Jeffrey Graham, Senior Bureau Official and Acting Global AIDS CoordinatorBureau of Global Health Security and Diplomacy

Caitlin Burton, Chief Executive Officer of Zipline Africa

Africa Regional Media Hub

MODERATOR:  Good afternoon, and welcome, everyone, from across Africa and beyond, to the U.S. State Department’s Africa Regional Media Hub.  My name is Phillip Assis and I am the director of the hub.

Today I’m pleased to note that this is our second press conference in a row on the America First Global Health Strategy and the effectiveness of U.S. Government partnership with the American private sector.  Today we are discussing how the U.S. Government partnership with the Zipline drone delivery network is improving access to blood and medications across rural Africa and creating jobs in the process.

I’m pleased to note that we are joined by two experts today.  In the original announcement you may have seen that one of our experts was going to be Senior Official Jeremy Lewin; he was unable to join us, but in his stead I’m very pleased to welcome the U.S. State Department’s Senior Bureau Official for the Bureau of Global Health Security and Diplomacy Jeff Graham.  He is joined by the Chief Executive Officer of Zipline Africa, Caitlin Burton.

Today’s briefing is on the record, and you may quote our two expert panelists by their names and titles.  We will begin today’s briefing with brief openings from our two panelists, and then we will turn to your questions.  And we’ll try to get to as many of your questions as possible in the time we have allotted.  Some – we have received some questions in advance, but if you would like to ask any live questions on the call, please type those questions into the question-and-answer tab, and include your name, location, and media outlet, please.  And please do use the Q&A tab as opposed to the chat box, and note that, from our end, we only see your Zoom login information.

With that, I will turn the floor over to Senior Bureau Official Jeff Graham.  Thank you.

MR GRAHAM:  Thanks, Phillip.  Happy to be here, and good morning everybody, and good afternoon – wherever you are.  Really also excited to be here with my colleague Caitlin from Zipline to talk about this very exciting investment.

Let me just start by saying a couple of things.  In September the Department of State announced our new America First Global Health Strategy, which seeks to enhance return on U.S. taxpayer dollars while reducing waste, eliminating a culture of dependency in the aid system, and ensuring assistance is strategically aligned with our foreign policy goals.  And as part of that health strategy, we need to be able to deliver life-saving medical products to people in need across Africa, especially in hard-to-reach areas.  And so that’s why we’re working with Zipline, an American company, using their American-made robotics and drone tech to deliver these life-saving products at greater speeds and greater efficiency.

And as part of this deal, as you’ve heard, we’re providing up to $150 million to expand access to life-saving medical supplies, including blood and medicines, to as many as 15,000 health facilities across Cote d’Ivoire, Ghana, Kenya, Nigeria, and Rwanda.

This is only the start.  By expanding U.S. private sector reach and leveraging America’s unmatched innovation in tech and science and medicine, we’re going to deliver on a much-needed 21st century upgrade to how the U.S. conducts foreign assistance.  This is in line with our overall approach of making America safer, stronger, more prosperous.  And so through this partnership with Zipline, we’re going to strengthen resilient local health systems abroad, prevent the spread of infectious diseases and enhance emergency outbreak response, boost private – sorry, public-private sector collaboration and open new markets for American companies globally.  We’ll ensure that the U.S. remains the partner of the choice and the leader in global health, especially in the areas of tech, science, and medicine.  We’ll create manufacturing jobs in the United States and local jobs on the ground.

So with just a modest – what we think of as a modest U.S. capital investment, these countries will actually become more responsible for maintaining and continuing to invest in their own country-led health systems, which is the main thrust of our strategy.  This is all about helping countries get ready to do most of this work on their own through some investments through the United States.

We’ve already started working with the governments of Rwanda and Zipline to announce the new distribution centers, and which are going to double their daily deliveries in Rwanda, but I’ll let Caitlin talk about that.  And I think it’ll reach as many as 130 million people across the continent.  So it’s a very exciting partnership and we’re happy to – happy to be part of it.

So let me stop there and turn it over to Caitlin and Zipline.  Thanks.

