On our way: Zipline’s quest to be the medical drone logistics company of choice

Anybody remember Bata?

Of course, we are kidding.

Who would claim not to know Bata, the shoe making company that – growing up – achieved the unique feat of convincing us that it had local roots, and that the Weinbrenner and the Toughee our kids wore to school was an exclusively local product that could not be found anywhere else?

Little did any of us know that people in Zimbabwe, South Africa, Nigeria, Senegal, Kenya, Morocco, South Africa, Egypt, Sierra Leone, Libya, Sudan, Algeria, Senegal, Congo, Tanzania and elsewhere in Africa had exactly the same embarrassingly naïve thoughts as we did.

Well – with none of the dark history that led to the spread of Bata across colonial Africa like a veldt fire – drone logistics company Zipline hopes that one day soon it will be as indispensable a medical drone logistics company to the world as Bata is to the shoe making industry.

Zipline wants to be the DJI of medical drone logistics, and we are all up for it.

This was revealed by the company’s Global Operations manager, Nicholas Hu, in a recent interview with the Digital Health Forward Podcast, where he traced his footsteps to Zipline’s fledgling days delivering blood in Rwanda, to today’s massive operations where they have expanded into Ghana and are delivering an assortment of medical supplies – vaccines, samples, COVID-19 equipment, among them.

It was a really interesting interview, where Nick opened up on his unfailing commitment to health care delivery in the world, and his organisation’s future plans to the podcast’s host, Dandi Zhu.

On his healthcare background and journey with Zipline so far

The big, overarching theme throughout my career is, I’ve always been very interested in health access. I know health access is a very broad term; for me, it covers everything from understanding patient journeys; looking at the different aspects of delivering healthcare; everything from supply chains to the tools are healthcare practitioners use; behavioural psychology.

As for my career, I’ve been exploring all the different aspects of what goes into providing really great quality health access. It stems from some pretty traumatic moments earlier in my life where I had the experience witnessing somebody having a seizure while at an airport. It was a pretty normal seizure, but to me at the time, it was a quite terrifying experience. The feeling of helplessness really bothered me a lot because no one else around knew what to do. I didn’t know what to do; I just felt helpless.

Five, ten minutes later, the paramedics came, put the person in the recovery position; that person sat up, had some water, and he was good to go.

But I still filter felt terrible. Mainly because I wanted to know how I could have helped. So after high school, I decided to get Emergency Medical Technician training, and I actually worked in an ambulance over the summer during my first two years of college. It exposed me to a lot of really interesting things about how the healthcare systems work.

I then travelled to Tanzania in Africa, where I got introduced to healthcare mentors working in the country. In Tanzania, I learned that you can’t always have your fancy ambulances everywhere; you need to figure out what works locally for the community, and understand everything from the economics to cultural aspects. Many people in the villages that we were working with prefer traditional birth attendants than going to hospital.

So, together with the medical director at a hospital I was attached, we came up with an idea to provide motorcycle ambulances.

That experience in Tanzania taught me that you can’t just come in with a solution for a different society just because it works in the USA.

I returned home for my Master’s in Global Health and those studies opened my eyes to understand global influences at play, like global health funding.

As for the opportunity with Zipline, I actually had my interview with the Zipline guys at a farm in Half Moon Bay (in California). I just fell in love with the concepts and how the founders were driven to solve problem of health access. I really couldn’t say no.

Was there already a prototype then, or all of it was just an idea?

Yea. But it was very different from where we are today. There was an initial prototype landing and a launcher system, which used to be this pneumatic launcher that made this really crazy poof sound at every launch, and the recovery system was these inflatable mats like giant bouncy castles. The tests were done manually, using test pilots, which we no longer do today because all testing has become automated.

There had already been numerous prototypes, and one of the reasons why I joined was that Keenan (Wyroboek, Zipline Founder and now Head of Product Engineering), who was our CTO then, and the team in engineering were just phenomenal with their rate of innovation. Within a couple of months after I joined, there was a brand-new different model brand-new different recovery system, a brand new launcher, which I had never seen before at all companies I had worked with.

What is Zipline’s overall goal, and what problems are you trying to solve?

