• India's Universal Immunization Program is one of the largest in the world, but vaccine logistics remain a challenge.
  • The Medicine from the Sky Project will launch drone delivery pilots in the next few months to bring vaccines to India's more remote populations
  • Technologies like drones could play a key role in realising Universal Health Coverage (UHC).

Immunization is one the most cost-effective public health interventions, preventing 2 to 3 million lives from being lost annually from life-threatening diseases.

But more must be done to ensure people can access vaccines, particularly in India, which has one of the largest cohorts of children under 5 and pregnant women in the world.

Enter drones.

The Universal Immunization Program (UIP) of India is one the largest in the world in terms of quantities of vaccine used, number of beneficiaries and immunization sessions conducted, geographical spread and diversity. With a vaccine logistics network of 27,000 cold chain points, 76,000 pieces of cold chain equipment, 700 refrigerated vans, 55,000 cold chain handlers, and 2.5 million health workers, the UIP vaccinates 26.4 million infants and 30 million pregnant women annually.

Every year, 9 million routine immunization sessions are held, requiring robust and fool-proof vaccine logistics. With the COVID-19 immunization drive underway – which is being hailed as the largest immunization drive in the world – vaccine logistics in India need to be strengthened further.

The introduction of the electronic vaccine intelligence network (eVIN) in 32 states across the country has helped digitise the supply chain in real-time. However, the techno-economic assessment of eVIN, conducted by India’s Ministry of Health and Family Welfare in 2017-2018, brought to light the impediments that still exist. For example, 26% of the eVIN cold chain reported stock-outs during the period of assessment, while over one-fifth reported vaccine wastage. Effective Vaccine Management, an analysis conducted by WHO-UNICEF in 2017-2018, shows India ranked within the 51-75 percentile among 89 countries on the EVM score.

The vaccine supply chain in India
Impediments still exist in India's vaccine supply chain.
Image: Government of India

With its vivid socio-demographic profile and diverse geographical set-up, India must also ramp up its immunization coverage. The National Family Health Survey 2015-16 reports that just 62% of children up to one year of age are fully immunized with all basic vaccines, while 78.4% have received the third dose of the DPT vaccine and 81.1% have received the first dose of the measles vaccine. The factors limiting vaccination coverage include large mobile and isolated populations that are difficult to reach, and low demand among underinformed and misinformed populations who fear side effects and who are influenced by anti-vaccination messages.

There are many levels of the immunization supply chain but the ‘Last Mile’ is the most crucial, not only in terms of maintaining the cold chain but also in terms of cost. Most vaccines are mandated by the WHO to be stored between 2-8 degrees centigrade, failing which they lose their potency. In some of India’s hilly states, treacherous terrains and tribal populations, vaccines are still transported by health workers on foot, boats, motorbike and even mules from the cold chain point – which might take hours to reach the last immunization session site.

The Strategy Advisory Group of Experts on Immunizations (SAGE) report suggests that even when conditions are favourable, the accessibility and availability of all vaccines in all places at all times remains a challenge. This is largely due to a lack of access to passable roads throughout the year. Worldwide, 1 billion rural residents are unconnected to the rest of the world, reports the Rural Access Index (RAI).

Hit with a second wave of infections, India has become the new coronavirus hotspot
With rising infections, India has an urgent need for COVID-19 vaccines.
Image: The Economist

To strike a balance between a country’s resources and the urgent public health needs of its population, it is essential to leverage emerging technologies that can improve access to quality and timely health care for its citizens. In the world of emerging transportation, Unmanned Aerial Systems (UAS) show great promise in terms of bridging the health care divide.

Today, drones are being used to carry vaccines, blood products and other health items, cutting the trip time taken by traditional methods of delivery from hours to just minutes, enabling more reliable and less expensive transport. Matternet estimates after a $900,000 investment, each flight will cost an average of $.24. In Ghana, drones were used to deliver 11,000 doses of vaccine within three days of arriving in the country, representing 13% of Ghana’s total vaccines administered in that period.

GAVI suggests that countries with a lower transport composite index and low district-level immunization coverage could benefit from drone use to increase vaccine access. The World Economic Forum’s Mobility Platform and India Centre for the Fourth Industrial Revolution have been supporting the National Government of India and State Government of Telangana to deploy this technology to improve access to healthcare for their citizens. The Medicine from the Sky Project is set to launch drone delivery pilots in the next few months supporting activities in Telangana and other states that have remote populations and arduous geographies.

If successful and scaled, the technology could strengthen the Universal Immunization Program of India. Drones would be most efficient for hilly and tribal terrains where stock-outs are experienced more often. This can also help bolster the country’s ongoing efforts to control the mortalities and morbidities pandemic as India battles to continue fight the virus. The systems put in place in the short term to support drone delivery of vaccines can become important health care infrastructure in the long term delivering a variety of life saving goods.

In a nutshell, the project aims to answer one important question: How can we accelerate the transformation to digital, resilient supply chains and infrastructure that reduces wastage and improves health outcomes?

The use of drones in resource-constrained countries requires careful deliberation as it requires substantial investment. Modelling software like HERMES have been used to predict the cost effectiveness of drone use for vaccines. Similar modelling techniques should be used to determine how best drones can be used to complement the existing supply chains by identifying the bottlenecks and taking into account the strengths of each mode of delivery. This novel idea also brings with it constraints which need to be considered before implementation, such as regulations and operational limitations as well as community engagement. However, these constraints are expected to decrease with time.

What is the World Economic Forum doing about drones?

The World Economic Forum is partnering with governments and companies to create flexible regulations that allow drones to be manufactured and used in various ways to help society and the economy.

Drones can do many wonderful things, but their upsides are often overshadowed by concerns about privacy, collisions and other potential dangers. To make matters worse, government regulations have not been able to keep up with the speed of technological innovation.

In 2017 the World Economic Forum’s Centre for the Fourth Industrial Revolution teamed up with the Government of Rwanda to draft the world’s first framework for governing drones at scale. Using a performance-based approach that set minimum safety requirements instead of equipment specifications, this innovative regulatory framework gave drone manufacturers the flexibility to design and test different types of drones. These drones have delivered life-saving vaccines, conducted agricultural land surveys, inspected infrastructure and had many other socially beneficial uses in Rwanda.

Today, the Centre for the Fourth Industrial Revolution is working with governments and companies in Africa, Asia, Europe and North America to co-design and pilot agile policies that bring all the social and economic benefits of drone technology while minimizing its risks.

Read more here, and contact us if you're interested in getting involved with the Centre for the Fourth Industrial Revolution's pioneering work in the governance of emerging technologies.

Drones are envisioned to add on yet another milestone in Universal Health Coverage. This is the time when we should go beyond cost and supply chain performance and look at health-related outcome indicators such increased vaccination coverage, morbidity, mortality, DALYs or even monetary benefits. The lessons of the Medicine from the Sky pilot project can help inform programs around India and provide lessons for other countries around the world.

One theme of the World immunization Week 2021 is ‘Vaccines bring us closer’. Drones can be part of the solution that reduces the distance between health care and the people that need it.