For varying reasons, southern US states like Alabama are seeing some of the lowest vaccination rates in the United States, leaving the region vulnerable to new mutations. 

But some are doing their best to change this reality.

Sheila Tyson, who works with a small team, moves from one modest home to another in the mostly Black neighborhood of Memorial Park in Birmingham, Alabama's largest city.

"This Sunday, I want all of you [in the park]," Tyson says to anyone who opens his door.

"We will have free food until we run out, and we will get vaccinations - have you received yours?" adds the leader of the so-called "Black Women's Round Table in Alabama."

Despite her foot injury, Tyson is one of the few local officials working relentlessly to get residents' consent to receive vaccinations.

She tirelessly visits parks, schools, day care centers and playgrounds in some of the region's poorest neighborhoods.

- 'They fall like flies' -

"We are in a race with life and death," she says.

When cases of the virus spiked in Alabama in December and January, people were "dropping like flies," she said.

She notes that with the Delta mutant spreading across the United States, people are "very concerned, not just about Black people but for everyone else."

Tyson heard conspiracy theories that led some to refuse vaccination, including the idea that "the vaccine would infertile African-American men."

Such  ideas stem from a bleak history of discriminatory health-care practices - not least the US government's infamous syphilis experiments from 1932 to 1972 on hundreds of Black men in Tuskegee, 200 kilometers from Birmingham.

As a result, Janice Cobb, a 60-year-old seamstress in Memorial Park, notes, many African Americans — who represent 27 percent of the state's five million residents — are adopting a "wait and see" strategy toward vaccines.

State health official Scott Harris explains that given this widespread uncertainty, aggressive local efforts like Tyson's are the most effective approach, but they are not enough to raise vaccination rates significantly.

To date, only 40 percent of Alabama residents aged 12 and over have received at least one dose of the vaccine, a rate only marginally higher than that of other southern states such as Louisiana (38 percent) and Mississippi, which have the lowest The rate in the country increased by 36 percent. Those states lag far behind the national average of 64 percent.

These states played a major role in preventing the goal of vaccinating 70 percent of Americans by the July 4 Independence Day holiday.

- Fear of 'coercion' -

Harris was not surprised by the belated results for the region, which is among the poorest in the country.

"We are at or near the bottom in almost every health indicator," whether in terms of cancer, heart disease or child mortality, he told AFP. But the frequency of the vaccine among white men surprised him. Many rural residents believe that the vaccine carries a higher risk of disease.

"We didn't really expect this level of rejection," he added.

Frank Arrant, a barber in the small town of Oneonta, north of Birmingham, points out his skepticism about the vaccine. Given that he has diabetes and is 70 years old, he is considered one of the most vulnerable groups. However, he is convinced that the vaccine might kill him.

"There were a lot of people who came to the barbershop and died as a result of the vaccine," he says.

"They were here that week and they said -- I'll get the dose -- and three days later they died. That scares people."

Despite this, health experts say that with millions of doses given, the vaccine has proven to be very safe.

The resistance to vaccines in Oneonta in Ploante Province has an undeniable political element.

And residents "are worried about being forced to take it," Arrant explains, with President Biden telling everyone: 'You should do it.'

But he added, "This is our life and we will not take it (vaccines). People in the south make their own decisions."

For JD Davidson, a 22-year-old soldier from the Birmingham suburb of Homewood, it stems from "the anti-authoritarian stance of Southerners long rooted in Southern culture.

"With increasing political divisions, it becomes very important not to do this because it helps strengthen your identity," he adds.

Davidson believes that when prominent Democrats like First Lady Jill Biden visit the South to encourage vaccination, it "makes things worse."

Given this context, Harris does not expect a significant increase in vaccination rates in the coming months.

But he says that with 1.8 million Alabama residents who have been at least partially vaccinated, and another 550,000 who have survived COVID-19 and become immunized, any new outbreaks will likely be concentrated in isolated areas populated by the unvaccinated.

He hopes that Alabama, which lost 11,300 people to the virus, will not repeat last winter's dark period when thousands of new cases were recorded daily and hospitals approached the "breaking point."