Editorial
Look! Up in the sky! Its a bird. Its a plane. Its a medical drone!
Access to health care and health-care supplies is an
important issue for those who live in rural and dicult-
to-reach areas, with mortality in inaccessible regions
strikingly worse than in urban areas. Technology has
an ever growing role in improving health-care access,
from adopting simple technologies, such as a paper
centrifuge capable of spinning at 300 revolutions per
second (it can separate pure plasma from whole blood
in less than 2 min), to harnessing mobile technology.
Telemedicine has allowed specialist medical knowledge
to be accessed in the most remote areas of the world,
and portable diagnostic devices allow tests to be
completed in local health centres. During the past year,
drones have been trialled in various settings around
the world, predominantly in Africa, where the delivery
of medical supplies can be challenging because of poor
ground transport infrastructure. A recent partnership
between the Rwandan Government and Zipline, a
California based company, is testing the use of xed-
wing drones for the delivery of blood products. These
drones are launched via catapult, can travel up to 100
km/h, and do not need to land to make their delivery
instead, the package is released above the ground,
where it parachutes down while the drone returns to
the main site.
The provision of safe blood and blood products is
important in all health-care settings, but establishing
and distributing an adequate and safe blood supply is
an ongoing challenge in many countries. For example,
approximately 6 million blood transfusions are
administered to seriously ill patients in sub-Saharan
Africa each year, falling short of the estimated 18 million
units needed for life-saving transfusion. Children are
particularly vulnerable to blood shortages because of
their high requirement for transfusion arising from
severe life-threatening anaemia caused by malaria or
malnutrition. Organisations such as the Safe Blood
for Africa Foundation and Africa Society for Blood
Transfusion aim to help improve safety and availability
of blood transfusion. Voluntary blood donation rates
in Africa are generally low compared with high-income
countries, and although all blood should be tested
for infectious diseases, there is a lack of complete data
on whether this occurs. Alongside these challenges,
transport remains a major impediment to access
www.thelancet.com/haematology Vol 4 February 2017
to safe blood transfusion. The UKs Department for
International Development has allocated funding for
a trial in Tanzania, where Zipline drones will be used to
deliver blood and other medical consumables within a
75 km radius from Dodomas main blood bank, serving
more than 100 health centres, and cutting transport
times from nearly 2 h by road to under 20 min by drone.
Although the Zipline drones could be a potential
Zipline
answer to the delivery of vital supplies, the challenge
of getting items from remote areas to central hubs
also needs to be addressed. Unsurprisingly, theres an
app for thatone that allows a health-care worker to
plan delivery routes for a multi-rotor drone, which can
involve multiple take-os and landings. In Malawi,
these drones are being tested by Unicef and Matternet
(another California based company) for the delivery
of paediatric blood samples for HIV testing. Screening
for HIV in children who are born from HIV-positive
mothers requires testing in specialist laboratories, and
delays in initial diagnosis often occur. Blood samples
from rural HIV clinics are currently transported by
motorbike, which requires a large batch of samples
to make the journey cost-eective. It is hoped that by
reducing the transportation time of blood samples,
the time to diagnosis will be substantially shorter and
enrolment of children to anti-retroviral treatment will
be increased.
With all new technologies, many challenges arise
alongside the potential benets. Cost-eectiveness
needs to be taken into consideration. Communities
might be better served by spending money on investing
in improvements in ground transport links. In terms of
humanitarian and emergency aid, payloads often are
measured by the ton, not the kilogram. Security and
public acceptance are other important considerations.
Drones are expensive pieces of equipment, and it could
be possible for them to be intercepted and stolen
during their missions. Furthermore, in many parts of
the world, drones are not associated with health and
humanitarian missions, but with surveillance and
military activity. However, the potential for drone
technology is vast, and hopefully the technology
will be able to revolutionise the health landscape
in inaccessible regions, as telemedicine has done.
The Lancet Haematology
e56