CNN  — 

The coronavirus pandemic unfortunately has been dominated by politics. We first saw it with the pushback on mask wearing. Today, it continues with who and who will not get vaccinated.

The impact of this political divide is no clearer than in West Virginia. This comes as the pandemic rips through the Mountaineer State.

West Virginia had been a success story for vaccinations. Back in early March, West Virginia ranked in the top four in terms of the adult population that was vaccinated. The state and Gov. Jim Justice received widespread praise for its vaccine rollout.

But now, West Virginia ranks last in the country for the percentage of the adult population that is fully vaccinated. Just 48% of adults are fully vaccinated, according to the Centers for Disease Control and Prevention. This makes West Virginia the only state in the country where less than half the adult population is fully vaccinated.

The slowness with which West Virginians have taken up the vaccine comes despite a governor who has been begging people to get it. Although Justice has not yet called for a vaccine mandate, he’s done basically everything else. He had memorable press conferences and offered prizes to try to up the vaccination rate in his state.

The problem is that Justice has been overwhelmed by the demographic and political fundamentals that have plagued the vaccination effort throughout the country. Once vaccines became more plentiful nationally, it became less about how good states (and leadership) were at giving out vaccines and more about whether people were willing to take them.

It turns out that there haven’t been that many adults who have been willing to in the Mountaineer State.

The issue starts with politics. West Virginia is one of the most Republican states in the country. Former President Donald Trump won the state by nearly 40 points in 2020. The only state that he won by more was Wyoming, which ranks in the bottom three for adult vaccination as well.

As I’ve previously noted, the correlation between the vaccination rates in states and how those states voted in the 2020 election has only become stronger over time. Georgia, a state President Joe Biden barely won, is the lone state that went blue in 2020 that is in the bottom 15 for adult vaccinations.

Indeed, even Trump’s appeals on the vaccine haven’t worked. He encouraged (not to the same level as Justice) people to get a Covid-19 vaccine. Trump was met with boos.

Less noted is that education rates have also been highly correlated with vaccination rates. Indeed, the states in the top 25 for college-educated adults have on average about 10 points more of their adult population vaccinated compared to the states in the bottom 25 for college-educated adults.

West Virginia has fewer adults with a college degree than any state in the nation.

Perhaps more unbelievably, the low rate of vaccination has continued in September. A lower portion of the Mountaineer State’s adult population has gotten their first Covid-19 dose this month than any other state in the nation.

This is in spite of how bad the coronavirus situation is in West Virginia right now. States with high infection rates tend to see an uptick in their vaccinations.

There are 95 new daily cases per 100,000 residents on the weekly average in West Virginia. Alaska is the one state with more cases, and it’s in the top half for new adult vaccinations this month.

West Virginia also is the worst in the country in current hospitalizations. Second is Kentucky, which is in the top five for new adult vaccinations this month.

West Virginia also has the third most deaths over the last week controlling for population size. The two states with a higher death rate (Alabama and Florida) are in the top half for new vaccinations.

What Justice and West Virginia are teaching us is that politics is trumping public health, even when things are truly dire.

That doesn’t mean that leaders can’t try to move the electorate. It’s just that you can’t make certain people do what they don’t want to do, no matter how bad things get.