For the past five weeks, nurses at Cobre Valley medical center in Globe, Arizona, have been vaccinating anyone aged 18 and over, after becoming one of the first places in the US to completely open up vaccine eligibility. And yet, with less than a third of the local population vaccinated, hospital staff have been alarmed to see appointments dropping significantly in recent weeks, from about 250 a day to 175.

The picture contrasts heavily with that experience in more urban parts of the country, where supplies are still constrained and many people are desperate to secure doses. But it chimes both with what is being seen in other rural counties across Arizona, where take-up is lower than average, and with national polls that show rural Republicans are among the most vaccine-hesitant groups in America.

“National surveys tell us rural [Donald] Trump voters are more concerned than most about getting vaccinated,” said one Arizona health official, who asked not to be named for fear of drawing the ire of Republican voters. “And that’s the trend we seem to be seeing across Arizona. ”

Health officials in Gila County where the hospital is say that young people in particular do not believe Covid poses enough of a risk to get inoculated. “The younger crowd feels that the chance of dying of Covid is pretty low, so they do not want to waste their time getting vaccinated,” said Michael O’Driscoll, the county’s director of health emergency management.