Zipline’s mission is to provide every human on earth with instant access to vital medical supplies. What that means for us is that it doesn’t matter where you live, you should always get access to medical supplies. You may live in rural Orlando or rural Idaho, but our mission is that that your local healthcare provider will always have the products and tools they need to ensure you are receiving high quality care.

Throughout my journey in healthcare, I’ve learnt that there is no silver bullet solution to healthcare, but Zipline is covering a lot of health access in a way. We have solutions that address supply chain, like last mile logistics and how you do inventory management.

We help with supply chain outcomes that have a direct impact on organisations, like how to get things from point A to point B; optimising stock, and how to create optimal ordering behaviour.

Vaccine supply is something we are also working on in Ghana; the Global Alliance for Vaccines has made some awesome initiatives to push vaccine availability across 95 percent of Africa, so one of the problems we are trying to figure out in Ghana is how to push that figure to 99 or 100 percent.

We are confident that if we get the supply side of things right, it will result in better healthcare outcomes in the long term. We actually have an example in Rwanda, where the former health minister, Dr Diane Gashumba, tweeted that (following a sustained, constant and timely supply of medicine) there had been no maternal deaths at some hospitals in 6 months.

Zipline wants to bring medical drone logistics to all corners of the world

On why Zipline chose Rwanda for their pilot tests

That’s a great question. The biggest reason was that, Rwanda is known as the land of the thousand hills. From a geographic and topographic perspective, it is a very difficult to get from point A to point Bin the country, even with a very solid road infrastructure. Because of the undulating hills, going a couple of miles actually takes you 20 to 30 minutes; sometimes even an hour, depending on where you are going.

From a use case perspective, it was a perfect fit.

More importantly, it was the partnership that Rwanda provided. The healthcare system and the leadership here is extremely progressive; they are always looking for innovations on how to really push the envelope of what is possible and challenge the stereotypes that may exist. They really have invested heavily in everything, from a really strong community health worker framework to providing strong primary care.

We were able to have maximum support from not only the office of the president, but also from the ministry of health to bring this project to fruition very, very quickly. Overall, I think in the (East African) region is changing, but Rwanda definitely has a more favourable ecosystem to the faster change.

On how they have worked with heath care stakeholders and aviation authorities in the country

I think Keller (Rinaudo; Zipline co-founder and CEO) was really excited to pick the most regulated industries; healthcare and litigation. You need to really push the boundaries to make an impact in these industries.

For the aviation regulators, this was the first system of its kind. No other government in the world had launched a national scale drone system. We spent a lifetime with the RCAA, working on hundreds of pages of regulations as well as building our safety case. The authorities were open to working with us to ensure that there was a way we could operate safely in a system that did not exist anywhere else in the world. So we worked together to develop a global standard; many governments are now looking at Rwanda to see the framework they use and the policies they have implemented.

On the health care side, things were different; obviously people were rightfully concerned about dropping products thirty feet from the air. We conducted validation studies with regulators – who wanted to understand aspects like thermal and durability issues – and in some cases we performed better than traditional methods. We had to convince them that we could deliver better than roads, which can be bumpy; and also made sure that they were comfortable with the packaging, showing that there was plenty of margin to deliver within a regulated thermal window. We also invested in top notch equipment like refrigerators with real-time temperature monitoring, as well as some of the best backup equipment too. These investments helped in building more trust with the authorities, and they began to see us less as a pilot and more as a sustained operation that they could rely on.

As for the customers – lab technicians, nurses and doctors – we are very proud and lucky to have a really close relationship with them. The lessons that we learned early on are probably the most valuable lessons we had today, in understanding what the healthcare workers need to serve the patients; and how we can best make it easy for them, so we won’t have to take up hours of the day doing inventory checks or having to drive to the blood centre. Understanding those pinpoints – like logistics, getting order approvals from higher authorities, knowing whether we have a product in stock, internet connectivity – helped shape helped shape our product today.

We also could introduce new products in places where infrastructure, like electricity, was intermittent, or where equipment may not exist yet. Like at smaller clinics with small solar fridges that are not able to carry bigger loads, we could order cold chain goods, because for them they are on demand. We have learnt dozens of lessons like that in Rwanda and Ghana. While drones are really vital innovation, there are other add-ons that can enable a health care system to work well.

And we are still learning. It is absolutely exciting for me and to really be on the cutting edge of what this technology can be applied to.