MODERATOR:  Thank you.

MS BURTON:  Thanks, Jeff.  Hi, everyone.  I’m Caitlin Burton; I’m the chief executive of Zipline Africa.  I actually wanted to start the briefing today with a quick story.  On October 30th, a Rwandan woman from Nyagatare district, who was pregnant with twins, went into premature labor and suffered a placental abruption.  The hospital didn’t have enough blood of her type on hand, and so getting that by road would have taken about six hours – far too slow to save her life.  And so luckily, this hospital was part of Zipline’s network, and we got nearly seven pounds of blood there in 40 minutes, and that mother’s life was saved, and she can now raise her twins happily herself.

While that story is very special and meaningful to this family, it’s not unique.  It happens hundreds of times a day across the countries Zipline serves.  It’s made a huge difference for the populations we reach.  And actually, maternal deaths are down by more than half at Zipline-serviced facilities in Rwanda where this woman’s story take place, and other countries where we’ve been able to measure it.

So for those who aren’t familiar, Zipline – we build and operate drones that fly 24 hours a day, 7 days a week in all weather.  And this enables a centralized, on-demand supply chain model that ensures every patient gets the treatment they need when they need it.  And it eliminates waste, it reduces administrative complexity, it saves money.

Just like how African countries skipped landlines and went straight to mobile phones, these health systems are really skipping the 19th century infrastructure that doesn’t serve anyone particularly well and is increasingly complex to manage, and it’s replacing it with this modern infrastructure whose performance isn’t measured in on-time in-full deliveries – that’s a given – but rather in raising treatment rates and improving health outcomes.

So thanks to the partnership we’ve had with these five African governments over the years, we now have evidence that we’re the least expensive and most effective way to do this.  And thanks to an equally bold and visionary partner today – the U.S. State Department, who is stepping in to help these pioneering countries – Rwanda, Ghana, Nigeria, Kenya, Cote d’Ivoire – we’re going to be able to scale this service nationwide.

I also – I just want to call out a few visionary partners that we’ve had over the years.  There’s a small number of deeply invested partners who are committed to moving the needle on intractable health challenges, and they were willing to kind of radically depart from the status quo.  The Elton John AIDS Foundation, the Gates Foundation, Gavi, Pfizer Foundation, and the UPS Foundation all supported the reach – the operations in our partner countries to improve health outcomes for tens of millions of people, and understand exactly why this approach matters.  Together with these partnerships with African governments, we have been able to cut maternal deaths by 56 percent.  We’ve reduced zero-dose prevalence by 42 percent in a single year.  We have reduced missed opportunities to treat severe malaria by 66 percent.  And the list – the list goes on.  And now we have the chance to bring this impact to countries nationwide thanks to this partnership with the State Department.

At full scale, the award will expand coverage to up to 15,000 health facilities that serve about 130 million people.  It will create about a thousand jobs and drive an estimated $1 billion in annual economic growth in our partner countries in Africa.

And I think the bigger vision is, what we’ve discovered over the years, is that with a well-trained workforce, with innovative drugs, and with the most efficient and cost-effective logistics infrastructure on the planet we can finally imagine ending HIV transmission in a country, ending maternal mortality, ending severe malnutrition, just having health systems that reach everyone equally wherever they are not with a complex web of one-off programs but with a single piece of highly cost-effective infrastructure.

So we – I just want to thank Secretary Rubio, Under Secretary Jeremy Lewin, SBO Jeff Graham on the call today, everyone in the U.S. State Department for their bold vision, their smart strategy, and their swift execution.  I think that this award is changing foreign aid but it will also forever change the trajectory of human health and development.

So thank you all for the partnership.  We’re really excited to answer questions today.

MODERATOR:  Great.  Thank you both, Jeff and Caitlin.  Thanks to our speakers.  We’ll now turn to your questions, and we’ll take questions related to the topic of today, which of course is Zipline drone deliveries in Africa and the America First Global Health Strategy.  Once again, questions should be entered in the Q&A box, not the chat, with your name, outlet, and location.

