Updated July 28, 2021 at 10:52 AM ET

Just 34% of Alabamians are fully vaccinated – ranking last in the United States. And the state is experiencing a fourth wave of COVID infection that is spiking across the South, a region with low vaccination rates, and rapid spread of the more contagious delta variant of the virus.

In Alabama, hospitalizations are up five-fold since the beginning of July and public health officials are sounding the alarm.

"The slope of this increase, the rate of which the hospitalization numbers are going up, is unprecedented in Alabama," says Dr. Scott Harris, the state health officer.

Brittany Williams is 32 and works in medical billing in Mobile. She's seen more new COVID-19 cases recently, both at work and in her own family. That's what convinced her to overcome her anxiety about the vaccine.

"I really wanted more research to come out. I didn't want to be the first," says Williams, who recently stopped to get her first dose at a pop-up clinic the local health department had set up at a food truck festival along the Mobile River. "It's a little scary, but the virus is even scarier."

The nurses reassure Williams when she asks about possible side effects of the vaccine, including if it could affect her fertility. She's convinced it's safe, and takes the shot.

"Whoo," she exclaims after it's done. "I did it."

Health officials worry about the rise in COVID-19 infections

Health officials are trying to reach more people like Williams — people in the 18- to 49-year-old age bracket. One strategy is coming to public events like this food truck festival, or flea markets. They're also holding clinics at churches, barbershops, and truck stops. Public universities are offering incentives such as extra dining dollars and premium parking for students who return to campus fully vaccinated.

Alabama's Gulf Coast is experiencing the highest per capita spread of COVID in the state, yet only about one in three people are vaccinated. There have been outbreaks in daycare centers, sports camps and churches, mostly fueled by the delta variant, according to epidemiologist Rendi Murphree, director of disease control at the Mobile County Health Department.

She says it's a frightening situation.

"That combination — low vaccination rates, delta variant, super high numbers of cases occurring on a weekly basis — it's not likely to get better anytime soon," Murphree says. "It's just spreading like wildfire."

She says the vaccine could be the firebreak, but getting people to take it means overcoming misinformation and mistrust.

"We hear different reasons, like 'I don't need the vaccine, I never get sick,'" she says. "Some people, particularly in minority populations, are still very distrustful of the health care system that has not served them well in the past."

Merceria Ludgood, president of the Mobile County Commission, is worried about the worst-case scenario.

"If we aren't able to figure out a way to get more people vaccinated, then we're going to be in the throes of this for years and years," warns Ludgood. "It's terrifying because we can't help but see a spike in deaths."

Ludgood also believes there's a political dimension to the low vaccine uptake.

"It's almost as if 'if I don't get the vaccine, then this helps to make [Democratic President] Biden fail.'"

In conservative Alabama, epidemiologist Murphree says she reminds people where the vaccination push came from.

"Project warp speed was a Republican administration effort," she says. "The vaccine was developed not by the government, but by scientists, with the full support of a Republican administration."

Murphree and other health officials have been recruiting doctors, pharmacists, religious leaders, and sports figures to help get the word out that vaccines are safe, and free. University of Alabama football coach Nick Saban has encouraged Crimson Tide fans to get a shot, and says his team is nearly 90% vaccinated. And a former Auburn coach turned politician is also trying to help.

"I'm Tommy Tuberville, United States senator for the great state of Alabama, but you can call me coach," Sen. Tuberville says in a video posted on Facebook.

"We're on the one-yard line, but we just need one more play to run it in. You can help us get the win against COVID by getting vaccinated."

Messaging aside, state policy curtails the response to this new wave of COVID. A new Alabama law, for instance, prevents governments, businesses, schools and colleges from requiring vaccinations.

And Republican Gov. Kay Ivey rejects calls for mask mandates, even for unvaccinated kids in public schools, a measure recommended by the American Academy of Pediatrics, and now the Centers for Disease Control and Prevention.

Ivey says she's done all she can to get the pandemic under control, and is growing frustrated with people who won't get inoculated.

"It's time to start blaming the unvaccinated folks not the regular folks. It's the unvaccinated folks that are letting us down," Ivey told news reporters last Thursday. "These folks are choosing a horrible lifestyle of self-inflicted pain."

Even with rising COVID-19 hospitalizations, vaccine skepticism persists

Back at the Mobile food truck festival, the sense of urgency is getting through to vendor Lillie McCoy.

"We need some type of protection to help us get through this because I don't want to die," she says. "We got to do our part by getting vaccinated."

McCoy says finding time to get the shot had been an obstacle for her, and this pop-up clinic solved the problem. She got her first dose just before opening Soul Heaven Café, a food truck she runs with her husband.

"What a great opportunity when it's right here for free and I can get it done while I'm here at the festival," she says before prodding her husband Antonio Smith to get vaccinated.

"Come on. You going to get yours?" she asks.

He doesn't budge.

"I ain't ready for it yet," he says.

Smith says he wants more proof that the vaccine is safe, especially for someone like him with underlying health issues.

"How do I know that it's going to protect me?" he asks. "That's all I want to know."

That's the kind of assurance health officials are trying to emphasize now that nearly all of Alabama's COVID hospitalizations and deaths are among the unvaccinated.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

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