in different parts of Africa?
In Malawi, we've had 2,024 HIV and TB samples being transported by drone from May-Dec 2021 – this makes sense since HIV is still a big problem in Malawi, affecting up to 10% of the population.

In Mozambique, the main focus of the drones network that VillageReach is currently helping set up will be on Covid samples – and all other lab samples, as per the decision of the Mozambique National Institute of Health, in charge of Covid testing. In early 2022, following successful drone test flights of Covid and TB samples in Maputo province, VillageReach will work with INS, Swoop Aero, and the Inhambane province to establish a drone network that will pick up lab samples daily from 5 hard-to-reach district hospitals, for faster processing at the provincial or national lab.

Many companies are now looking at local persons who can operate these drones and are giving them training in many parts as well. What is VillageReach's role, do share details on the same?
Swoop Aero being the drone service provider, they have developed a training programme for the aviation component of a drone delivery service. In fact, in DRC and in Malawi where they are currently operating on an ongoing basis, they hired and trained local staff to operate the delivery service, including pilots, drone hub managers, and ground operators. They have 7 local staff on their team in DRC and 10 in Malawi.

VillageReach focuses on training the health facilities, district health offices, and Swoop Aero local teams focus on supply chain best practices, including packaging of infectious materials, product management, and data/reporting once the products arrive on site. Since the drone delivery service is integrated into the existing supply chain, it is important that this new mode of transportation fits and uses the supply chain and logistics best practices.

VillageReach is also engaged in gathering evidence for the usage of drones in the public sector and especially in the health domain? Would this initiative become a case study for how the looming threat of Yellow Fever was neutralized or mitigated via the use of drones?
This latest experience demonstrates how the integration of drones into an existing supply chain (SC) has great potential at helping shape the SC ecosystem and improve its reach, responsiveness, and resiliency. The fact that the provincial government also turned to drone technology to help support the Yellow Fever prevention campaign is living proof that people are starting to think creatively and are open to using innovation to help solve some of their problems. Now that it is more "common" and accepted that in certain conditions drones can be used to transport both routine and on-demand immunization products, PPE, medicines, vaccines, and lab samples, it is time to explore new use cases and explore how operationally several use cases can be layered.

Setting up a drone delivery network is a huge endeavor requiring lots of resources, time, expertise. It only makes sense to use the network for as many applications as possible, layering the use cases, which by the way will also help make the economics work better. And we must think across various sectors - now that drone deliveries have been proven feasible and reaching significant outcomes in the public healthcare sector, we must explore additional business cases across all sectors beyond public healthcare including private healthcare, e-commerce, agriculture, fisheries, protection of the environment, disasters and emergencies, etc. At the end of the day, drone delivery is a logistics service that is agnostic to the cargo being transported.