The first one comes from Ms. Irene Okechukwu – and apologies for mispronunciations – and she is from the Real Broadcasting Network of Nigeria.  Her question is:  “How will rural communities be engaged to build trust in drone delivery, especially in areas where residents may have safety concerns or lack awareness of the technology?  And are there plans to ensure that underserved populations, including people in hard-to-reach or marginalized regions, benefit equally from this program?”

MS BURTON:  I can take that.  Absolutely.  I think rural and hard-to-reach communities are usually the most served by our technology; it’s a true equalizer for health access.  But what we’ve also seen over time is our operation sites become community centers themselves.  Kids love to see drones take off.  We open our hubs for community visits and school tours, robotics workshops.  We do a lot of community outreach.  We host a lot of blood drives.  We help the governments that we partner with raise awareness on things like World Malaria Day, taking our drones out of our nests and into communities where people can kind of touch and feel the technology themselves.  It’s super powerful.  Of course, we hire from the local communities that we operate in.  We’re 100 percent locally led, but also we find that after operating for a while everyone knows someone whose life was saved by Zipline.

Someone told me recently that every time they see a Zipline drone in the sky they smile because they know someone’s life is being saved, and I think once that becomes how people understand the system to be, it’s a really welcome – it’s a really welcome part of everyday life.  So, yeah.

MODERATOR:  Great.  Okay, thank you.  Our second question comes from Ms. Dabia Mohamed from the Al Jazeera Media Network in Ethiopia:  “What criteria guided the selection of the five African countries chosen for this project?”  And I would add, which African countries are next in line for Zipline?

MR GRAHAM:  Maybe let me start with that one.  So in terms of this particular award – this is an investment in places where there already is a Zipline relationship with countries and with governments.  And so it made sense to start there.  As Caitlin just described, this is, I think, a really interesting way of approaching this which is not bringing in Americans to do this work in rural communities.  This is about having Africans do this work in their own communities.  So what we’re making is an upfront investment.  So we chose the countries where Zipline was already there.  Maybe Caitlin can talk about how those expansions are going to work in those individual countries.

In terms of what comes next, I won’t speculate.  Let’s stay focused on the current investment now, but just look for more exciting and innovating investments coming from the U.S. under this strategy in the future.

Caitlin, over to you.

MS BURTON:  Yeah, I mean, in a way these governments selected us, right?  Like, they had the vision.  They were tired of struggling with the status quo and so they adopted Zipline even when they were often receiving other supply chain services for free, and they have been spending their own budget on having Zipline for years already, and they’ve been able to realize tremendous gains from that.

And so I think the question here was:  How can we get that faster?  How can we scale that as fast as possible?  How many lives could we save if we had this infrastructure nationwide now instead of over the 10 years it’s going to take us to self-finance that?  So the U.S. Government and the America First Global Health Strategy, they kind of had this vision.

If this is what these governments are asking for, if they’ve proven that it works, if they’re willing to pay for it themselves, if they can only access it at scale, that’s a perfect example of commercial diplomacy, I think.  It’s giving them the technology, the jobs, the entrepreneurship that they’ve been asking for and it’s giving it to them as quickly as possible so that they can realize the benefits that this delivers as fast as they can.

So yeah, it was kind of a self-selecting group and there are more of them out there, but as Jeff said, we’ll leave to another day.

MODERATOR:  Great, thank you.

Another question from Nigeria, which is:  “How will this initiative ensure long-term sustainability once the initial U.S. funding cycle ends?”  Actually, another journalist asked the same question:  “And what plans exist for knowledge transfer and capacity building so that African governments can eventually run these drone networks independently?”  Or another way to put it is:  What happens after U.S. Government funding?

MR GRAHAM:  Maybe I’ll just start with the easy part, which is that again, that’s the whole thrust of the new U.S. strategy.  I think what we are pushing is an entire mindset shift in how we do foreign assistance, moving from a system of staying engaged for decades and decades where there was no endgame, no exit strategy.  Now we are moving to a self-sufficiency strategy.  And so I’ve just come from a trip in Africa where we were negotiating agreements all across the continent trying to move countries toward glide paths for running their own health systems over the next five years.  And this is part of that approach.

