Location Key to the Most Complex Vaccination Campaign Ever: Este Geraghty Outlines Why

Safe and efficient immunization of the global population against the COVID-19 virus will require the most complex global vaccination campaign ever undertaken in history. The effort requires clear planning for massive manufacturing, supply chain and logistics, prioritization of populations and tracking progress. These challenges alone must be supported by good quality data, delivered in real-time or near real-time through interoperable systems, underlines Dr. Este Geraghty, Chief Medical Officer, Esri.

By Anusuya Datta

Equitable access to the vaccine for COVID-19 virus is said to be the key to beating the virus. There can’t be any select winners in this. Your thoughts?

If we are to “beat the virus” we’ll need to effectively prioritize the populations that get the vaccine first. It’s not as if the full amount of vaccine needed to serve the people of the world will all be available at once — it will be manufactured and delivered in phases. The ideal and most equitable strategy is to first vaccinate the people with the highest risk of exposure to SARS-CoV-2 — healthcare workers on the front lines. From there, prioritization will look at other highly exposed groups, like essential workers. There will be a focus on people who are more likely to have severe disease (older individuals and those with certain medical conditions) as well as people in situations that could increase transmission of the virus, like in congregate living conditions (nursing homes, university dormitories, prisons). All this to say that equitable access is key, not equal access and not prioritization based on factors like wealth and national resources.

What are some of the extreme challenges for distribution of one or more viable vaccines and efficiently distributing them to billions of people around the world?

It seems clear that there will be more than one vaccine made available to combat COVID-19. That’s good. However, the vaccine candidates currently in the final stages of clinical trials have very different requirements, both for the level of cold storage and for the dosing regimen. So far, the top candidate vaccines each require two doses, but they are given at different intervals. In addition one vaccine candidate requires ultra-cold storage while the other has a more standard cold storage requirement. This means that some places may not be able to accommodate storage requirements for both vaccines and that the delivery of vaccine will need to be carefully tracked individual to individual for proper delivery of both doses. The challenges continue from there.

The time is now for leaders to fine-tune the planning related topriority and delivery of the vaccines, assess logistics with publichealth and emergency management advisors, analyze supply chain capacityand operations, and determine a communication strategy.

Where and how do you see location intelligence and analytics playing a paramount role in these?

Since the outbreak, government and healthcare leaders have relied on GIS and location technologies for real-time visualization dashboards, data sharing, analysis, and planning. The same approach will prove crucial for vaccine distribution.

As I have written in my blog, the time is now for leaders to fine-tune the planning related to priority and delivery of the vaccines, assess logistics with public health and emergency management advisors, analyze supply chain capacity and operations, and determine a communication strategy. For all of these efforts, GIS will be foundational to help plan, implement, and manage efficient, equitable vaccine distribution.

In the US, for example, the Department of Health and Human Services (HHS), in coordination with Department of Defense (DoD) and the Centers for Disease Control and Prevention (CDC), recently provided a strategic vaccine distribution overview along with an interim playbook for state, tribal, territorial, and local public health programs and their partners.

The agencies outline next steps that include engaging with other leaders, stakeholders, and the public; distributing vaccines quickly and with transparency; ensuring safe administration and availability; and monitoring necessary data through an IT system capable of supporting and tracking distribution, administration, and other necessary data. GIS is an integral part of that IT system, and will be central to vaccine distribution efforts, supporting engagement with stakeholders and the public as well as providing real-time awareness and transparency.

What, according to you, are the key areas that health agencies and governments need to begin prioritizing now?

There are five key ways GIS can support COVID-19 vaccine distribution to help health agencies and governments execute their plans and end this pandemic as quickly as possible.

  • Identify facilities capable of storing and distribution. As I alluded to, both of the leading vaccine candidates require cold storage, with one requiring ultra-cold storage at -70 degrees Celsius. Other factors such as parking, accessibility to vulnerable populations, distance from vaccine production facilities, traffic, and overall venue size will also impact which facilities can best store and distribute a vaccine.
Sample vaccine venue map in which red dots indicate capacity for ultra-cold storage, and yellow dots can provide normal cold storage. Dot size indicates overall capacity. Lines represent drive time and distance to the venue from various population centers. The darker blue the dot representing the population center, the higher the concentration of prioritized populations.
Image courtesy Esri
    • Identify and prioritize critical populations. There won’t be enough supply immediately available, so it’s important to be both strategic and ethical with the available resources. The proposed prioritization, as described above, ensures critical infrastructure workers — those most likely to be exposedto COVID-19 — are among the first to be vaccinated. The next group prioritized are those at increased risk for severe disease or death from COVID-19, such as people in nursing homes and assisted living facilities, those who have underlying medical conditions, and adults age 65 years and older. The third group in the prioritization describes people who are at increased risk of contracting and transmitting the virus (e.g. those experiencing homelessness, college students, tribal communities, communities of color, and incarcerated individuals).

Health departments need to develop a detailed view of the priority populations. At the same time, they need to assess the additional burdens these populations may face, such as lack of transportation or barriers to communication for non-native speakers.

