With a sizable Black minority traditionally mistrustful of vaccines and with many conservative rural whites convinced that the vaccine is more dangerous than Covid-19 itself, Southern US states like Alabama have some of the country's lowest vaccination rates, leaving the disadvantaged region vulnerable to dangerous new virus variants.
But some people are trying their best to change that.
With a small team and an energy level that belies the crushing Southern heat, county commissioner Sheila Tyson knocks on the doors of modest homes in Memorial Park, a mainly Black neighborhood of Birmingham, Alabama's largest city.
"This Sunday, I want you all out there (in the park)," Tyson, a leader of the Alabama Black Women's Roundtable, tells anyone who opens their door.
"We will have free food as long as it lasts, when it's gone it's gone, and we are going to have vaccine shots -- have you had your vaccines?"
Despite an injured foot, Tyson is one of the few local officials to actively campaign for vaccine acceptance, tirelessly visiting parks, schools, day-care centers and stadiums in some of the area's poorest neighborhoods.
- 'Dropping like flies' -
"We are in a race against living and dying," she says.
When Covid cases spiked in Alabama in December and January, people were "dropping like flies," she says.
And as the Delta variant of coronavirus spreads across the United States, she says, "We are very concerned, not only about the Black and brown people but about all people."
Tyson has heard the conspiracy theories that keep some people from getting the vaccine, including the notion that "the vaccine would sterilize African American men."
Such baseless ideas stem from a grim history of discriminatory healthcare practices -- not least the infamous syphilis experiments carried out by the US government from 1932 to 1972 on hundreds of unwitting Black men in Tuskegee, 120 miles (200 kilometers) from Birmingham.
As a result, many African Americans -- who represent 27 percent of the state's five million inhabitants -- have a "wait and see" attitude toward the vaccines, said Janice Cobb, a 60-year-old seamstress in Memorial Park.
Given such widespread suspicion, ultra-local efforts like Sheila Tyson's are the most effective approach, said state health officer Scott Harris -- but they are not enough to substantially raise vaccination rates.
As of today, only 40 percent of Alabama residents aged 12 and above have received at least one dose of a Covid vaccine, a rate only marginally above those of other Southern states like Louisiana (38 percent) and Mississippi, which at 36 percent has the lowest rate in the US -- with all of them far behind the national average of 64 percent.
Those states played a considerable role in preventing the Biden administration from reaching its declared goal of having 70 percent of Americans vaccinated by this July 4 holiday weekend.
- Fear of being 'forced' -
Harris is not surprised by the lagging results of the region, which is among the poorest in the country.
"We are at or near the bottom in just about every health indicator," whether in terms of cancer, cardiovascular disease or child mortality, he told AFP.
But the extent of vaccine hesitancy among white men has surprised him. The belief that the vaccine carries higher risk than the disease is widespread in some rural areas.
"We didn't really anticipate the degree to which we would see that resistance," Harris said.
Frank Arant, a barber in Oneonta, a small town north of Birmingham, is among the vaccine skeptics. As a 70-year-old diabetic, he is particularly vulnerable to the virus. Still, he is convinced the vaccine could kill him.
"We have had a lot of people in our barber shop to die from taking this shot," he said.
"They would be here that week and saying, 'I'm going to get my shot,' and then three days later -- dead. That scares people."
Despite such anecdotes, health experts say that with millions of doses already administered, the vaccine has proved extremely safe.
Oneonta is in Blount County -- where 90 percent of voters supported Donald Trump last year -- and vaccine resistance there has an undeniable political component.
People are "worried about being forced to take it, with President Biden telling everybody 'You got to do this,'" said Arant.
But, he added, "It's our lives and we are not going to take it. The people in the South make their own decisions."
To J.D. Davidson, a 22-year-old soldier from Birmingham's Homewood suburb, "a lot of it stems from the anti-authoritarian stance of Southerners that has long been rooted in Southern culture.
"As political divisions increase, it becomes that much more important to not do it because it helps strengthen your identity."
He believes that when prominent Democratic figures like First Lady Jill Biden visit the South to encourage vaccination, "it only makes things worse."
Given the context, Harris does not expect a major increase in vaccination rates in the next few months.
But he says that with 1.8 million Alabamians at least partially vaccinated, and an additional 550,000 having survived Covid and being potentially immune, any new outbreaks will likely be concentrated in "pockets" of the unvaccinated.
And he hopes that Alabama, which has lost 11,300 lives to Covid-19, will escape the dark days of last winter, when there were thousands of new cases a day and hospitals teetered dangerously close to the "breaking point."