So it’s looking at upfront, short-term investments by us that translate into long-term, sustainable projects that we leave behind; rather than having the U.S. Government stay in these countries, running a supply chain network for decades, we’re going to make an upfront investment and then it will be sustainable.

But Caitlin, maybe you can answer the other part.

MS BURTON:  Yeah, I know, I think you’re spot-on.  By design this is meant to be self-sustaining and long term for the countries that take it on.  We looked around at what was happening with foreign aid this year and we thought there’s a real opportunity to reset the trajectory for development instead of having the U.S. Government kind of own and operate a supply chain for decades.

Countries are – they’re already doing a version of that with Zipline at regional scale.  And moreover, they have been saying for a decade they want trade, not aid.  They don’t want to be kind of treated like a charity case.  They want technology; they want jobs; they want entrepreneurship; they want growth.

So yeah, I mean, I think the governments adopted this themselves because they – it has unparalleled impact on population health.  It can solve problems like maternal mortality and child deaths once and for all.  When the countries have already adopted it, they just need support to bring it to scale faster.  So think of all the lives that would be lost kind of needlessly over a decade of scaling the system on their own.  So why wait?

I think this is about being really catalytic, but it’s the governments’ vision really that we’re all investing in here.  They have a plan for long-term sustainability.  They put this in their budgets and they pay for the service.  And the funds, by the way, that they pay get spent right back there in the economy.  It covers people’s salaries; it covers service provider costs; it covers utilities; it covers taxes.  So it’s – in many ways this is kind of a win-win.  It’s the government spending their own domestic resources on a kind of fundamentally game-changing piece of infrastructure that the U.S. Government is able to support them accessing as quickly as possible at scale.  But the long-term ownership, the long-term service provision is run locally and it’s paid for locally by the governments from day one.

MODERATOR:  Great.  Thank you.  Next question comes also from Nigeria.  This is – this question is from Adejuyigbe Francis Adegoke from the Fishe Govima Network.  And his question is: “Which Nigerian health facilities, up to the stated total across all countries, will benefit from the Zipline drone delivery system?”

MS BURTON:  That’s a great question.  This is determined by the Nigerian Government, and so they need to tell us where the service is going to be most effective and certainly cost-effective, what specific health burdens they want to use it to target.  And then we set up the system to maximize coverage that’s going to deliver on those goals at scale.

And so the nature of our conversations with the Nigerian Government right now really focus on BHCPF facilities, as the Basic Health Care Provision Fund.  It’s kind of a new model the Nigerian Government has, where they invest in ensuring that there is one, like, highly-equipped facility with highly trained personnel with a flawless supply system that can always meet its mandates to patients and having one of those in every single ward in this massive country of 230 million people.  So I think there’s about 14,000 or 17,000 of those facilities planned.  About half of those are currently online.  And Zipline – our first order of business is going to be integrating into and serving that network of BHCPF facilities.

From there we will be able to expand to all sorts of community distribution and other sorts of state facilities.

MODERATOR:  Great.  Thank you.  We have another question that came from Ms. Dabia Mohamed at Al Jazeera: “How does this initiative align with the United States’ broader strategy in Africa, particularly amid growing global competition in health and technology?”

MS BURTON:  Jeff, do you want to take that first?

MR GRAHAM:  Yes, I had an unmuting problem.  Yeah, let me – I mean, I’ll try to stick to the health space.  First of all, the – I think the main difference of the way we’re approaching the health assistance and the strategy is, again, moving from a model that for good reasons and with good intentions ended up being – creating a cultural of dependency in Africa, where we were just providing the medical support to African – citizens of African countries, rather than really pushing the governments to get to a place where they would do this themselves.  Again, there are reasons for that that happened over time, and it’s all described in our strategy.  But this is a push to something new, which is – it’s long overdue to make this shift.

