Global alliance helping start-ups inject innovation into vaccine delivery

What do drones, smart fridges and wearable tech have in common? Apart from perhaps making your Christmas list this year, they are part of a global strategy to save millions of lives through immunisation. In Tanzania, tech start-up Nexleaf Analytics works with the government to combine the Internet of Things (IoT) and data analytics for the monitoring of thousands of connected fridges, ensuring vaccines are kept at an optimum temperature for viability.

Nexleaf is part of a cohort of healthcare-oriented tech start-ups that are incubated and accelerated within Infuse, an innovation hub created by global non-profit organisation Gavi, the Vaccine Alliance, with the express purpose of improving vaccine delivery systems in developing countries.

Gavi, created in 2000, has helped developing countries to prevent more than 10 million potential deaths through its support for immunisation programmes and vaccination campaigns. Since 2017, 65 million children in more than 60 countries have been immunised with Gavi-supported vaccines. Part of the challenge, however, is in getting vaccines to the hardest-to-reach areas of developing countries, and ensuring that these vaccines survive extreme weather conditions.

New technologies such as drones or smart fridges can meet these challenges but they cannot be power-hungry, rely on expensive-to-replace parts, or require overly specialist technicians to regularly maintain them because – although they may be developed at cutting-edge start-ups – they must be robust enough to operate in low-income countries. Lives depend upon it.

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This is why Gavi launched Infuse (Innovation for Uptake, Scale and Equity in Immunisation) at Davos in 2016: it is a beacon for tech start-ups looking to scale while helping the Vaccine Alliance tackle global health priorities. Moz Siddiqui, senior manager of strategic innovation and partnerships at Gavi, says that in conversations he has had with private investors, they say Infuse is a bit like a venture capitalist itself: "When we explain what we do they say: 'So, you're basically a VC for global health', except we're not taking equity from any of these companies; we're providing them with mentoring, exposure and the right connections to certain organisations such as ministries of health and others that can help them navigate this space."

Drone delivery

One of the first companies that Infuse worked with is Zipline, a drone delivery start-up. Zipline and Infuse partnered with UPS to ship blood and medication to inaccessible regions of Rwanda, where healthcare workers previously made the journey by bike, donkey or on foot in all kinds of extreme weather. Trips that had taken days and hours were cut down to hours and minutes and Zipline now delivers two-fifths of the country's blood supply outside the capital.

“We’re paring start-ups with the private sector so there is a learning process from large corporate to start-up and, similarly, there is a value add for large corporates to be working with a start-up. We’re also looking at how to inject them with capital to get them to the point of being able to scale. So if you think about what venture capitalists do: while they take strategic bets we are making strategic decisions, already knowing what specific use cases we have in mind,” Siddiqui says.

Zipline is one of Infuse’s flagship start-ups or what is known, in Infuse vernacular, as a “pacesetter”: they create a path and set the pace for others to follow. The pacesetters set the tone and, in Nexleaf’s case, have stimulated an entire market.

“This ensures we are always getting the next iteration of that particular technology,” says Siddiqui. “We want to know if there are even more innovative sets of technologies out there because the end result is to provide countries with technology they can use to improve their own vaccine delivery systems.

“Stimulating an entire market helps reduce the time between supply and demand of vaccines. We know, given the scale, that we probably can’t find just one technology; we need to find a whole range of them. It defuses the risk but it also defuses a potential market monopoly that we might be inadvertently creating,” he explains.

Last year, Gavi took its fight for global immunisation directly to Silicon Valley. It convened a meeting in the valley with Y Combinator, Salesforce, and Google.org alongside the philanthropic community, venture funds and academia on how best to tap into the tech sector to improve vaccine delivery while benefitting the companies that come on board.

Google.org is already part of this and has teamed up with Gavi and Nexleaf Analytics to help scale the start-up’s data-driven “cold chain” equipment; this is that system of thousands of connected smart fridges that ensure storage of safe and potent vaccines.

“The challenge that we face is that vaccines need to be kept between two to eight Celsius and the current method for doing that isn’t the most optimised. Nexleaf have created a sensor that allows it to get real-time data from fridges,” says Siddiqui.

“This is important because if you’re a country with around 1,000 fridges out there you want to know which of your fridges are working. When they’re not working you end up deploying your technicians, knowing that it’s quite costly, so you need to be more precise. In terms of IoT, organisations like Google.org understand how to use this data quite carefully and they are interested in asking: how do we build this out?”

Siddiqui says it is about limiting the rate of vaccine wastage to help governments save money and because the cold chain is critical, especially in hot countries, predictive data analytics, given enough sensor data, can start to make educated guesses about what fridges will fail, and when, and prevent this from happening.

Nexleaf's ColdTrace sensor technology is attracting attention beyond Tanzania and proves that technological innovation doesn't always have to begin in developed countries, as chief executive Keller Rinaudo has said, explaining that the combination of a readily available market and low regulatory compliance can get a product to market more quickly than in Europe or the United States.

Nevertheless, big US tech companies have left their mark: Google.org invested US$2 million in Nexleaf, as did the Bill and Melinda Gates Foundation, which has been a driving force throughout Gavi's development. The foundation's initial pledge of $750 million in 1999 provided the seed money to launch Gavi in the first place, with more than $1.5 billion in donor contributions and pledges to date.

Bill Gates has, in the past, said of Gavi's importance: "One of the highest priorities of the Gates Foundation is to increase access to life-saving vaccines for children in the world's poorest countries."

Robust system

In terms of Gavi’s future goals, the aim is to immunise 300 million children by 2020 and, as Siddiqui says, “also leave behind a really robust system that countries can then own and operate. That is the driver of all of this innovation.”

In order to do this the Vaccine Alliance must push past global immunisation coverage, which they say has stalled at about 80 per cent for several years. Part of this problem lies in the “last mile”: lack of infrastructure or inaccessible, remote locations can stymie vaccine delivery and solving this is what led to high-tech solutions such as drones.

But drones alone don't solve the problem. When the last mile involves ensuring vaccination is a core part of antenatal care, healthcare workers need a more human touch. Another Gavi pacesetter is Khushi Baby, an Indian company that made its debut on Kickstarter back in 2014 and has created an inexpensive digital necklace that allows the owner to wear their medical records.

When a nurse visits a rural village, equipped with an NFC-enabled mobile phone, they simply hold it close to the necklace to check if the infant's vaccinations are up to date. The reason for designing this tech as a necklace is that Khushi Baby's founders noticed many mothers placing amulets on a black thread around their child's neck in order to ward off disease. Now, in conjunction with 80 healthcare workers, they have 12,000 mothers and infants in 375 villages in the Udaipur district of Rajasthan, India, wearing these devices.

“Our superpower within the vaccine ecosystem is scale. We now work across 68 countries and we purchase vaccines for 60 per cent of the world’s birth cohort,” says Siddiqui.

“We are always thinking about how to make sure we are finding some really interesting, applicable, potentially game-changing technologies that are not just disrupting industry for the better but which we can adapt to our context.”