Hundreds of people file into the old Sears department store outside of Morgantown, West Virginia.
Inside, 30 vaccine stations have replaced what used to be aisles of clothing racks. The dreary halogen lights cast an appropriate hospital-like glow over a large space humming with efficiency.
“We’ll administer over 2,700 doses over an eight-hour period,” said Todd Karpinski, chief pharmacy officer for West Virginia University Medicine.
"Every person is scheduled so they know exactly when to come in to avoid any of the mass chaos that we may see."
Alice Dean received one of those 2,700 doses. It was her second shot, meaning she is weeks away from being fully inoculated.
It was an early birthday present for the grandmother of nine, who would turn 80 in two days.
“It’s a feeling of ease," Ms Dean said. "I can now go out in public. I will still be careful, you know, I’ll still wear my mask, stay distanced and wash my hands."
West Virginia, a small, rural state long associated with high rates of poverty, the decline of the coal industry and leading the nation in health problems such as heart disease, has delivered more doses of the Covid-19 vaccine per capita to its citizens than any other state but Alaska.
It is a monumental achievement, and it all started with a gamble.
West Virginia is the only state that opted out of the federal government’s vaccine programme, which linked up with major US pharmacy chains Walgreens and CVS to inoculate residents of long-term care homes.
While that programme may have worked for other states, healthcare professionals in West Virginia quickly realised it would not be suitable for their rural population.
“We had about 250 pharmacies in the state of West Virginia, about half locally, privately owned, so we designed a bit of a different plan,” said Dr Clay Marsh, West Virginia’s Covid-19 chief.
Instead of running their programme through major pharmacies, West Virginia went local, using the deep roots and connections small-town pharmacies have in their communities.
“We culturally have a community that is service-oriented,” Dr Marsh said.
So far, West Virginia has fully vaccinated more than 6 per cent of its population.
The state has administered 220,000 first doses to about 13 per cent of the eligible population.
West Virginia was also one of the first states in the country to completely vaccinate their long-term care homes, a move that caught the attention of the US administration within hours of Joe Biden becoming president.
Mr Biden's coronavirus co-ordinator, Jeff Zients, called West Virginia's governor to ask what other states could learn from them, The Washington Post reported.
How did they do it?
After deciding to rely on their trusted network of independently owned pharmacies instead of the bigger chains, the state’s leadership turned to another reliable partner.
Early in the pandemic, Governor Jim Justice called on the state’s formidable National Guard to step in to help slow the spread of the virus.
The guard set to work creating personal protective equipment, delivering supplies and administering Covid-19 tests.
Months before the vaccine was available, the guard was already busy planning.
“We understand mission development and mission planning. We know how to do supply-chain management,” Maj Joshua Poling said.
“If you just look at the logistics of the military as a whole, how well we do things, moving even into like a combat environment, where we’re 100,000 troops overseas with equipment and food and all those logistics, the military does it well.
"So having the military as the hub for this vaccine distribution, I think, it’s made all the difference.”
The state, under the watchful eyes of the guard, formed a joint inter-agency task force at the end of last year.
The task force works out of a gym at the National Guard base outside the state capital of Charleston.
The basketball hoops have been raised, but the weights and lifting equipment still occupy precious floor space.
Next to the sports equipment, dozens of Plexiglas cubicles form the nerve centre of the state's vaccine strategy.
“We found at the beginning of this, it was real challenging trying to do this through electronic means,” said Brig Gen Bill Crane, head of the state’s National Guard.
"But once you get everybody together and everybody sees how hard everybody else is working, everybody kind of picks up their game a little bit and works real hard towards achieving what the citizens need."
Fifteen agencies from state and federal levels have personnel in the gym.
Together, they orchestrate the complex act of inoculating West Virginians against the virus.
When the state receives doses of the vaccine, the guard sends it out to five centres across the rugged, mountainous terrain.
Each centre was chosen carefully with the intention of making the vaccine easily accessible to West Virginians as quickly as possible.
“Our goal is to have the vaccine in somebody's arm four days after we receive it from the federal government," Dr Marsh said.
"Five days is acceptable, and if people have designated clinics on a weekend, then seven days.
"But at the end of seven days, all of the vaccines need to be used and we’re ready for the next group."
Not only are all of the vaccines being used, but the state is administering more vaccines than they are being given.
At one point, it had used a seemingly impossible 108 per cent of the vaccines it had received. It is now down to 106 per cent.
This is because officials identified early on that, with the right syringe size, they could squeeze an extra dose out of the vaccine vials.
“We’re creating an environment and culture where we welcome creativity and differences of opinion,” Dr Marsh said.
That creativity has allowed West Virginia to excel during one of the country’s darkest hours and it is starting to translate it into lives saved.
"We've seen a 46 per cent drop in mortality over January and over a 60 per cent drop in hospitalisations, so it has been dramatic," Dr Marsh said. "This is a vaccine effect."
The state receives 25,000 doses of the vaccine a week, but it wants more.
“We could probably do 100,000, maybe even 125,000 shots a week if we could get more vaccines," Brig Gen Crane said.
"So at this point, it’s really about getting more vaccines into the state so we can get them into the arms of our citizens."
West Virginia’s success with the vaccine is a big morale boost to a state in desperate need of one.
“It starts to give us the opportunity that people in West Virginia will start to change the narrative, perhaps from one that may be scarcity based to one that’s more abundance based," Dr Marsh said.
"And that is the way that we start to do really important work in West Virginia, which is to change the arc and the trajectory of the health of the future of our state."
For Ms Dean, it means being able to see her grandchildren without fear – a sense of relief shared by thousands of other vaccinated elderly people across the state.