And in fact, I’ll tell you, I’ve met with many ministers of health across Africa who uniformly welcome this approach and have said, in fact, we wish you had done this earlier, not because they don’t like having assistance, but it’s — because of the way it works, if we don’t build a system where they end up responsible for their own health outcomes, we’ll just never get to that stage.  So the strategy really is the leading edge of the Trump Administration’s new approach on how to do this, because at the end of the day our goal is not necessarily to – we’re doing lifesaving assistance, but we’re not trying to do it forever.

We’re trying to get countries able to do this themselves.  And frankly, every aid dollar in the world won’t solve problems of economic growth and development in Africa.  They’re – countries are going to have to move to other systems to figure that out.  And so Zipline is a great example, again, of investing in something that becomes locally owned, locally grown, sustainable, builds the local economy, and contributes to GDP growth while delivering lifesaving assistance at the same time.

MODERATOR:  Great.  Did — Caitlin, did you have something to add to that or no?

MS BURTON:  I mean, I – yeah, I think this award is squarely focused on two things:  what African government partners want, which is scaling access to this cutting-edge technology that saves lives; and then how to improve things for America, whether that’s reinvigorating American manufacturing or being a better steward of taxpayer dollars.  I think it ticks a lot of boxes in terms of what we’re all – what the U.S. Government is trying to achieve with its foreign assistance strategy and also what is good for America and good for the – for our partner governments.  And so kind of a win-win-win.

MODERATOR:  Great.  Okay.  Very good.  The next question – let’s see.  I think we got time for just two more questions.  So the next question comes from Adejuyigbe – sorry – Adegoke, who asks: “What impact will American-made AI robotics and anonymous logistics technologies have on overall health outcomes in Africa?”

MS BURTON:  I mean –

MR GRAHAM:  Maybe I’ll start and then Caitlin – oh, Caitlin, do you want to start?  Yeah.

MS BURTON: No, no, no.  Please go.  Yep.

MR GRAHAM:  All I was going to say is you said it already in your first answer, which is leapfrog technology is the best way to say this.  I think there’s a – the great example that Caitlin mentioned already in Africa of rather than spending decades trying to catch up on digging trenches for telephone lines either buried or in – on poles, move to cellular technology and just skip over that generation.  This is exactly the same thing.

We’ve just had multiple meetings with countries about their health systems, and in a health system, if you’re trying to deliver commodities what matters – the hardest part and what matters the most is the last mile.  Getting commodities onto a tarmac in a capital city is easy.  Getting commodities from the capital city out to the regional warehouses is also pretty easy.  Getting it those last couple of steps is actually very, very hard, particularly in countries that don’t necessarily have their road networks built all the way out or where villages are very hard to reach.  So I think you first have that piece.

And secondly, I think you’re introducing some really great new technologies.  I don’t know if the question is getting at are countries ready for this tech.  Of course they are.  So it’s – we’re providing them with things that they don’t have to wait generations to get the latest tech.  I think this is a fantastic way to introduce it now and skip over the slow process in between.

But Caitlin, please jump in.

MS BURTON:  Yeah.  I mean, I would add to that that I think there’s a common misconception that this is just a transport method.  But it’s actually a whole supply system.  That’s what kind of robotics enables is – it’s the centralized, on-demand system that creates an extremely reliable system.  It can’t be interrupted by the things that other forms of transport are interrupted by.  But more importantly, it – a lot of the trade-offs that you have to make in a health system have to do with controlling for quality by also controlling access.  You kind of limit – you limit where patients can access certain kinds of care in order to limit your exposure to potential theft or fraud or expiries, or whatever it is.  And these sorts of trade-offs have never been good for patients.  And that’s why – it’s one of the reasons why we continue to have these health burdens that are completely solvable.

I think that a lot of those kind of old-school supply chains, they measure their performance in inputs like how many drugs they procured, how many drugs they brought into the warehouse, some kind of turnover rate.  Maybe they measure it in on-time performance, in-full distribution, what actually is ordered arrives on time.  With Zipline those things are – it’s impossible for us to not deliver everything on time and in full.  It’s kind of guaranteed.  It’s the future of the system.  It’s what robotics can do.  They’re uninterruptible.