Take us through the Zipline drone delivery process (again)

Whenever a nurse or a healthcare worker needs something, let’s say oxytocins; what that nurse will do is go on her phone open up her WhatsApp, or fill out an order form (on the website), or she can call us – whatever is easiest for her. This takes a couple of minutes, because our operators have to walk the client through what we have in stock, and offer alternatives if the exact product is not available.

Once the order is confirmed, it takes between five and seven minutes to get the order plan the packaging – and putting the appropriate thermal masses right depending on the transportation window – and getting it out to our flight operations team. The package is about the size of the cake box, weighing up to 1.75kgs. They pack up pretty quickly, and confirm on a fulfilment system. Throughout this entire process, the customer will be getting updates on either WhatsApp or the order form.

Once the package is out the window, our flight operations team will load package into the body of the Zip and carry it to the launcher, where the battery, the wing and the nose cone will be fitted. Then they will go through the pre-flight and air traffic control checks to make sure that we have approval.

When we are good to fly, the Zip is launched; and when it is five minutes away from its destination, the nurse gets a notification that the order will be arriving soon, please be ready. We drop the package with a parachute at the health care facility, and notify the healthcare worker to collect it; and to the patient it goes. Right away.

This all happens in under an hour.

Nicholas Hu. Photo: Digital Health Forward

Lessons learnt and advice to operators looking into delivering and changing healthcare in Africa?

If they can, I’d encourage people to go personally and see the problems for themselves. It helped me personally. Working with the medical director in Tanzania, my professors at Berkeley, and the awesome engineering team at Zipline and witnessing how they solve the customer problems and testing what works and what doesn’t; it has been invaluable for me.

Any new developments with regards to the Zipline mission?

Yeah. Especially with COVID-19; we been able to identify new ways in which we can support the healthcare system. In Ghana, for example, there are a couple of really great initiatives we spearheaded. We provided a really effective aggregation system, in which government health centres brought COVID samples to our distribution site, so we could deliver them to Noguchi Memorial Institute for Medical Research, from where the samples would be tested and taken to the respective hospitals they had come from. Normally, the process would have taken ten hours, hundreds of miles and ambulance resources away from important business, like patient referrals.

But we could do it in between 30 minutes and two and half hours. We distributed thousands of samples this way.

One other thing we did was distribute vaccines, at the instigation on the EPI (Expanded Programme on Immunisation), which asked us to supplement the existing vaccine supply chain. Because the country had been locked down, and with health workers in occupied with COVID-19, a lot of services were affected, which included supply chains for vaccines. We delivered up to ten times more vaccines in those weeks than we previously did, delivering vials direct to health posts and small community level compounds.

During the recent elections, we were asked to help out with the supply of masks to poll workers in the Omenako region (70km North of the Capital, Accra). We got the order on a Saturday, started deliveries on Sunday; by Monday 9AM when the polls opened, we had delivered 18,000 face masks in over 160 deliveries across the 33 districts.

Also, in the USA, there a use case for COVID-19 vaccine delivery, especially when you look at the ultracold Pfizer vaccine that needs to be kept at very low temperatures. You can imagine that with Zipline having just-in-time delivery helps reduce the burden on the cold chain. That’s just one of the couple of things that are coming up in the US that I’m excited about.

On Challenges

Well… there are so many! But looking back at the early days, I’m really proud of our team being able to navigate the challenges we’ve had to date; from the regulations to the fact that a company that was prototyping in Halfmoon Bay in California decided it was a great idea to travel half way around the world to Rwanda to start our first commercial operation. We have accomplished a lot, and I don’t want to discount the challenges along the way. There are many more ahead and, especially as we learn from our customers and these use cases, and find out ways that our products can make an even larger impact.

We have the potential to really transform healthcare supply chains around the world and we need to do it thoughtfully and sustainably. It is going to be a big challenge creating scalable frameworks for regulators, for example. Every country that we operate in will have its own specific requirements, and we are going to have to figure out how we are going to apply all the lessons we have learned, but also ensure that we are complying with potential new unique regulations specific to a certain country or locale.

As with any international company, there will be challenges regarding how to expand operations across multiple geographies and scale operation in a meaningful way. It is vital that we be thoughtful about the steps we take across the world and make sure we will localise our solutions.

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