Martinsburg (United States) (AFP) - Patients stream steadily into the Covid vaccine center that Todd Engle can almost touch from his West Virginia backyard. But like scores of other Republican voters, force would likely be required to get a dose into his arm.
Many of the party's millions of supporters are among the nation's most vaccine-skeptical people, which experts see as a dangerous barrier to finally taming the virus that has killed more than 540,000 in the United States.
"If they try to make me get it, they're just going to (have to) put me in jail," the 58-year-old Engle told AFP from the porch of his home in Martinsburg, referring to health authorities. "I just don't trust them."
West Virginia is heavily Republican -- over 68 percent of its voters chose Donald Trump in November's election -- and it has long been one of the nation's poorest places.
Yet not all West Virginia Republicans are vaccine skeptics.
The state of under two million people has been lauded for quickly getting Covid vaccines to its people while bigger, wealthier and Democrat-led states have sometimes struggled to do the same.
Part of that effort is the vaccine site behind Engle's home, which operates in a recreation center gymnasium with the kind of efficiency that bustling, pre-pandemic airports could only dream of.
Nurse Angela Gray, 51, said the site has administered as many as 1,500 shots in a day.
'Vaccine hesitancy on steroids'
"I try not to look at politics; that doesn't matter," Gray noted as nurses in masks, face shields and gloves delivered shots behind her. "But I've seen a lot of my fellow Republicans who are getting vaccinated."
She added that Republican elected officials in the area have spoken up for the safety and effectiveness of the shots and gotten inoculated themselves, a key part of efforts to convince the skeptical.
But in towns across the United States, skeptics are numerous.
According to a poll last week, 41 percent of Republicans nationally said they would not get the vaccine, compared to just 11 percent of Democrats.
It is a startlingly high number considering that 74 million Americans voted in November for the Republican presidential candidate, Trump.
African-Americans and anti-vaccination activists have also shown high levels of opposition to the Covid shots, but among Republicans the phenomenon appears more directly linked to America's political polarization.
Vaccine hesitancy expert Neil Johnson told AFP he sees a collision of factors, including the belief that mainstream media outlets exaggerated the pandemic to hurt Trump, and long-held resistance to vaccines generally as well as distrust of the government.
"It's like the usual hesitancy on steroids, because the distrust took on a political dimension because of the election last year," said Johnson, a George Washington University professor. "It was like a perfect storm to have an election in the year of a pandemic."
Trump, who often minimized the virus's danger, on Tuesday gave his most explicit endorsement for the national mass vaccination campaign since he left office in January.
"It's a great vaccine, it's a safe vaccine and it's something that works," he said during an interview on Fox News.
But Trump left office in January without disclosing that he and his wife, Melania, had themselves quietly been vaccinated.
'All about herd immunity'
For Christine Miller -- the treasurer of the Republican club in Berkeley County, where Martinsburg is located -- Trump's words came too late, because people have already decided.
"It's a personal choice. People in the rural areas, though, I don't see them going for it. I see them doing too much research for themselves," said the 63-year-old, who as a cancer survivor with chronic bronchitis is in a high-risk demographic.
She said she won't take the shots currently available.
"It's not worth the risk," Miller told AFP before a club meeting, saying she was concerned about reports -- which experts say are rare -- of serious side effects. "I can wait."
Johnson, the hesitancy expert, said waiting or not getting the vaccine at all carries significant risks for the United States, which has by far the world's largest absolute death toll and caseload.
"It's all about herd immunity," he said, referring to the point when most of a population has acquired defenses against a virus, whether through vaccination or from having survived the disease.
Vaccination campaigns can reach large portions of populations, he added, but success is determined by whether an overwhelming majority of people can be inoculated.
If and when that point is reached in Martinsburg, West Virginia, it will most certainly be without 76-year-old Betty DeHaven, a Republican club supporter.
"They would have to hold me down and force me to take the vaccine," she told AFP. "I consider that one of my rights, that I can refuse."