Fighting Yellow Fever in the DRC

The Democratic Republic of Congo (DRC) government joined hands with non-profit organisation VillageReach in 2020 to launch the Drones for Health Programme, in which drone technology would be used to bridge the transport gap and initiate faster delivery of vaccines and other medicines in the Equateur Province in north-east DRC.

The drones – provided by VillageReach’s technology partner Swoop Aero – have been a game changer for medical delivery in the province.

As a result, it should come as no surprise that the partners in the Drones for Health programme have agreed to expand the scope of drone use to delivery of medicine to fight yellow fever in the region.

Olivier Defawe, the Director Health Systems at VillageReach, explains the new job description for their drones in the DRC in the article below, which we have gleaned from DroneLIFE.

Defawe leads the design and implementation of a broad portfolio of health innovations to improve health care delivery at the last mile at ViillageReach; and has been the Drones for Health program lead since its inception in 2015. He oversees the implementation drone delivery programs in Democratic of Congo (DRC), Malawi, Mozambique, Central African Republic and the Dominican Republic.

The COVID-19 pandemic has overwhelmed health systems across the globe. But in its shadows lurk other diseases that need equally serious attention.

To face these threats, creative solutions are required to stop the next health crisis. This is exactly what the provincial health officials of Equateur province in the DRC last year, in collaboration with the Ministry of Health and the Expanded Programme on Immunisation (EPI), are doing by leveraging an ongoing drone delivery network established in 2020.

The programme will support a mass yellow fever immunisation campaign targeting over 90 percent of the population, one village at a time.

According to the World Health Organisation, although the DRC introduced yellow fever vaccination as part of the national routine vaccination programme in 2003, coverage remains around 56 percent, below the recommended minimum threshold of 80 percent.

Low coverage has led to a resurgence of the disease in the country, with six outbreaks erupting between 2010 and 2019. A major outbreak in neighbouring Angola in 2016 spread into the Democratic Republic of the Congo’s capital Kinshasa and two other provinces.

Yellow fever is caused by a virus spread through the bite of infected mosquitos. Some patients can develop serious symptoms, including high fever and jaundice (yellowing of the skin and eyes).

Carried out in seven of the 26 provinces in the DRC and targeting people aged nine months to 60 years, including nearly 300 000 refugees, the campaign is a collaborative effort involving the country’s health authorities with the support of the WHO and other partners including the Bill and Melinda Gates Foundation, Gavi, the Vaccine Alliance, PATH, UNICEF and VillageReach.

Delivery of the vaccine in Equateur province was a bit different from the rest.

Equateur province is home to a two-way delivery network using Swoop Aero drone technology to serve remote and hard-to-reach health facilities and communities. The Provincial Ministry of Health, with the technical assistance of VillageReach and financial support from donors coming together, including GAVI, the Vaccine Alliance, and the Bill & Melinda Gates Foundation, established operations to address the medical delivery needs given the challenging terrain in the region.

Given this success, it is no wonder that the provincial government is once more turning to the drone technology to help meet its objective of reaching more than three million people aged between nine months and 60 years of age during the 10-day Yellow Fever Preventive Campaign in Equateur.

Yellow Fever vaccine delivery in Equateur was a tad different – and faster – last year

Important reports help keep track of the vaccine campaign

Dr. Nicole Lubanda, the lead representative for yellow fever and measles from the EPI, travelled to the Bikoro Health District to serve as the national supervisor for the yellow fever mass vaccination campaign.

She learned of the support that the drones had provided to the district with routine vaccine deliveries. When she reached the site, one of the drones was arriving at the district-landing site from a trip to Maanga, which is one of three health catchment areas benefiting from drone deliveries of yellow fever vaccines. It is a village 100 km from the Bikoro health district office and only accessible by having to travel through a lake.

“The drone helps us to ship both vaccines and other products as well as daily reports so that we can keep track of the (progress of the campaign),” Dr Lubanda said. “(Within) about ten to twenty minutes, we sent between five and ten frozen accumulators or vaccines and this allows us to supply hard-to-reach areas in record time.”

Trips reduced from two days to just 25 minutes

Another village, Ipombo is in the Lolanga Bobanga Health District, 37 kilometres from Mbandaka, the capital of Equateur, a seemingly short distance that actually requires a two-and-half hour trip by canoe down the Congo River followed by an additional half an hour travel by road.

In previous campaigns, David Moponda, the head nurse of the Ipombo Health Facility, would have had to load his supplies of syringes, vaccines and diluents, as well as vaccination cards onto a canoe to make the journey. But for this campaign he didn’t worry as drones had transported them.

“This year has been different with the support from Drones for Health. More than 9,900 doses of yellow fever vaccines and diluents would be needed in Ipombo to vaccinate the targeted population between the ages of nine months and 60 years of age,” said David Moponda. “Within a four-day period, and only 25 minutes for each trip, the drones had already delivered 4,200 doses of the vaccine.”

Operations, however, have had to be suspended since the refrigerator of the health facility was already at full capacity. However, once space is freed up, flights will take off again.

The DRC is one of 27 African countries with the highest risk of Yellow Fever epidemics, with deaths estimated at 60,000 annually.

Yellow Fever vaccine campaign transformation

From a technical perspective, the drones transformed the vaccine campaign in three key ways:

  1. The drones enabled to leapfrog the lack of functional cold chain where the campaign was being conducted. Drones allowed for just-in-time delivery of yellow fever vaccines to the campaign team as the campaign progressed in the region, eliminating the need for cold-chain equipment.
  2. The drones allowed for rapid-response to unexpected needs encountered by the campaign team. This allowed on-demand resupply of products, like vaccination cards.
  3. Epidemiologic surveillance activities were increased and drones allowed for quick transport of samples from health facilities to provincial-level laboratories for processing.

Overall, the drones increased the reach, effectiveness and responsiveness of the yellow fever vaccine campaign.

Since the Drone for Health programme was launched in 2020, the provincial health authorities in Equateur have been distributing both routine and on-demand vaccines and other immunisation products monthly for children and women in 35 hard-to-reach health areas, via 20 drone landing sites. Because the drones can land almost anywhere, they usually bring back a broad range of products, including yellow fever and COVID-19 laboratory samples on their home journeys.

Other deliveries have included medical reports, and at times on-demand deliveries of personal protective equipment (PPE) in support of the COVID-19 response, as well as vaccines, medicines and contraceptives.

Now the results are in and the delivery network is delivering successful outcomes. In the last nine months, more than 15,000 children and 5,500 pregnant women who live in the most hard-to-reach locations have received immunisation services because of the introduction of drones.

As the Yellow Fever campaign nears its end, it is clear that creative solutions come from using what is already available, but in new ways – and leveraging a drone network used for routine delivery for a mass vaccine campaign has just expanded the value of drone technology for the health system in Equateur, DRC.

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