BY ROHAN GARG
Drones have long been associated with violence and destruction. Used frequently as a tool for surveillance and bombings in military conflicts, drones have inadvertently killed countless civilians and deteriorated mental health in warzone populations. Recent technological developments in healthcare, however, suggest that drones may soon serve the polar opposite purpose: saving lives. In particular, drones have demonstrated promising potential as a means of mapping disease epidemiology, delivering medical aid to patients, and diagnosing individuals in remote areas with greater efficiency.
Drones are already helping researchers make strides towards mapping infectious disease epidemiology. At the forefront of these novel research efforts is Chris Drakeley, Professor of Infection and Immunity at the London School of Hygiene and Tropical Medicine. Drakeley and his team have been actively monitoring an emerging Malaysian outbreak of Plasmodium knowlesi malaria, which occurs in humans but is hosted and transmitted by long-tailed macaques, a type of monkey.1 In order to investigate the geographical distribution of malaria-carrying macaques, Drakeley’s team conducted 158 survey flights with commercially available drones in the Sabah region of Malaysia, where epidemiologists had observed a recent upsurge in Plasmodium knowlesi malaria incidence.2 These drones were programmed to track the movement and behavior of individual macaques from roughly 300 meters above ground. After compiling and synthesizing macaque population data from all flight trials, the team was able to identify the areas where the risk of acquiring Plasmodium knowlesi malaria was highest.
In this fashion, aerial drone-produced images offered valuable insights into the geographical distribution of malaria, which could subsequently be used to inform policymakers on how to optimally distribute antimalarial supplies across the Sabah region of Malaysia. With regards to disease mapping, drones are likely to provide a more useful epidemiological portrait than the traditional method of satellite imaging. Aerial surveys that use satellite imaging are severely limited in their ability to provide detailed environmental mapping or frequent monitoring of wildlife movement. Drone-produced images, on the other hand, allow for “the mapping of small geographical areas at user-defined time points and spatial resolutions.”2 With the help of drones’ enhanced imaging capabilities, epidemiologists can respond to changing disease reports more quickly and efficiently, illustrating the potential for drones to advance epidemiology research.
Beyond the context of academic epidemiology research, drones might pragmatically be used to deliver emergency medical aid to patients. In several developing nations plagued by poor infrastructure and impassable roads, it is often inefficient or impossible for hospitals to attend to medical emergencies by means of an ambulance or other vehicle. Accordingly, international agencies are exploring the potential of drones to transport medical supplies.
The United Nations Population Fund (UNFPA), for example, has spearheaded a pilot project aimed at delivering contraceptives and life-saving medicines to women in rural Ghana. Urban drone operators pack a transport drone with medical supplies and guide it to remote areas inaccessible to cars, where local health workers receive and distribute the supplies. Dubbed “Project Dr. One,” this initiative has already reduced average delivery times from two days to thirty minutes.3 “Drones not only overcome infrastructural challenges of poor roads, heavily forested areas, or deserts, but can also slash the time needed to wait for life-saving medicines and other supplies”, explains Renee Van de Weerdt, a senior advisor at the UNFPA.2 By essentially avoiding the inefficiencies and hindrances associated with poor infrastructure, drones not only reach rural communities, but they reach rural communities far more quickly than a ground vehicle possibly could. In response to the cost-effectiveness and efficiency of Ghana’s Project Dr. One, several neighboring African nations have expressed interest in establishing similar nationwide initiatives, signaling a global ripple effect in the movement towards drone delivery programs.
Indeed, the deployment of medical drones is already underway in the United States. Zipline, a medical drone startup based in Silicon Valley, announced last August that having garnered interest from the Obama administration, it was seeking the Federal Aviation Administration’s regulatory approval for three projects designed to bring medical supplies to underserved communities in the United States.4 These initiatives would bring medical supplies to Smith Island in Maryland, Native American reservations in Nevada, and the San Juan Islands in Washington.5 Having already instituted successful blood delivery programs in rural Rwanda, Zipline hopes to now target rural and remote communities in the United States where health inequalities often go unnoticed. Although developing nations might come to mind as a first choice for the deployment of medical drones, Zipline’s efforts in both Rwanda and the United States emphasize that the use of drones for medical deliveries are beneficial in so called first-world countries as well.
