Making Medical Deliveries by Drone is Solvable

Renato runs zip Line International. To be clear, his drone delivery service isn't dropping off last minute anniversary presence or late night takeout. Zip Line is focused on delivering medical supplies. According to the WHO, over five million kids under the age of five die every year due to a lack of access to basic medical products and care. Zipline regularly delivers whole blood platelets, fresh frozen plasma, and clotting products.

These kinds of medical deliveries are especially helpful in places with unreliable roads and large populations living in remote and rural areas. Today, zip line deliveries can reach just about any location across Rwanda and the entirety of Ghana, and they just started to deliver in the US so North Carolina is learning from Rwanda. Is that how you would

characterize it? During this pandemic, the ability to take medical appointments online has been a lifesaver, keeping us safely away from enclosed office spaces and out of hospitals that are overcrowded with COVID nineteen emergencies. Zip Line sees the work they do as the next step in a remote medical service chain. In many ways, the logistics service, the kind of instant delivery the zipline provides, is just the other half of the telepresence. Kelornado is the CEO and founder

of zip Line International. My sollable is making sure that every human on earth has access to basic medical products. My co host an Apple Bomb, spoke with Renaldo. Here's their conversation. Explain to me how it works. In other words, there's a there's a nurse who sees that she needs a particular blood product in rural Tanzania. Does she pick up a phone and call someone? Is? How does the system work? And how is it that the drones are ready to go? And you know, are they are they

in some kind of medical base to start with? What does the system look like? Although there's a lot of complicated technology behind the service that we provide. The experience of the service itself is extremely simple, which is essentially a push a button on a phone, get the medical product that you need to save a patient's life delivered to your GPS coordinates. There's no training really required for

nurses or doctors or health workers. They can place orders in a number of different ways, either via an online form or by calling a phone number, or also by using what'sapp. What'sapp actually winds up being an incredibly reliable kind of infrastructure in a lot of these countries, and so any nurse or doctor or health worker can place

an order. All of the complexity of you know, autonomous aircraft and like getting regulatory approval and knowing how to do safety and maintenance, etc. Is kind of handled in the background. You know, they'll get a text message saying thanks for letting us know an order has been dispatched. It is twenty four minutes away. And then much like using ride sharing, they'll get a text when it's saying, hey, the products one minute away, please step outside. It's going

to be delivered into your mailbox. And the runes really move fast enough to make this work. Yeah, So that you know, the simple technology, Zipline builds distribution centers and then the aircraft themselves. We employ teams of engineers and operators at each distribution center. Each distribution center can serve around twenty thousand square kilometers or something like eight thousand square miles, which is typically between two and ten million people.

So for example, we cover the whole country of rwand that with two distribution centers cover the whole country of Ghana with about eight. That's where we store inventory of medical products. And then each distribution center will serve around two hundred to four hundred primary care facilities and hospitals, and each of those facilities is getting a delivery, often several times a day, sometimes several times a week, depending on the size of the facility. But essentially is just teleportation.

It means that now tell it's possible to teleport products from a central place out to all these different places where patients may need something. The benefit of having a teleportation like service for national healthcare systems is that they can dramatically improve access, particularly for vulnerable populations. They can reduce waste because you're sending less stuff out to the last mile and before it's actually needed by a patient. And finally, you can actually increase the diversity of the

products that are available at primary care facilities. So it makes it possible to treat patients closer where they live. And what are the finances of it? Isn't it too expensive for a country like Rwanda to have to have a drone service delivering medication when it comes to questions around the unit ac comics of what we do, that's actually one of the big advantages of delivering in this way. If you have a lot of medicine in the system and a lot of these things expire, it's very expensive,

may have specific storage requirements or short shelf life. A lot of medicine gets thrown out. Millions and millions of dollars in medicine actually expires every year and gets thrown out. And so by having a more efficient logistics system that by the way, is cost comparable to using trucks or motorcycles, you can actually save these healthcare systems a lot of money.

