This week, 1-month-old Joy was vaccinated against hepatitis and tuberculosis. Those are standard childhood vaccinations, but there was something definitely non-standard about the way they reached Joy. They arrived by drone.
Joy and her mom, Julie Nowai, live on Erromango, part of Vanuatu, an island nation made up of some 80 Pacific islands, lying west of Fiji. With very few airfields, paved roads or available refrigeration in Vanuatu, around one in five children do not receive vaccines, according to the government.
In a bid to make sure children in remote spots are vaccinated, Vanuatu has launched a program using drones to deliver the medications.
The country's Ministry of Health and its Civil Aviation Authority are leading the project. UNICEF, the Australian Government and the nonprofit Global Fund to Fight AIDS, Tuberculosis and Malaria are providing support.
Swoop Aero, an Australian drone company, delivered the vaccines on December 18. And baby Joy was the first child up. She missed getting vaccinated at birth because her mother was unable to walk 25 miles across the island's rugged terrain to reach available nurses, according to UNICEF.
"This is a significant step because it shows that a government is showing commitment to address the vaccine delivery issue and is interested in exploring new possibilities," Dr. Bruce Lee, an associate professor of international health at the Johns Hopkins Carey Business School, wrote in an email to NPR.
Registered nurse Miriam Nampil vaccinated Joy and a dozen other children as well as five pregnant women in Cook's Bay. Without the drone delivery, she would have faced the daunting task of carrying the ice boxes needed to keep the vaccines chilled on her trek to Cook's Bay.
Vaccinations require proper storage and handling, including steady temperature control.
During the 25-minute drone flight over Erromango, UNICEF said the vaccines were kept cool in styrofoam boxes padded with ice packs.
"When vaccines [are] flying around at different altitudes, one of the concerns is temperature exposure, because they aren't in a flying refrigerator," noted Dr. Lee of Hopkins.
UNICEF said an indicator was in place to send an alert if the vaccines' temperature fell out of an acceptable range.
The trial is expected to continue with more deliveries on Erromango Island in January.
One key to the program's success is getting the word out to the community, UNICEF's Pacific Island countries representative Sheldon Yett told NPR. To that end, local nurses and community leaders have been meeting with villagers to explain how the drones work and how they can bring vaccinations that keep children healthy.
Drones have been deployed in other parts of the world to deliver life-saving supplies to hard-to-reach areas.
In 2016, the California-based company Zipline contracted with the Rwandan government to provide blood, plasma and platelets to health centers by drone. So far, it has delivered thousands of units of blood to 19 hospitals. Zipline spokesman Justin Hamilton told NPR that starting the drones will also deliver vaccines in the country beginning in December.
Ghana is next. The government there has signed an agreement with Zipline for the delivery of medical supplies via drone from four different bases in the country.
And stateside, the FAA has agreed to let the company use drones to deliver medical supplies in North Carolina beginning in 2019, Hamilton said.
Vaccines are a critical cargo. According to the World Health Organization, an estimated 19.9 million children did not receive routine immunizations in 2017.
"A sizable percentage of vaccine supply chains around the world are broken, meaning that many life-saving and life-improving vaccines are not reaching the people," Lee said, adding that drone technology can help. "We just have to keep in mind that technology alone is not a solution. It has to be used correctly and fit properly into a system."
Patrick Meier agrees. He's executive director of WeRobotics, a nonprofit dedicated to bringing robotic technology to the developing world. Meier told NPR that a crucial element to the program's success is the involvement of community members in its implementation.
"Many cargo drone projects in this space tend to be short demo projects that don't focus on local capacity building," Meier said. To "demonstrate a sustainable business model," Meir said, "would mean training local pilots and engineers to ultimately take the lead."
UNICEF said if the trial proves successful, the Vanuatu government intends to train local drone operators and expand the program to include other health supplies.