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.
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."