Drones are not only revolutionizing the way that healthcare solutions are delivered but also transforming the way in which medical diagnoses are conducted across the world. In Bhutan, for example, the rugged mountainous terrain and extremely low ratio of doctors to people (only 0.3 to 1000) has necessitated a telemedicine system.1 However, in cases where doctors need blood or other biological samples for accurate medical diagnoses, the existing telemedicine framework is not sufficient and it often takes several days for samples to travel on the road from the patient to a doctor. In order to address this issue, the startup Matternet partnered with Bhutan’s health ministry and the World Health Organization to pursue an investigative project involving the transport of diagnostic specimens via drones. During the testing period, Matternet successfully flew drones carrying dummy blood samples between a remote clinic and the capital city of Thimphu, located fifteen kilometers away.6 By virtue of this pilot study, Matternet validated the utility of drones in delivering blood samples for medical diagnosis in Bhutan and is now seeking funding from Bhutan’s government for a nationwide project in the country. Matternet has further demonstrated the potential for drone delivery of blood samples in Malawi. Partnering with UNICEF to conduct a trial with infants, Matternet successfully flew blood samples from rural clinics to Lilongwe, the capital of Malawi.1
The pilot projects in Bhutan and Malawi highlight the way in which drones can be used to accelerate medical diagnoses by transporting biological samples more quickly from patient to doctor. Yet many scientists note that we must proceed with caution towards the transport of biological materials. Timothy Amukele, assistant professor of pathology at Johns Hopkins University, has taken the lead in investigating the ways in which biological samples might be altered during drone flights. “Transporting blood or other biological samples is not like transporting a book or shoe,” Amukele explains. “They are much more fragile.”4 To that effect, Amukele conducted preliminary tests in which he flew 168 healthy blood samples for roughly forty minutes at a field location in Maryland. These samples were paired with 168 other samples that were kept stationary. After the flight trials, more than thirty of the most common chemistry, hematology, and coagulation tests were performed on all of the samples. Statistical analyses led Amukele to the conclusion that the transportation of blood samples via drones does not affect the accuracy of routine medical tests.7 The full adoption of drone transport of diagnostic specimens, however, will require similar studies for other types of specimens, laboratory tests, and environmental conditions.
Moreover, the use of drones in healthcare initiatives will require the development of firm international regulations concerning aviation policy and the consent of rural populations where drones might deliver supplies. Given that a multitude of countries—including but not limited to Nigeria, Israel, Iraq, Pakistan, and the United Kingdom—are currently also using drones for lethal strikes in military operations, it will be imperative to establish international norms for drone usage and to educate rural populations about the role of drones in healthcare interventions. As observed by public health specialist Belinda O’Donnell, “If I were walking to a clinic in northern Cameroon and saw a drone, my first thought might be, ‘Am I about to be collateral damage in a Nigerian government strike on Boko Haram?’ not ‘Look at that stunning breakthrough in medical logistics.’”8 In order to maximize the efficacy of medical drones and to comply with basic ethical standards, global health leaders must take into account public perceptions of medical drones and develop programs to educate communities prior to launching drone delivery programs.
The notion of advancing global health with the use of drones is clearly not perfect. Drones will not fully solve the global shortage of healthcare workers, and they require a robust system of cooperation between urban hospitals and rural community leaders. However, extensive efforts are underway to remedy these issues and many more so that very soon, drones will serve the purpose they were always meant to: saving lives.
Rohan Garg is a first-year in Branford College interested in the fields of global health and economics.
——————————
References:
1 .Sachan, D. (2016). The age of drones: what might it mean for health?. The Lancet, 387 (10030), 1803.
2. Fornace, K. M., Drakeley, C. J., William, T., Espino, F., & Cox, J. (2014). Mapping infectious disease landscapes: unmanned aerial vehicles and epidemiology. Trends in parasitology, 30(11), 514-519.
3. Bassett, L. (2016). Contraception Drones are the Future of Women’s Health in Rural Africa. Retrieved from https://www.huffingtonpost.com/entry/birth-control-drones-africa_us_56a8a3b4e4b0947efb65fc11
4. Landhuis, E. (2016). Doctors Test Drones to Speed Up Delivery of Lab Tests. Retrieved from http://www.npr.org/sections/health-shots/2016/09/13/493289511/doctors-test-drones-to-speed-up-delivery-of-lab-tests
5. Grossman, D. (2016). Drones to Deliver Blood and Medicine to Rural America. Retrieved from http://www.popularmechanics.com/technology/infrastructure/a22164/drones-to-start-delivering-medicine-to-rural-america/
6. Purnell, N. (2015). In Bhutan, Drones Used to Deliver Medical Material. Retrieved from https://blogs.wsj.com/indiarealtime/2015/07/20/in-bhutan-drones-used-to-deliver-medical-material/
7. Amukele, T. K., Sokoll, L. J., Pepper, D., Howard, D. P., & Street, J. (2015). Can unmanned aerial systems (drones) be used for the routine transport of chemistry, hematology, and coagulation laboratory specimens?. PLoS One, 10(7), e0134020.
8. O’Donnell, B. (2016). A Field Guide to Drones for Global Health: The Good, The Bad, the Unknown. Retrieved from https://aids.harvard.edu/a-field-guide-to-drones-for-global-health-the-good-the-bad-the-unknown/
Yale Global Health Review 