What we measure are impacts.  So we measure the increase in facility visits.  We measure the increase in treatment rates.  We measure systematic improvements in population health at a grand scale.  And so I think what we’re finding, this is the highest-impact, most effective way to improve population health at such a large scale.  So I think that’s what technology does, it takes an analog system that’s kind of tinkering at the margins, trying to make it marginally better, and you can leap over that, as Jeff said, and you can just get to the finish line and solve the problems.

MODERATOR:  Thank you.  Our final question, I’m actually going to combine two questions.  One comes from Carmen Puan of Politico, and the other one comes Abubakari Sadiq in Ghana.  The question is the – we have this $50 million.  Is that for each of the five countries, or what is the level of co-investment from each of those countries?

And related to that, the question from Ghana, is what is the burden on the taxpayer?  This question is specifically for Ghana, that – what is the burden on the taxpayer for each of the questions – each of the countries in question?

MR GRAHAM:  So –

MS BURTON:  So the – okay, Jeff, please.

MR GRAHAM:  Yeah.  No, no, you do it.  You answer it.

MS BURTON:  I was going to say the funds are not evenly distributed.  The countries all have different sizes; the population served as highly variable.  What we do is we work with each country to determine kind of where – what their greatest health burdens are that they’ve not been able to solve, where the greatest access challenges are, where the health system is just not succeeding at meeting its mandate for patients, and we size the network accordingly.

This is meant to be nationwide, and it’s meant to be able to deliver the volumes of product required to kind of engineer the health outcomes that we want to see.  We know how to do that now.  We know how to solve maternal mortality; we know how to solve malnutrition and these sorts of things.  So the networks get sized based on that, and then the governments, they pay the operating cost.  So the operating cost is kind of fixed.  It’s known, and it’s a long-term commitment.

But I think what’s really important to focus on here is that in the past you might sink $50 million into a project just to address maternal mortality in a region, or just to address HIV infections in a region, or mother-to-child transmission.  And what you’re doing here is you’re paying for a single piece of infrastructure, and it attacks each of those things – you know what I mean?  It addresses all of the health burdens.  There is no specific investment for one.  There is no specific adaptation or programmatic element to one.  It’s just ensuring that those products reach patients where they are, where the outbreaks are happening, where patients are seeking care, whether it’s in the community instead of in clinics that might be stigmatizing.  It just creates a really responsive system.

And so, kind of how we size it and how much money goes to each country and how much funds – domestic funding countries put into it is really a reflection of what we’re trying to achieve together, the goals that we have for the system.

MODERATOR:  Great.  Thank you.  Thank you, both of our speakers today.  That concludes our questions.  I’ll turn it over to Senior Bureau Official Jeff Graham for any final words.

MR GRAHAM:  Thanks.  I’ll be extremely brief, just to say thank you to everybody for joining us today.  I hope you can tell we’re pretty excited about this.  We’re excited about the strategy.  We’re excited about Zipline being our – kind of kickoff, one of our big kickoff investments, and what is, frankly, a really cool technology and something that I think will be – have dramatic impact in rural communities in particular in Africa.

And so my thanks again to Caitlin for joining me and for providing great answers, and for all of you for listening.

MODERATOR:  Thank you.

MR GRAHAM:  We hope for more in the future.

MODERATOR:  Great, wonderful.  Well, thank you, Senior Bureau Official Jeff Graham, and thank you, CEO Caitlin Burton.  And thank you, journalists from across Africa for participating today in today’s briefing.

A transcript of today’s briefing in both French and English, along with an audio recording of this briefing, will be available to you shortly after this call.  And if you have any questions about the briefing, please reach out to us here at the Africa Regional Media Hub at afmediahub@state.gov.  And also, if you publish any articles or broadcasts based on today’s briefing, we would appreciate a copy at that same email address.

Finally, I’d like to invite everyone to follow us on X.  Our handle is @africamediahub.

Thank you, and I wish you all a pleasant day.

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