One of the few times I visited West Virginia -- Harper's Ferry -- there was a large Ku Klux Klan rally that began as I was leaving. (I sped up that departure).

There is a strong link between the deep racism and xenophobia of white West Virginians and their willingness to buy into right-wing politics. The government, after all, "forced" desegregation and "gives handouts" to Black people, in their eyes. This embrace of right-wing culture inevitably leads them to anti-vaxx hysteria. And the eugenical beliefs of anti-vaxxers -- if you have a strong immune system, you don't need to worry; code for "good genes," as Trump put it -- obviates the need for white people to get the jab. So the very identity West Virginians have as white Americans is deeply intertwined with rejecting vaccination.