| As vaccinations rose across much of the U.S., Covid cases fell and hospital staff breathed a sigh of relief. But not everywhere. President Joe Biden missed his goal this month of getting 70% of U.S. adults at least one shot, with some states well below that figure. The laggard states skew heavily Republican and are places where vaccine doubts and skepticism of authority run deep, and where the pace of shots has slowed to a trickle. Some of those states, pillars of Trump country, are now seeing a new wave of illness. Cases and hospitalizations are rising nationally again, driven in part by outbreaks where vaccine coverage is low, cases are high and delta is dominant, according to the CDC.  Covid-19 vaccine signage at a medical center in Springfield, Missouri. Photographer: Liz Sanders/Bloomberg Southwest Missouri has among the worst outbreaks in the U.S. -- one hospital there, in Springfield, set a record for itself this week for Covid admissions, exceeding the highs seen nationally during the winter, while another has reopened a specialized Covid unit. "We've seen a massive ramp" of cases, said Craig McCoy, president of Mercy Springfield Communities, which operates one of the two major hospitals. The delta variant is fueling the surge, but vaccine hesitancy remains strong. Fewer than half of adults in Springfield have at least one shot, and surrounding counties are even lower. Health officials across the region say that the vaccines face a series of headwinds: disinformation, doubts about their efficacy, concerns about side effects and a belief that the virus won't be that bad. The dynamic plays out even in the families of those who know the impact of Covid. Larry Krauck fell ill last year, and holds Mercy's record among surviving Covid patients for days spent on a blood oxygenation machine called an ECMO. "The only thing this virus is good at is trying to kill you," Krauck said, sitting outside one part of the hospital campus where he's still in rehabilitation treatment. Even among his own friends and family, however, vaccine doubts abound. His niece, Jennifer Davis, is among those who are unvaccinated, and worries about vaccine safety and trusts her immune system against the virus, after seeing its impact on Krauck. Her hesitancy signals what health officials in Springfield are seeing: the delta surge isn't triggering a new wave of vaccine demand, and the inoculation effort in America is now arm-by-arm, door-by-door.--Josh Wingrove | 
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