Deliver anything from vaccines to lightbulbs to tonight’s dinner.

Background: Both the COVID-19 pandemic and ensuing vaccine distribution campaigns have had significant health equity implications in Sub-Saharan Africa. In Ghana, the vaccine campaign included over 2.5 million doses of COVID-19 vaccines delivered using drones, or unmanned aerial vehicles (UAV), to regions both rural and urban across the country. Our aim was to evaluate the ability of UAV in transporting COVID-19 vaccines to underserved areas.

Methods: In this retrospective, ecological study, we used a complete dataset of all fulfillment information for UAV-delivered vaccines in Ghana, joined with demographic, and socioeconomic data from the Ghana Statistical Service. GIS analysis and structural demographic data was used to group health facilities and distribution centers (DC) into rural and urban groups. Bivariable and multivariable regression analyses examined how vaccines were distributed across all health facilities, as well as its differential effects across rural and urban distribution centers.

Findings: Across 2 million vaccine doses delivered to 497 health facilities from 6 DC in Ghana, utilizing UAV, we found that health facilities in districts with households that were more socioeconomically disadvantaged received more vaccines on a population adjusted basis. On multivariable regression analysis, each quintile increase in ground transport distance between the health facility and regional medical store was associated with 9.33 (95% CI, 4.62 – 14.0) more vaccines delivered. Every additional percent in lack of access to improved sources of water or households led by women was associated with 3.82 (95% CI, 3.49 – 4.15) and 6.76 (95% CI, 6.19 – 7.33) more vaccines respectively. These effects persisted in both the rural and urban DC groups but were greater in the rural DC group.

Interpretation: The analysis shows an equity-oriented use of aerial logistics in the distribution of vaccines during the COVID-19 pandemic in Ghana. Additional impact was seen in areas that were more underserved as measured by structural demographic factors. Drones could be further deployed to help promote health equity on a national level.