Ensuring that children in the world’s poorest countries have access to immunisation is the most pressing concern for Seth Berkley, chief executive of Gavi, the Vaccine Alliance. Of all the health interventions, say experts, vaccines are unrivalled at bringing the maximum benefit to the highest number of people in the most cost-effective manner. “We have the highest immunisation rates in history,” says Dr Berkley. “That being said, we are still missing 15 or 20 per cent in the developing world.” Of those, many are so-called zero-dose children or families, potential patients who have never had a single vaccine. “If you’re missing them for vaccination, they’re missing everything. They’re not in the health system at all.”
Dr Berkley argues that technology, though not a panacea, can play an important role in identifying non-vaccinated communities, tracking individual patients and delivering vaccines to people in remote locations. “I’m a great believer in leapfrogging,” he says, citing the well-known example of Africa’s jump straight to mobile technology. “We have new vaccines, new drugs . . . but those tools don’t work unless you can get them to people.” One of the challenges in Africa is rapid urbanisation. The population of the continent will double to more than 2bn by 2050 and could, on existing trends, double again by the end of the century. Much of that growth is happening in cities, where four in 10 Africans already live.
While in theory that should make it easier to reach concentrated populations of patients, in practice many living in the continent’s often chaotically unplanned cities which are virtually invisible to the health system. “Today the largest number of non-immunised kids are in the slums,” says Dr Berkley. “People are moving into slums at an unprecedented level, looking for jobs and opportunities. They don’t end up with a fixed-base domicile and they move around. They are not legally registered. For them to be able to access healthcare and be properly followed up is very difficult.”
Gavi, which has received more than $4bn in funding from the Bill & Melinda Gates Foundation since 1999, has tried to encourage vaccination through a variety of innovative technologies as well as relying on old-fashioned word of mouth. Chatbots are used to spread the immunisation message in different languages. In Nigeria, crowdsourcing of information derived from patients sending reports about health conditions on the ground allows health authorities to learn more quickly where people are missing treatment. “This gives people power because often they don’t trust the system.”
Gavi is also supporting efforts to use mobile data to keep track of populations. While some people, including Kenyan author Nanjala Nyabola, have expressed concern about governments keeping tabs on people’s information, Dr Berkley believes that the advantages can sometimes outweigh the pitfalls. His organisation is working with Simprints Technology, a Cambridge-based biometrics company, and NEC, a Japanese information technology company, on facial recognition and fingerprint technology in infants so that children’s medical history can be tracked independently of their parents. Gavi is also working with two campaign groups, Living Goods and Last Mile Health, to improve vaccination efforts in Kenya, Uganda and Liberia through a combination of technology and community outreach.
In Tanzania, says Dr Berkley, even nomadic Maasai herders have mobile phones and wander in and out of coverage areas sufficient to be tracked. In rural areas, there is a different set of problems. Here, says Dr Berkley, drones are proving surprisingly useful. Zipline, a California company, has pioneered the delivery of vaccines and plasma by drones in Rwanda. The country is small but mountainous, making drones ideal for quick delivery. “You can get blood anywhere in 20-30 minutes,” says Dr Berkley. “This has been an extraordinary success.”
Gavi is now experimenting with the technology in the Democratic Republic of Congo and Ghana. In DRC’s Equateur Province, it is trying out drones suited to getting supplies to isolated communities, sometimes in dense forest. In more urban Ghana, in west Africa, drones are operating around the clock with the aim of reaching 2,000 clinics around the country of nearly 30m people. One idea is to get rabies vaccines or anti-snake venom to people who have been bitten. Rabies is always fatal once infection takes hold, so speed of delivery is vital. Technology, Dr Berkley concedes, cannot solve all problems. The recent outbreak of Ebola in eastern DRC, already the second worst in history, is evidence of that.
The antidotes to Ebola have never been stronger. Health workers have deployed a vaccine to some 200,000 people that, if administered quickly enough, is thought to be 100 per cent effective. Even those infected stand a far greater chance of survival thanks to the discovery of two anti-Ebola drugs in which trials have indicated a 90 per cent efficacy rate. Without treatment, some 70 per cent of those infected with the virus die. Yet in eastern DRC, the one ingredient missing is trust. After years of violence and abuse at the hands of the authorities, local communities have little faith in medical experts.
In December, the government cancelled elections in the region, blaming the Ebola epidemic, further fuelling rumours that the disease may have been fabricated. As a result, some 50 per cent of people who have died of the disease have had no contact with health workers, dramatically raising the risk of spreading the infection. By August, more than 2,000 people had died of the disease of some 3,000 confirmed cases. “Technology doesn’t solve that fundamental problem,” says Dr Berkley. “It can only make a difference if it is actually used.”