The sky's the limit
Authors: None The Lancet Digital Health
Journal: The Lancet Digital Health (2022)

When you think of a drone, what comes to mind? To some, it is a device for taking personal photos. But to others, it is a life-saving technology. Drones have been a game changer for the transport of medical products to remote locations, obviating the lengthy and sometimes perilous journeys made by health-care professionals on roadways and waterways. Is it time to implement this technology on a bigger scale? The impact of drones on health care is often investigated through pilot studies and simulations, but real-world evidence is emerging. In 2016, the Government of Rwanda began working with Zipline, a US-based drone delivery company, to transport blood and blood products from two distribution hubs in Rwanda to health facilities countrywide. It is thought to be the first use of drones for primary health commodity delivery in Africa. Focussing on the 20 health facilities selected to receive drone delivery between 2016 and 2018, Marie Paul Nisingizwe and colleagues evaluated the speed of this autonomous delivery system and associated blood and blood product expirations compared with traditional road delivery. Depending on the road-based driving time estimate used, they found drone delivery was on average 79–98 mins faster than road delivery and was associated with a 67% reduction in blood and blood product expirations 1 year after the drone delivery programme began. These results show the real-world impact drones can have on health care. Drone delivery is not limited to blood transport. In Scotland, air mobility company Skyports has worked with the NHS to transport medical supplies including COVID-19 test samples and personal protective equipment between remote health facilities in the Argyll and Bute region, while the CAELUS project is aiming to develop a network of drones to deliver a range of medical products including medicines and transplant organs. Over in Uganda, Johnson and Johnson is supporting a project that uses drones to transport antiretroviral therapies to islands in Kalangala District. Drones have also been used to transport medical equipment; a feasibility trial in Sweden found that drones equipped with automated external defibrillators could reach 64% of cases of suspected out-of-hospital cardiac arrest faster than ambulances. There are additional benefits to using drones for medical deliveries. They can provide more equitable access to vital health care, particularly for those residing in rural and remote communities. Drones might also be better for the environment with potentially lower energy consumption and greenhouse gas emissions compared with trucks, although the current short battery life of drones necessitates the setup of local delivery warehouses, meaning the delivery system as a whole might not be as energy efficient. Progress in this field is encouraging; so why are we not seeing medical drones adopted on a larger scale? The cost of setting up and maintaining a drone delivery system is a barrier. The ministry of health in Rwanda provided funding for the country's drone programme; however, other countries might not have the infrastructure or funds to implement such a programme. Furthermore, the cost-effectiveness of drone deliveries is often unknown, and could not be evaluated in the study by Nisingizwe and colleagues. At the technological level, even when cost-effectiveness is evaluated the findings are often not generalisable given variations in costs between drone suppliers. While it is currently an expensive mode of transport, as the technology matures and the demand grows costs could reduce over time. Another challenge is that the reduced travel times and medical product wastage is only one piece of the puzzle; the direct effect of drone delivery on clinical outcomes remains to be determined. A further issue is the impact drones can have on civil liberties, such as by using in-built cameras and body heat temperature sensors to monitor the number of people present in public spaces to facilitate enforcement of physical distancing rules during the COVID-19 pandemic, raising concerns around privacy and consent. There could be advantages to embedding drones into health-care pathways, such as emergency medical services and primary health care. But greater financial investment and improvements in overall energy efficiency are needed to ensure drone delivery programmes are sustainable, as are clinical trials assessing their effect on clinical outcomes. Community sensitisation and tight regulation are also mandatory to build trust and support the long-term success of these programmes. Drones are no longer flights of fancy, but potential life savers.