So is this a little bit like as has been the case in a number of countries, including a lot of African countries, that people get cell phones before landlines earns or established. Essentially you're offering a technology that's higher and better than they would have if they were doing road deliveries. Are we skipping a stage of infrastructure in

order to do this? That is exactly how we often think about about this, and that's typically called leap frogging in global development, and the idea of leap frogging land lines to go straight to cell phones. I think it's a very similar thing to what's happening here. It's often the countries that have the highest need and the ability to move quickly on a new technology, they can actually

innovate the fastest. So for example, Kenya has like the highest rate of adoption for mobile payments of any country on Earth. I believe that was the case at least a year ago. Rwanda and Ghana have fully autonomous systems delivering large percentages of their healthcare supply chains and in a cost effective way, and that network of distribution centers

has become the largest commercial autonomous system on Earth. Funny if I have been to both Rwanda and Ghana and relative to other countries in the in their respective regions, both of them, for very different reasons, are relatively well run. That's true, you know, would this work in a less well run country. I mean, how much do you depend on the local health bureaucracy and you know, the training of local bureaucrats and technicians. I mean, it doesn't work without,

you know, an amazing partner on the other side. A lot of the success that we've had in Rwanda and Ghana is thanks to exactly as you said. You know, we chose Rwanda and Ghana for a reason, really innovative governments that are moving fast or investing in healthcare, investing in infrastructure. And for sure, there are some governments, both in Africa but also other parts of the world that just are not well enough organized probably to take advantage

of this kind of technology yet. But that said, I mean there are a lot of countries that are now following in Rwanda and Ghana's footsteps, the US, you know, potentially the biggest among them. A lot of countries are

looking at what they've achieved. I mean, the fact that Rwanda is now providing universal access to healthcare for every single one of its fifteen million or so citizens in a way that is a cost effective and be enables all these new paradigms of care, especially close to where people live and This is something that impacts every healthcare system,

especially coming out of this pandemic. So in the US, you know, the pandemic has led a lot of hospital systems to suddenly focus on, Hey, how do we decent centralized care. How do we treat patients closer where they live, extend the reach of the hospital system directly into the home. And they look at what Rwanda and Gone are doing and say, that's a good answer. So this is, for example, the reason that we launched with Navant Healthcare in North

Carolina in the middle of last year. So North Carolina is learning from Rwanda. Is that how you would characterize it, This trend of big hospital systems that used to rely on patients coming into the hospital to receive care. Patients hate that. The most vulnerable populations are the ones that are least likely to be able to even do that, to take time off work or have a car to get to that hospital in a city, and it's the

most expensive way of treating a patient. So as we actually start paying for quality of care and outcomes rather than paying for procedures, health systems become incentivized to treat patients closer where they live. If you can treat them at a primary care facility. That's amazing. If you can send a home healthcare nurse directly to their home, or you can just you know, have them talk to a

doctor via telepresence. In many ways, the logistics service, the kind of instant delivery the zipline provides, is just the other half of telepresence. I do have to say, I remember first hearing the expression telemedicine being used widely at the beginning of the pandemic, and it sounded so exciting until I realized that it really, most of the time meant talking to the doctor on the phone, which seemed

to seem much less exciting that fancy. It's like pretty it's kind of crazy actually that that was going to you know that that has taken so long. Is it possible that this is working partly because there's so few other drones being used this way. I mean, drones are used for photography, and they're used for they you know, they have a military function, but they haven't really been used as a delivery service before. I mean, can you imagine us running into trouble if there were lots of

people doing this or do you think it will? It's something that we're all just going to get used to over time. People often ask about that. I I think people have this sense that like, oh my god, the sky is going to be darkened by drones, and I actually think, just from a physics perspective, probably people's intuition is a little bit off about how big the sky is.

You know, when we're flying, we fly below the commercial aviation floor, but well above where you can hear the vehicle or even really distinguish the vehicle from a bird. It's very hard to see an aircraft when it's flying by it four hundred feet which is our cruise altitude, and the sky the sky is just really really large. That leads obviously to the next question, which is what do these drones look like? How big are they? How fast do they fly? And how do they operate? I

read somewhere that the drones use don't actually stop. It's not like they land and deliver something and then take off again. They drop the goods. I mean almost like parachuters. Can you describe what that looks like. They weigh about forty pounds each and they launch and land only at our distribution centers. So this means that when we receive an order. That order will come via SMS or via WhatsApp or via a phone call to our fulfillment center.

