Since the COVID-19 pandemic began over a year and a half ago, about one in 434 rural Americans have died of coronavirus, compared with 1 in 513 urban Americans.

But now, that divide is getting more serious, according to data from the Rural Policy Research Institute.

As of mid-September, roughly 41% of rural America was vaccinated, compared with about 53% of urban America.

Limited supplies and low access were a big factor at first, but now vaccine hesitancy, misinformation and politics are to blame for the low vaccination rates.

Paul Eichler, 69, of Frewsburg, in Chautauqua County, got his booster shot at the Seneca Allegany Events Center in the Cattaraugus County city of Salamanca. He was one of several people who got a booster, while only a few got their second dose.

There were no first-dose appointments for a community with a vaccination rate of about 50%.

“I'm very disappointed that people don't take this serious enough to go out and get a vaccination. It's such a small thing to do," Eichler said.

Cattaraugus County Public Health Director Dr. Kevin Watkins said there were more than 1,200 new cases in October alone, and an increase in deaths, with seven reported in one day earlier this month.

"The vaccine is starting to wane and we're seeing quite a few of the breakthrough cases here in the community as well," Dr. Watkins said.

Watkins said last May, there were days with zero new cases reported. Compare that to earlier this month, when the county had a daily positivity rate and seven-day average of above 9%, blamed in part on the Delta variant.

"Having such a low vaccination rate could have led to the widespread transmission that we're seeing here in the community," Dr. Watkins said.

Cattaraugus joins many rural counties across the state, like Allegany and Hamilton, are also dealing with a high number of cases, while many of those same communities having low vaccination rates.

Watkins said he has once again increased staff, used COVID-19 funding to order supplies that the state used to send for free and combat rural, spread-out communities where many refuse to be told what to do and not get their shot.

"And that has been quite difficult mainly because staff have stated to develop what we call COVID fatigue and it really takes its toll on the workforce that we have dealing with the positive cases that we're seeing in the community," Dr. Watkins said.

Meantime, COVID-19 testing continues while staff is also making wellness calls to those recovering from the virus.

Both Dr. Watkins and Paul encourage others to roll up their sleeve and help put an end to the pandemic.

"It's been going on for too long and too many people are getting sick and too many people are dying," Paul said.