In fact, many people in Missouri are getting very sick, and they’re almost all unvaccinated. Less than 100 miles away from the Ozarks region, in Springfield, an all-hands on deck effort has been launched to fight the pandemic once more. Scraping for hospital workers to keep up with demand, state lawmakers have petitioned the governor to sign a waiver that will allow registered nurses to come in from other states. Coaches, faith leaders, firefighters and health workers are all begging local groups to get vaccinated.

That’s prompted the vaccination rate to creep up past 40 percent, not nearly enough to reach herd immunity, said Springfield’s mayor, Ken McClure. McClure said he’s had to get more frank with how he’s talking to residents. When a father told him his daughter hadn’t been vaccinated because she feared she wouldn’t be able to conceive, McClure responded, “she can’t conceive if she’s dead.”

“We’re hearing a lot of anecdotal stories of young people, no underlying health condition going in with no vaccination and they’re dead within a few days,” McClure said. “It’s going to spread statewide, we’re the tip of the spear.”

Missouri has seen an aggressive surge in Covid cases since early July, representing one of the largest outbreaks in the nation. Caseloads and hospitalizations returned to levels not seen since the thick of the pandemic last year. Over the last seven-day period, the state saw an average of 1,500 new Covid cases a day—the highest in six months—and an average of three deaths per day, according to the state’s health department.

In the past week, high-profile Republicans and conservatives have seemingly awakened to promoting the vaccine as cases explode. Alabama Gov. Kay Ivey, whose state saw a 400 percent increase in Covid vaccinations in recent weeks declared, “it’s time to start blaming the unvaccinated folks, not the regular folks. It’s the unvaccinated folks that are letting us down.” And Fox news’ Sean Hannity told viewers “I believe in the science of vaccination.”

The Biden administration is hopeful that conservative influencers can help convince those hardened against the vaccine to drop their opposition. But past attempts at persuasion haven’t fully worked.

The alternative is a more stick-heavy approach, which the White House has so far resisted. But there were indications from those interviewed that if they were deprived the ability to travel or work unless they got vaccinated first, they would indeed get a shot. In one case, Lindsey Simon, a server at Margaritaville resort, said she finally got her first shot because she feared she wouldn’t be able to get to a state fair in Springfield, Ill. where she has tickets to see a performance “on my bucket list”—the actor and comedian, Gabriel “Fluffy” Iglesias.

And yet, even if requiring vaccines is the lever the Biden administration ends up pulling, those who know Missouri say they don’t expect people’s behavior to suddenly change overnight. There are cultural elements at play here, after all, more powerful than mere acts of politics.

“The irony is it’s not the dumb rubes in Missouri who don’t understand the nature of this disease,” Gregg Keller, a longtime Republican consultant in Missouri. “Missourians understand this far better than these supposed medical experts we’ve been giving tens of millions of dollars every year.”

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