The digital sign outside First National Bank flashes Bible verses along with the temperature, and many Marion County residents work in small plants that make mobile homes and components for prefab housing. Most area jobs are blue-collar, and TVs are typically turned to Fox News . A conservative, working-class ethic runs deep.

The area went heavily for President Donald Trump in the 2020 election. And yet resistance to the vaccine is so strong that two counties over, in Cullman, some booed Trump when he encouraged vaccinations during a rally that drew thousands last summer.

COVID-19 has killed almost 18,000 people in Alabama, giving the state the nation’s fourth-highest rate of deaths relative to population. Marion County’s rate exceeds the state average at 1.78%, with more than 140 deaths, according to data from Johns Hopkins University .

Health officials expected to have a hard time persuading Black people to get government-sponsored vaccines in Alabama, home of the infamous Tuskegee syphilis study and a place where distrust of Washington runs deep. They started work on public education campaigns weeks early in mostly Black areas , which now have some of the state’s highest vaccination rates, at 60% or more.

But they didn’t expect the stiff resistance among rural whites that has kept vaccination numbers stubbornly low in places like Marion County, which is 94% white. While rural transportation difficulties, confusion over vaccine costs — they’re free — and a lack of healthcare access have also been factors, the partisan divide in America killed the vaccine drive for some before it really got started, officials said.

“Rural white men who identify as conservative are just not interested in this. That caught us off guard,” said Dr. Scott Harris, head of the Alabama Department of Public Health. “By the first or second month of the vaccine campaign, it became clear that those folks just weren’t going to come in.”

Richard Kitchens is among that group. The owner of a clothing and sports shoe shop on the square in Hamilton, Kitchens said he isn’t interested in the vaccine after getting COVID-19 in 2020 before vaccines were available and having relatives who contracted the illness , developed only minor symptoms and recovered.

Short of a proven guarantee against illness — which no vaccine provides — he doesn’t see the point.

“I guess if I knew I could go out and get a shot and wouldn’t get it or spread it, I would go get it, and they say it helps,” Kitchens said. “But I think that will be determined sometime down the road maybe.”

Doris Peterson is fully vaccinated, but she said she didn’t get a booster on the advice of her two adult daughters, neither of whom is vaccinated. Peterson said she is used to being one of the few people around still wearing a mask in public .

“Most of the time I am it,” she said.

Kelly Moore, a former Tennessee health official who now heads a CDC-funded vaccination advocacy organization named Immunize.org, recalled seeing data from a recent survey that hit her like a punch to the gut.

The results were presented at a CDC meeting of vaccine experts earlier this month. The January survey of about 1,000 adults asked unvaccinated participants what, if anything, would change their mind and persuade them to get a shot. Half said “nothing.”

“It was quite demoralizing to see those results, frankly,” Moore said.

With the pandemic still a mortal threat, public health workers haven’t given up on getting more people vaccinated, even if it feels like an uphill slog.

Jordan Ledbetter, a nurse who works at the Marion County Health Department, was thrilled when two people came in for first-time shots on the same day recently.

“That was exciting,” she said. “There are days when I haven’t given any vaccines.”