It is known as the last-mile problem, and East Africa is solving it: the extreme difficulty in delivering life-saving health products from the city to rural locations as a result of inadequate infrastructure, communication and transportation. It is a problem the world over, but particularly serious in the developing world. It is, of course, an acute problem during emergencies or catastrophes caused by nature, war or civil strife.
East Africa is leading the world in pursuing innovative solutions to the problem. By jumping platforms in a rapidly evolving technology, Rwanda and Tanzania have secured the services of California-based robotics company Zipline to provide the world’s first drone medical delivery services. They do so with breathtaking efficiency, saving many lives.
Rwanda, an innovator of note, pioneered this approach. wheras an ambulance takes four hours to deliver blood to a remote area, a drone gets it done in 15 to 45 minutes. Rwanda’s drone port, in the Shyogwe sector, supports an Unmanned Aerial System to ensure medical deliveries to the remotest corners.
Tanzania’s service will start in 2018. On-demand drone delivery includes blood transfusion supplies, emergency vaccines, HIV antiretrovirals, antimalaria drugs and critical medical supplies. Working directly with the Tanzanian health ministry, Zipline will establish distribution centres in Dodoma, Mwana, Lake Victoria and Mbeya, covering the furthest corners of the country.
For the technically curious, 30 drones each carrying a 1.5kg payload make 500 flights daily at 110km/h. Health employees use text messaging to place the orders. The drones take off and land at the distribution centres only. Deliveries are dropped from the sky at a designated spot marked by paint.
I learnt about Zipline at a recent dinner in New York hosted by the World Economic Forum and the Nuclear Threats Initiative to discuss biology, technology and the Fourth Industrial Revolution. The city is awash with all manner of meetings when the UN General Assembly gets together, but this one was special: leaders from government and business came together to look at applications of recent discoveries in science and innovations in technologies, of which Zipline, combining GPS, robotics and other technologies, was one.
It does not take much to realise how extraordinarily useful such a service would be in public health emergencies, although there are obvious constraints, for which solutions must be found.
First, the system requires geographical mapping, the setting up of infrastructure and local training. In virgin settings, these take time. Basic infrastructure is required in order to have an emergency response.
Second, because drones are increasingly used for terrorism purposes, full government support, interagency co-operation and international diplomatic cover is needed.
Third, drones struggle in extreme weather conditions, which will shut down suppliers for days or even weeks, potentially compromising emergency as well as routine care. Pandemics require supply chains of specialised medical countermeasures such as vaccines, drugs and therapies that will be vulnerable to climate and weather risks.
There is a lot of pressure to find solutions to the problems because the need, as we have seen, is compelling. In Bangladesh, which experienced seasonal flooding during the monsoon season from March to September, a third of the country was left under water, leaving a staggering 41-million people vulnerable to infectious disease outbreaks.
about 1,200 individuals, mostly children, lost their lives, agricultural crops were lost and millions were placed at risk for dysentery and waterborne infectious disease. The situation deteriorated with the arrival of more than 400,000 Rohingya refugees, drawn from a Muslim minority population fleeing persecution from what the UN high commissioner for human rights called Myanmar’s "textbook case of ethnic cleansing".
about 230,000 children are among the refugees and 1,267 have been separated from their families. Refugee camps are overcrowded and people are struggling to find shelter, food and clean water. The need for nutritional support and healthcare is urgent.
At the other end of the world, the Atlantic hurricane season brought Harvey, which affected Mexico’s Yucatan Peninsula and smashed into Texas and Louisiana; Irma, which tore through the northeastern Caribbean and devastated Florida; and Maria, which left a trail of destruction in Montserrat, Dominica, the British Virgin Islands, Haiti and the Dominican Republic, with Puerto Rico the worst off.
Here, too, the need for emergency medicines and products is acute. The US states, best equipped to cope, given their resources and infrastructure, are recovering fast, except for Puerto Rico, which is in crisis and will be so, along with many other Caribbean islands, for a good few months. They can do with all the help they can get. The most enticing and vexing possibility is the use of medical drones in theatres of war such as Afghanistan, Syria, Yemen, South Sudan and Somalia.
There is little doubt that had Medicines Sans Frontiers, that noble army of frontline doctors, gained access to vaccines and medical measures supplied by drones under the cover of, say, the Red Cross, many lives would have been and can be saved.
The World Health Organisation (WHO) could not distribute millions of medical products to deal with Yemen’s devastating cholera outbreak because Saudi Arabia blocked their distribution using traditional logistical means.
Terror groups such as Islamic State and al-Qaeda have been using drones for surveillance and the lethal dropping of small bombs and grenades for well over two years, creating a dynamic that will squeeze out any possibility of using drones for public health and medical purposes.
The Pentagon is so alarmed by the increasingly deadly attacks targeting Iraqi troops, Syrian militia members and US advisers that it has launched a $700m crash programme to devise tactics and technology to thwart the airborne menace.
Earlier in 2017, at New Mexico’s White Sands missile range, nearly a dozen military contractors tested laser guns, high-tech nets and other experimental systems to find ways of destroying Islamic State’s growing fleet of deadly drones before they can carry even bigger bomb payloads (current ones carry one small bomb).
US troops use jammers, cannons and a range of other devices to disrupt, disable and destroy Islamic State drones and quadcopters rigged with explosives.
We must counterbalance technology propelled by war with technology propelled by the common good of the globe, as pioneered by East Africa.
This past week, Columbia University president Lee Bollinger and WHO director-general Tedros Adhanom launched a global health security and diplomacy programme that seeks to do precisely that. It aims to create a think-tank to support continuing and new lines of work to prevent, mitigate and respond to global health threats as common purpose.