We have trained pharmacists who can take a product, for example, say two units of blood loaded into a package. That package is loaded into the airplane. The airplane is set onto a launcher, and once the flight computer has booted up and is ready to fly the aircraft, we launched the aircraft. It actually accelerates from zero to about eighty kilometers an hour and about a third of a second, so really really fast. It will fly out to the GPS coordinates of the hospital or primary care facility that

placed the order. And then when we deliver, we actually descend from our cruise altitude of about four hundred feet to somewhere between thirty and six feet, and we deliver into a mailbox, which is really just a made up rectangle on the ground. It's the size of a couple

parking spaces. So as long as the primary care facility or hospital has a couple parking spaces, whether that's actual parking spaces or a little grassy patch or even you know, for example, in the hospital in North Carolina, we deliver onto the rooftop of one of our hospitals. They can kind of set up their mailbox wherever they like, and then they know that the product is always going to

be delivered into that mailbox. We use a really simple paper parachute attached to the package to make sure that the package comes gently to the ground, and that enables us to basically provide this autonomous service without ever having untrained humans come close to the vehicles. And does it ever fail well, it plane operates in the real worhold. And what one thing I've learned is like nothing is

a one hundred percent in the real world. So certainly, like you, especially in the early days of the service, we had certain instances where the packaging land quite in the mailbox. We've had instances where the plane will encounter emission failure and have to turn around and come home, and then you know, we'll use another plane to do that delivery maybe fifteen minutes later. All logistics kind of

operates on percentages, and that things one hundred percent. We guaranteed our customer ninety six percent service uptime, and we've actually achieved something like ninety nine percent service uptime, so

way higher than any kind of traditional logistics. You know, these kinds of vehicles can operate more reliably than motorcycles and cars, and they can operate in kinds of weather and conditions that actually traditional logistic systems don't operate in at all, and that is one of the main value propositions of this kind of technology. In the US, there's I'm afraid drones have a negative connotation. They don't make people think of, you know, life saving technology. They make

people think of military strikes. Has that been a problem for you when while moving these ideas to North Carolina and proposing their use in other places? Do you find Americans are more resistant to the use of drones and delivery? That's a complicated question. I mean, you know, if you think drones have a bad connotation in the US, just imagine where they've actually been used by the US government to kill people. Like those countries have an even more

negative connotation. But yeah, absolutely, I think that this general technology has been thought of as technology that kills people rather than technology that saves people's lives, and that is part of the narrative that we are trying to rewrite. The reality is that autonomous systems of this kind can have a huge impact in equalizing access, building logistics systems that serves all humans equally and ensuring that where you

live does not determine whether you live. It's just going to take time for people to see that other half of the coin. And you know, in Rwanda and Ghana today, the community acceptance for this national service is through the roof because most people have a cousin or a family member or a friend who has received a product and is perhaps even alive because this service is available and it's pretty simple. And by the way, they don't call

them drones. They just call them sky ambulances. Sky ambulance sounds a lot nicer than drone act, but it's also more specific to what it's actually doing. I think we actually tend to call things. There's a joke among roboticists that there are no useful robots because once something is useful, you just call it the thing that it does, rather than a robot. So for example, like a dish washer is a dishwasher or not, like you know, a robot that watches your dishes, And I think the same is true.

You know, yeah, we don't really talk about drones. And in fact, I think one really important thing to understand about zip line is that none of our customers care about drones. All they care about is does something go from point A to point the fast enough to save someone's life. Recently, you've done a deal with Walmart. Have you created a partnership with Walmart? Tell me about that? Is that do you have the idea of expanding this beyond medical supplies to other things? Is that The purpose

of it. What we're doing with Walmart right now is Walmart actually operates, you know, pharmacies that are closer to a lot of the most rural, vulnerable populations in the

US of any company in the country. And so what we're focused on doing with Walmart is extending access to their pharmacy as well as specific health and wellness products directly to the home, so that people, if they need something, they can order it and get it delivered instantly, as opposed to have to go to a pharmacy, especially in the time of a pandemic. Can you deliver in the same way to somebody's house, I mean, to you know, letting a little parachute float down into their front yard.

I mean, it's a good question and actually something that we'll have you know, we'll be making some announcements on over the coming year. Our goal is to serve every single GPS coordinates, every single home in all the countries where we operate. You know, today we can serve some of them, not all of them, but that percentage of

homes that we serve will increase over time. Is there an issue in your business in drone delivery of privacy in the way there was with telemedicine that things that used to be one to one or things that you know, conversations that used to be absolutely privileged are now recorded somewhere or available to other people. Have you run into that as a barrier in what you do as well? Luckily on the privacy front, we really just fit in the same way that other logistics systems would fit in.

