In downtown Little Rock, a chorus echoes around the room at Willy D’s Rock & Roll Piano Bar as groups of friends clutching beers and each other sing along to the soul hit “Stand By Me”.

Yet far from standing together, the capital of Arkansas is deeply divided over how to deal with a resurgence of Covid-19. Cases are increasing, hospitals are filling up, and health officials are struggling to convince residents in the city and across the state to get vaccinated.

The pace of vaccinations in US states has become starkly correlated with politics, with Republican voters less likely than Democrats to get a jab, just as they are more reluctant to wear a mask or observe social distancing.

About 35 per cent of people in Arkansas are fully vaccinated, according to the Centers for Disease Control and Prevention, and only two states, Mississippi and Alabama, have lower rates of inoculation. By contrast, 56 per cent of people in the state of New York, a Democratic stronghold, have been fully vaccinated.

That poses a huge challenge for local health officials in red states as they battle the highly transmissible Delta variant, which now accounts for 83 per cent of cases nationwide, according to the latest estimate from the CDC.

The public health agency, which last week said the US was experiencing a “pandemic of the unvaccinated”, believes the proportion of Delta cases is even higher in places with low inoculation rates such as Arkansas.

In Willy D’s Rock & Roll Piano Bar customers must agree to a bag search and a pat-down by a security guard, but no one’s temperature is checked and masks are non-existent © Nikou Asgari/FT

“I am very concerned about the next several weeks and months,” said Jennifer Dillaha, medical director of immunisations at the Arkansas health department. “The Delta variant is spreading in our state. The growth of cases is exponential. The rise in hospitalisations is exponential.”

Surging Covid cases risk overwhelming the health system in Arkansas, which serves a population of roughly 3m. More than 780 people are currently hospitalised with the virus in the state, a number that has roughly doubled in the past two weeks.

“If we continue at the same pace of hospitalisation, we will double the number of patients in the hospital by the beginning of August,” Dillaha predicted. “We’ll hit 1,300 patients or more, which is as high as we ever got in this past winter.”

scatterplot correlation between Trump vote share in 2020 and hesitancy to get a vaccine, at the state level. states that Trump won had a higher % of adults say they were 'hesitant' or 'very hesitant' to get a vaccine

In Willy D’s, customers must agree to a bag search and a pat-down by a security guard, but no one’s temperature is checked and masks are non-existent. Kevin Newman, a 31-year-old estate agent who voted for Donald Trump in November, said he had not been vaccinated because he doubted the severity of the virus.

“If Covid was really serious, we’d have to pay for the vaccine,” said Newman. “Everything else is expensive so why are they giving it out for free? It’s suspicious.”

Similar opinions abound on social networks such as Facebook, which was last week accused of “killing people” by President Joe Biden for allowing vaccine misinformation to spread unchecked.

Health officials in Arkansas are trying to reach more people by offering vaccines at shopping malls and churches, while doling out incentives like free hunting and fishing licenses. But so far their efforts have done little to move the needle.

At a riverfront summer festival in North Little Rock on Saturday, stalls offered free food and toys alongside vaccines. Yet over the space of an hour, just four people took up the offer of a jab.

“Every one that we get now is important,” said Barbara McDonald, a nurse at the University of Arkansas for Medical Sciences (UAMS) who was running the pop-up site. “A lot of it is fear. If they don’t understand it, then they don’t want it. So education is important.”

Some of the reluctance is ideological, underpinned by the belief that being nudged into taking a vaccine imposes on a person’s civil liberties. Others fear that the jab poses a significant risk to their health after reading discredited theories online.

At a riverfront summer festival in North Little Rock on Saturday, stalls offered free food and toys alongside vaccines. But over the space of an hour, just four people took up the offer of a jab © Nikou Asgari/FT

Steven Shaw, a 58-year-old Trump voter, said he had read online that Covid vaccines can alter your DNA. “That’s my understanding, from what I’ve heard, that it’s not really a vaccine so I’m kind of leery of it.”

Shaw also criticised cruise ships that require vaccinated and unvaccinated people to occupy different areas of the vessel, likening the rules to the Holocaust. “In terms of separation, it’s the same thing what happened with the Jews in Nazi Germany.”

McDonald has worked 60-80 hour shifts each week at her hospital since the start of the pandemic, and noted that many of her patients were now people who refused to get a jab. “Inside I’m frustrated, but I can’t show that. I’ve just got to speak to people and educate them.”

Line chart of covid cases per 100k in Arkansas, Mississippi and Alabamam which are states that have low vaccination rates. Covid cases have been increasings in these three states in recent weeks

Not everyone in Little Rock is against vaccinations. In Doe’s Eat Place, a rustic restaurant chain known for its steaks and hot tamales, the walls are adorned with grinning photos of regular customers, including Bill Clinton, the former US president and Arkansas governor. And the staff must wear masks.

Clinton’s popularity in Little Rock has declined dramatically since he left office, but for the restaurant, which sits in a heavily Republican city, the photos of and letters from the ex-president are a source of pride.

Doe’s Eat Place, a restaurant chain known for its steaks and hot tamales, requires that its staff wear masks © Nikou Asgari/FT

In Doe’s Eat Place the walls are adorned with grinning photos of regular customers, including former president Bill Clinton © Nikou Asgari/FT

Suzie, a waitress at Doe’s, said vaccine hesitancy and politics were inextricably linked in Little Rock and Arkansas. “It’s become political and it’s hurting a lot of people . . . The rural areas especially are very conservative.”

That hurt is translating into higher hospitalisations across the state. Robert Hopkins, head of general internal medicine at UAMS, said that on one day last week the facility was “completely full” and patients were forced to wait in the emergency room.

Hopkins, who is also chair of the National Vaccine Advisory Committee, said that patients now tend to be in their 40s, compared with the 60 or 70-year-olds who made up the bulk of admissions during earlier phases of the pandemic.

The deteriorating situation in Arkansas is replicated in red states across the country. Hospitals in neighbouring Missouri have been forced to transfer patients to other facilities and are seeking funding for more beds and staff.

“I don’t see anything turning it around, except vaccination,” said Dillaha from the Arkansas health department. “So if we’re not able to greatly increase our vaccination rate, then we’re going to be in for a very difficult fall.”

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But far from encouraging people to get vaccinated, many Republican officials are pushing the other way. At least eight states with Republican legislatures and governors, including Arkansas, have banned schools and colleges from requiring vaccinations or proof of inoculation, for instance.

In April, Asa Hutchinson, the Republican governor of Arkansas, signed a bill banning government-imposed mask and vaccine mandates as well as vaccine passports, although he appears to have changed tack somewhat in recent days. Last week, he kicked off a statewide tour to encourage people to get a jab.

“It’s like he regrets it,” said Goldie Davis, a dental assistant, of Hutchinson’s apparent about-face, adding that her 34-year-old friend died from the virus on Friday. “Her whole family are Trumpers. It’s really sad. Everyone who’s not getting vaccinated are Trump supporters. It’s a form of brainwash almost.”

McDonald, the UAMS nurse, hopes that vaccine hesitant people will eventually change their minds. “As more time goes by and they know somebody who’s been vaccinated, and they see that they’re OK, they haven’t grown a tail or something, and then they’ll get vaccinated.”

She added: “You just pray and hope.”

Data reporting by Christine Zhang



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