Not everyone will be able to get the COVID-19 vaccine when it's ready. So even as companies like Pfizer and Moderna race to complete their clinical trials, governments are beginning to strategize how to distribute that very limited supply once it's ready. Este Geraghty, chief medical officer of the mapping software giant Esri, thinks her company's technology can help.

Before she joined the company, Geraghty specialized in informatics and statistics at the California Department of Health. That experience has come in handy these last seven months, as Esri has worked with state and local governments across the country to map the spread of COVID-19.

It's Esri's software that forms the backbone of Johns Hopkins University's vital COVID-19 dashboard and Esri's surveys that cities across the country have been using to map out the results of their contact tracing efforts.

Now, the 51-year-old company is looking ahead and helping governments think through how to ensure the people who need the vaccine the most will be able to receive it first. Geraghty spoke with Protocol about how Esri hopes to help.

This interview has been edited for clarity and brevity.

Why is mapping important to vaccine distribution?

We won't have all the vaccines ready at the same time with the ability to distribute it to everybody immediately. Given the manufacturing constraints and the differences in the vaccines that we think are going to be the ones to come out first, they require different kinds of facilities to administer them.

We think that the two furthest along are the Pfizer and the Moderna vaccines. The Pfizer vaccine requires storage at -70 degrees Celsius. That has significant implications for how you can transport it and where it can be stored. Probably only the largest hospitals and the larger pharmacies [can do it], but not everybody can store it at that level of cold storage. The Moderna on the other hand needs -20 degrees Celsius. That's really easy for just about anybody to create storage.

Now you have two different facilities with different capabilities. How do we get the two vaccines from these manufacturers to the different locations where they'll be distributed? With the Pfizer vaccine, you need to go straight to the point of dispensing, whether it's a hospital or pharmacy. It starts to get very geographic in the way you make these decisions.

When we get to state health departments working with the [Centers for Disease Control and Prevention], how do we make sure the vaccine goes to the right place in each state and locality? It gets back to identifying the right facilities capable of storing and distributing the two different kinds of vaccines. The next thing you want to do is identify and prioritize the clinical population. You've got to take care of healthcare workers first and other workers who are more exposed than the average population. These are the people who are most exposed coming into contact with a patient. If we don't take care of them and they become sick, then we lose our capacity, which is another issue. After that you get into populations that are more likely to have disease and die from the virus. Then there are things like congregate housing where people are living in nursing homes or prisons or university dormitories.

If we do this in a logical order, we have the best chance.

So a state or local government could use Esri to triangulate facilities that can store this thing and are closest to the highest density of congregate housing and health care workers?

You're getting the idea. You have a number of candidate facilities. Then the health department should be able to, with our software, evaluate the potential capacity of those sites and estimate a travel distance for the different phases of vaccination. When you get to a more general population, you're going to want 15- to 30-minute drive-times at the most to get to a vaccination venue.

It sounds like this would be pretty sparsely spread out throughout the country, not like going to your doctor's office and getting a shot in the arm.

That's right for the early phases. In those early phases, you'll pick the venues that can serve the largest part of your critical population. As we move toward broader vaccination, you can start to identify gaps where you have people who are a prioritized population and don't have a facility that's lined up or ready to distribute. That's where you can figure out where to put facilities to serve the largest population. You can also formulate other distribution methods. You can't put a facility in every place. A lot of people live way out in rural places, but still need vaccines. We've seen mobile vaccination teams go out. We can help route your mobile team so they can serve the biggest population efficiently.

Are you working with any of your government clients yet on this type of planning?

I'm not going to mention names, but I will tell you, it's a focus. We're dealing with a number of states, at least one city, and we've been having conversations at the national level as well. Every week it seems to get a little more in the forebrain of consciousness.

Whose decision will it ultimately be to figure out where the facilities should be located?

The decision is going to be somewhat joint as I understand it. The CDC is relying on the state public health department to come up with a plan. There's recognition that states across the country work in different ways with their local health authorities. If the health department wants a certain number of vaccines and has a distribution plan, it's expected the CDC will approve that plan, but they could override it.

Are there any other ways Esri plans to play a role in the vaccination distribution process?

Our software could be used to help with vaccine inventory and management. You need to be able to read the bar codes on the vaccines and keep track of your inventory and expiration dates and who got which vaccines. They both take two doses. If I got the first dose of the Pfizer vaccine, I cannot get the second dose of the Moderna vaccine. I need the same one. So we can help with that vaccine management system.

The other thing we're recommending to health departments is providing transparency and accurate communications. I think this whole process is complicated. I think people are going to want to know: When's it my turn? Where should I go to get a vaccine? And why is my turn not right now? You need to provide the information to help people understand the health departments are doing the right thing.

I shouldn't be conspiratorial, but it sounds like you'll have a window not just into where there are gaps, but whether there's corruption going on and are there vaccines being routed where there's not the most need. Will you have that kind of insight?

I think the system is set up pretty well so that shouldn't happen. What I fear more, and excuse my bias, is if people don't take a really geospatial approach to this, then they may end up not doing the prioritization in the most effective way. It may not be for lack of effort, but potentially lack of insight.