We're certified in the same way that you know, our motorcycle or a courier service that was delivering something quickly would be certified. That's actually not something that is like new or requires us to to you know, reinvent the wheel keller. Can you remember the first time you realized that this system was going to work when in real life a drone took off and it delivered a medical product to someone who needed it. Can you can you

remember that? That was, Like I certain experiences are probably indelibly you know, marked on your on your brain, and that's certainly one of them. I mean, I think the important context is when we were starting to build zip line, so many experts in global public health told us that this was a stupid idea and that it was never going to work. And it was in fact the governments.

It was the ministers of health who kind of helped change our mind and say like no, no, no, like this will work, Like let's focus, let's you know, let's let's go see if we can deliver, for example, just blood, which is what we started doing in Rwanda. And I remember, you know, when we actually launched, the President of Rwanda came. He was one of the early champions for us getting

started there. He launched the first aircraft. It went made a delivery, and I remember as we were sitting waiting for the plane to come back and land at the distribution center, like a hundred kids had gathered on the fence.

We have a fence around our distribution centers, and there were one hundred kids on the fence kind of like looking in waiting with us to watch this plane coming inland and he just casually pointed at all of them and he said, those are the future engineers of Rwanda, And it really made me realize that this is, you know,

in some ways, this is bigger than healthcare. This is this is building a world where people who have been left behind by traditional economies, left behind by traditional kinds of logistics systems, are actually going to have a chance

to lead the world. And by the way, you know, these kinds of jobs, these kinds of startups and new ideas and new innovations are going to create jobs and opportunities, and we've found I mean, I think the most important thing about zip line to understand is that the superheroes behind this story are the flight engineers and flight operators who operate all of our distribution centers across the world,

and those teams are one hundred percent local. What are a few things that listeners could do to help you solve this problem, in other words, to encourage medical innovation to bring these kinds of delivery systems to their own communities. What do you suggest that people do You know, that's an awesome question and one that I rarely get. In fact, I don't know if I've ever had someone asked that. One is that I do think people should demand more

from their healthcare systems. Healthcare systems that really survive and thrive are going to have to figure out how to provide care in a convenient, cost effective way closer to where patients live. You know. Another thing is that we're a global company, and we're really proud of what we get to do outside the US. But as a US Citi, isn't it If I were to speak for a second, I would say, it is so so important that we not allow ourselves to fall behind in pre new areas

of technology. Reason that we live in the richest country today is that our grandparents did an amazing job of moving really quickly on things like cars and airplanes and satellites in the space race, you know. And the reality is that there are a lot of industries that are those corollaries today, but I think the US is not pursuing them as aggressively, and in many cases we're allowing regulation to actually hinder the adoption of that technology in

the US, and other countries are not wasting time. China, for example, is moving really really quickly when it comes to things like nuclear fusion and quantum computing and drone delivery. We have to realize that if we don't innovate other as well, and we won't necessarily lead the world forever. Are there books or articles that you've read, other things to read or watch that you can suggest for people who are who are interested in pursuing this subject further.

You know, drone delivery is a little trickier because it's it's just so nascent that you know, I don't think the books have been really written yet, but I can say, you know, this broader trend that I'm describing of really understanding the context of where growth is happening in the world.

I know two books that I deeply love. Factfulness by Hans and Ola Rosaling is an amazing book that just kind of explores like, what are the basic facts of the world we live in and where growth is occurring and where people live and what like a more equal

future would look like. And then Enlightenment Now by Stephen Pinker is just I think one of the most important books probably for every human on earth to read and definitely speaks to a lot of these trends I'm talking about about, like what would a hopeful future look like where humanity is becoming more equal over time rather than the opposite. Kelo Renado is the CEO and founder of

zip Line International. To learn more about drone delivery and remote medical access, please check out the links in our show notes. Salvabill. Senior producer is Jocelyn Frank. Research and booking by Lisa Donne. Catherine Girardo is our managing producer. Our executive producer is Mia Lobell. Solvable is a production of Pushkin Industries. If you like the show, please remember to share, rate, and review it. It really helps us

get the word out. You can find Pushkin podcasts wherever you listen, including on the iHeartRadio app and Apple Podcasts. I'm Jacob Weisberg.