A dot density map is a useful method for showing where various populations cluster. A similar approach to mapping priority groups for each phase of COVID-19 vaccination offers insight to leaders as they plan the vaccine supply across their communities.
Image courtesy Esri
  • Identify gaps in access and formulate alternative distribution options. After communities have identified potential vaccine distribution facilities along with critical populations to prioritize, they will be able to see potential gaps and evaluate solution scenarios for mitigation. It is perhaps likely that in Phase 2 of the vaccine distribution plan, the general population’s desire to be vaccinated will overrun capacity in vaccination venues. Government leaders will have options to increase capacity by engaging new partners in the process and/or by siting Points of Dispensing (PODs) in strategic locations to meet demand. GIS has long been used for various types of site selection and is especially useful when considering complex criteria, such as accessibility, population makeup, ingress and egress, budget, and more.
  • Implement a vaccine management and inventory system. Both of the current vaccine candidates require two doses for immunity against COVID-19. However, the time between doses is different for each vaccine candidate and the vaccines are not interchangeable. Therefore, it will be essential to understand who has received the first dose of a vaccination, which vaccine they received, and when they are due for the second dose. For this, healthcare providers and/or governments will need a quick and accurate data capture system that records individual vaccination information along with the barcode identifying the vaccine carton and/or vial. The data capture system will need to keep pace with the fast-moving vaccination process and support tracking of vaccine supply, expiration dates, and any potential adverse events. Additionally, officials will also need to keep tabs on inventory of personal protective equipment for healthcare personnel and vaccine kits.

  • Provide transparency and accurate communication. As vaccines are distributed, states and communities will need to know how well each facility is doing in executing the plan, monitoring whether their populations are experiencing adverse events, and tracking the proportion of the community that has been vaccinated. Early transparency will both inspire trust and provide critical information about how and why vaccination resources are allocated in each community. In addition, GIS can support the broader development of tailored communication messages for communities to combat vaccine hesitancy and build confidence in the process.
A dashboard view gives stakeholders and the public an up-to-date and transparent window into the current status of the vaccination effort.
Image courtesy Esri

What about logistical challenges like transport, storage and facilities management? And how location intelligence plays a critical role here?

There are many ways that location intelligence can support the logistical challenges.

  • Supply chain visibility & awareness. The authorities need to have detailed information of plants, suppliers and distribution all in one place. This will need integration of real-time data feeds and synthesis of information quickly. Continuous monitoring and alerting when a problem arises will keep the system flowing.
  • Planning & coordination. GIS can help to optimize the number of distribution centers and their locations. Through that optimization, it is also possible to reduce delivery time. Managing vaccine inventory spatially can also lower inventory carrying costs by only stocking the materials to meet the needs of the specific territory.
  • Supply chain dependencies. GIS can support greater understanding of dependencies and connectivity in the supply chain. Users can see upstream and downstream flow of resources so that they can isolate suppliers and locations affected by a disruption and estimate its impact on downstream channels.
  • Route planning & optimization. It is critical to use GIS to increase efficiency and safety, make the best use of trucks in services, lower mileage and emissions and schedule loads effectively. Every penny per mile saved could amount to millions of dollars in the big picture.
  • Situational awareness & monitoring. Keeping an eye on the process supports adaptation. GIS can help analyze risks and trends over space and time, track assets, protect personnel and materials and alert stakeholders to any disruptions. With an efficient monitoring system, there should be an increase in lead time to respond to potential service interruptions, allowing more time for mitigation.
  • Communicate. People understand map-based information. So, using a GIS to share the common operating picture in briefings and presentations to stakeholders can facilitate collaboration and understand across the board.

Has any of the work started in these areas and is Esri involved in some ways which can shed light on?

Work has begun in these areas, yes. Esri is sharing information and supporting our customers who are requesting help. Some customers are primarily focused on population prioritization efforts while others are looking to stand up vaccine inventory tracking systems. I’m not able to provide more details than that at this time.

Do you also foresee major security issues related to the vaccine – for instance storage facilities becoming a target of terror attacks, hijacking of vaccine trucks perhaps in parts of the world where law and order is an everyday challenge?

I hate to think that this should be an issue, but of course, security is definitely an issue. Location intelligence can absolutely enhance security planning and monitoring, so it would make sense for the geospatial community to assist colleagues in the security and intelligence community. As I’ve mentioned previously, sharing up to date information, giving leaders a common operating picture, should help to evaluate the system in progress, spot security weaknesses, and improve lead time toward response.

What are the thoughts that come to your mind when as we get closer to the vaccine?

Honestly, my first thought is “how fast can we work?” My second thought is “What don’t we know yet or have not anticipated?” If there is anything to be grateful for in the timing of this pandemic, I think its that GIS has evolved to support powerful web GIS capabilities and easy configuration of tools for faster success. This knowledge helps to calm my anticipation about what needs to be done. That said, there is much to do and we stand ready to help governments prepare for this effort.

Lastly, till we get a vaccine, what according to you is the best way to move forward and rebuild our lives?

I think it’s about balance – and has been for some time. We can go out and do many of the social and cultural activities of daily living – as long as we wear masks and social distance. We cannot forget hand washing and disinfecting. They remain important. If we diligently take these steps, and try not to lose interest in the process, we will all be safer out in the world. It’s not easy to remain dedicated to these preventive measures over such a long time period, so I think it’s important to regularly remind ourselves of the big picture. To be successful in balancing our health, social and economic lives at this time, we all need to participate fully. No one is safe unless everyone is safe.