On a partly cloudy morning last week, staff and onlookers watched with excitement and curiosity as a drone carrying polio vaccine doses was launched from the Matawale Health Centre in Zomba in eastern Malawi.

The drone was being sent to Chisi Island, one of the hard-to-reach parts of this district that is often left out of health initiatives due to its difficult geographical terrain.

But after wild poliovirus was detected in a young girl in Malawi’s capital, Lilongwe, in March 2022 and three further cases of vaccine-derived poliovirus were detected last year, the country started a supplementary campaign against polio.

Currently, 17 suspected cases of polio are awaiting diagnosis after specimens were sent to a laboratory in South Africa and health authorities are racing to vaccinate some 8.8 million children from birth to the age of 15 years with its immunisation drive.

The use of drones to deliver vaccines to Chisi Island and other hard-to-reach areas has seen an increase in immunisation coverage. It also offers hope to parts of the country where health infrastructure and roads have been damaged due to the recent Tropical Cyclone Freddy.

From bad roads and boats to mere minutes

Ordinarily, staff from the Zomba District Health Office (DHO) would drive 50 kilometres to Kachulu Beach with medical supplies including vaccines. At the beach, the supplies would be transported by a motor boat for 30 minutes before finally reaching the Island. Fuel for the boat alone costs K120,000 (about $126) f.

“This was costly and time-consuming for our office. Transporting commodities has been a matter of a few minutes using the drone,” says Zomba DHO spokesperson, Arnold Mndalira.

Before the fifth mass polio vaccination campaign, which ran from 12-15 July, the Zomba district office used a drone for the first time to transport COVID-19 vaccines, blood samples and specimen results, Mndalira explains

“The drone has a 3.5kg carrying capacity. Plus the advantage with this is that it can go several times within a short time,” Mndalira told Health Policy Watch.

The drones are supplied and managed by Swoop AERO, a global medical drone logistics networking company. 

The Malawi government and UNICEF launched an air corridor to test the potential humanitarian use of drones (also known as unmanned aerial vehicles) in 2017. 

This corridor is the first in Africa and one of the first globally with a focus on humanitarian and development use, according to UNICEF. 

Swoop AERO now delivers essential medical commodities to 60 remote facilities across six districts in Malawi.

“It’s so satisfying to deliver life-saving commodities such as vaccines using drones. It feels good to be part of making a difference in people’s lives,” says Anne Nderitu, Operations Manager for Swoop AERO. 

Health facility workers have been trained to receive the drone for the mass polio vaccination campaign and other medical commodities. By 14 July – day three of the campaign – the drones had already delivered 8,500 polio vaccine doses to hard-to-reach areas in Zomba, Chikwawa and Mangochi districts. The drone can carry 2,000 doses in one trip.

“We are targeting to reach 24 districts with this technology in the coming months. It’s imperative to extend these services to a wider Malawian public health space,” Nderitu says.

However, she notes that unpredictable weather is one of the drawbacks in drone operations.

But Africa’s poor transportation and logistics derail the distribution of medicines and vaccines, particularly medicines with short shelf lives.

“Drone technology is providing the logistical and delivery solutions that can potentially enable African countries to distribute essential supplies to disadvantaged communities, remove access restrictions and facilitate the quicker delivery of life saving medications and vaccines,”  according to the African Union Development Agency, NEPAD.

Tamanda Chikuni, a parent living near the Magomero Health Centre, praised the use of drones to deliver vaccines and medical supplies.

“My child has missed routine immunisations before due to vaccine stockouts at Magomero Health Centre. The facility could not immediately restock due to transportation challenges. The drone has simplified the process,” said Chikuni.

Benson Wyson, a Health Surveillance Assistant at Magomero Health Centre, says the drone technology has simplified his job: “Vaccines arrive on time. We no longer have to wait longer to restock. This has even made the mass polio vaccination more successful than the previous ones.”

Two days after the mass vaccination launch, the facility had already reached 7,000 of the 16,000 targeted children with the polio vaccines.

The facility is 34 km from Zomba District Health Office but it would take the whole day to receive vaccines and medical supplies due to logistical arrangements and transportation time With the drone, the process now takes 13 minutes.

Simon Kondowe, UNICEF Malawi’s Polio Cold Chain and Vaccine Management Consultant, says drone-driven vaccine delivery has assisted in boosting immunisation coverage for the polio campaign.

“UNICEF is committed to ensuring that immunisations are up to standard using innovative systems like drone technology. Some facilities in the country have become inaccessible following Tropical Cyclone Freddy but we are reaching them with medical suppliers using the drone,” he told Health Policy Watch. 

Helping to achieve universal health coverage

In many remote, developing regions of the world, drones are one of the most effective solutions to achieving universal health coverage, where mobility is a key stumbling block to meeting healthcare targets.

Professor Adamson Muula, head of Community and Environmental Health at Kamuzu University of Health Sciences (KuHes), says that Malawi and its development partners have taken a bold decision use drones.

“But while we can discuss the obvious benefits such technology has afforded it, we must also embrace rigorous assessment, especially by independent agencies and consultants as to the cost-effectiveness of such initiatives,” cautioned Muula, noting that the price to buy and maintain drones needed to be considered.

“Since the drones were introduced because of gaps in health services delivery, have these gaps been completely addressed? Or has the situation been that some problems have been addressed and others have been left unattended?” he asked.

Muula also observed many of Malawi’s usual health service delivery problems were addressed by technological innovations funded by development partners, which “makes the health sector extremely fragile”.

Image Credits: Josephine Chinele, UNICEF Malawi.