BIG STONE GAP, Va. — Cindy Stidham is a nurse with faith in most vaccines — but as scientists raced to produce one to counter the coronavirus, she figured she'd hang back.

“I’ll be the last in line to get it,” Stidham, a political conservative from the reddest corner of Virginia, told herself as the first two vaccines, developed with uncommon speed, won FDA approval late last year.

Yet there she was last week at a clinic at Mountain Empire Community College, in an Appalachian county where President Donald Trump won 80 percent of the vote in November, sweeping her long hair off to one side so her arm could get jabbed.

“It’s the right thing to do, obviously,” said Stidham, 46, who’d had a change of heart in January after the virus killed a friend’s nephew, who was 49 and previously in good health.

A similar about-face could be unfolding across mountainous far southwestern Virginia, which has some of the highest coronavirus vaccination rates in the state, despite national surveys showing ­rural Republicans are the most reluctant to receive it.

The area’s robust public health infrastructure, which for years has delivered typical flu vaccines in mass settings, is part of the reason. So was the wake-up call that followed Thanksgiving — a post-holiday surge in cases so high that two hospitals brought in refrigerated trucks because their morgues were overflowing.

And then came the death of one of the area’s most prominent figures: state senator, lawyer and cattle farmer A. Benton Chafin Jr.

Ever since Chafin (R-Russell) died Jan. 1 of covid-19, his daughter, Sophie Chafin-Vance, has been on a quest to get people vaccinated.

“I really do think the turning point for Southwest Virginia was my dad, who had no underlying health issues. He walked 10 miles a week, and at 60 years old, he’s dead,” she said.

Ahead, for now

Area health leaders hope the trend continues but say it’s hard to gauge appetite for vaccinations as long as they’re in short supply. At some point, they say, the region is likely to have more doses than takers.

The question is how many holdouts there will be, and whether their numbers will prevent the area from reaching the 75 percent vaccination rate that the Centers for Disease Control and Prevention recommends for herd immunity in a population.

“There probably will be a core of people who decline the vaccine, unfortunately,” said Sue Cantrell, the recently retired director of the Cumberland Plateau and LENOWISCO health districts. “We just don’t know what the size of the core is at this point.”

A third state health district, Mount Rogers, covers the remainder of the state’s sprawling far southwestern region, a cluster of 13 counties and three cities that are geographically and culturally closer to Kentucky and Tennessee than to Virginia’s power centers in Richmond and suburban Washington. While the region has bright spots — its school test scores are routinely among the best in the state — its residents are poorer and sicker than most Virginians.

Yet when it comes to coronavirus vaccination rates, the region is on par with the state average, and in some cases far ahead of it. Twenty-five percent of the area’s population has received at least one dose, according to state health data — just a hair over the statewide average of 24 percent. And the numbers are significantly higher in Chafin’s home county of Russell (30 percent) and four immediately adjacent counties: Washington (32 percent), Buchanan (27 percent), Smyth and Dickenson (both 28 percent).

Affluent, suburban Fairfax County, by comparison, is at 21 percent.

The higher numbers in far Southwest Virginia seem to be at odds with the findings of national surveys, including the Kaiser Family Foundation COVID-19 Vaccine Monitor, which found that 24 percent of people in rural communities say they will “definitely not” get a coronavirus vaccine, compared with 13 percent in urban settings and 14 percent in suburbs.

While 75 percent of Democrats and 51 percent of independents told Kaiser in February they had already gotten a vaccine or planned to as soon as possible, the number for Republicans was 41 percent.

“Surprisingly, we have a large number of people who are rolling up their sleeves and taking their vaccinations,” said state Sen. Todd E. Pillion (R-Washington), a dentist who helped administer vaccine doses to 1,905 people at a one-day clinic in Abingdon this month.

He credits the “amazing” job done by the region’s health department, hospital systems and pharmacies for efficient distribution and collaboration. He also thinks Chafin’s death was an eye-opener.

“That’s when we all realized, if we hadn’t already, ‘Hey, this can be your mom, this can be your dad, your brother, your sister,’ ” Pillion said. “It was a wake-up call, I believe, to a lot of people that were still under the impression that it couldn’t happen to them.”

'This was going to be bad'

Chafin knew it could happen to him, or his family or someone they loved. He was in Richmond wrapping up a General Assembly session on March 12, 2020, when Gov. Ralph Northam (D) declared a state of emergency because of the pandemic.

Once he returned home, Chafin called a family meeting at his house in Hansonville, in the Clinch Mountain foothills where his 300 head of Angus cattle grazed.

Chafin-Vance was there with her husband and two small children, as was her brother.

Around the kitchen table, over a dinner of meatloaf and mashed potatoes, the normally all-smiles Chafin delivered a stern warning.

“He told my whole family that this was going to be bad, and we needed to take it serious and we were going to lose people that we cared about,” Chafin-Vance, 33, said. “He needed to know that we were going to take the proper precautions.”

Weeks earlier, Chafin-Vance and her family had been vacationing in Disney World, confident the virus then emerging overseas would never make it to her country, much less her remote corner of Virginia.

“I said, ‘That virus isn’t coming to America,’ ” she recalled. “Everything comes to these mountains late. We are so protected and insulated by these mountains.”

But at her father’s urging, Chafin-Vance, a banker at a community lender launched by Chafin’s father and several fellow farmers, started working from home. Her husband, whose job entails visiting parolees and probationers at their homes, started throwing his work clothes straight into the mudroom washer before entering the rest of the house.

Chafin sometimes let his guard down. Photos on his Facebook page show him posing for photos maskless at a handful of indoor events over the summer, standing alongside sheriff’s deputies and Republican activists. But those were exceptions, Chafin-Vance and others who knew him said. While he had philosophical objections to the mask mandate handed down by Northam, he saw the wisdom of wearing one.

Chafin had one on throughout a marathon legal mediation session on Dec. 1, according to Del. Terry G. Kilgore (R-Scott), a lawyer who also took part.

For more than 12 hours in a spacious meeting room at Southwest Virginia Community College, Chafin and Kilgore were part of a team of eight, each of them masked and seated at separate tables spaced six feet apart. A former judge who served as the mediator went back and forth between their room and another for the opposing legal team.

They removed their masks only for lunch.

“It was a couple days later, I felt a little sick,” Kilgore said. “And then Senator Chafin had called me and suggested I go get tested. Ben had tested positive.”

Everyone in the room got sick except the judge and Kilgore’s son, a young lawyer also on the team.

Kilgore’s case was mild, and Chafin’s stayed that way for more than a week. Outfitted with a pulse oximeter, Chafin kept up with his legal work from home. He even felt well enough on Dec. 11 to whip up a big pot of his signature chili beans.

But the next day, the meter showed his oxygen level dipping dangerously low. His wife, Lora, drove him half an hour to the nearest hospital, dropping him off out front because visitors were barred.

“He opened the door and turned around and looked her square in the eye and said, ‘This may be it for me, Lora,’ ” Chafin-Vance said. “And she said, ‘No, Ben, you’ll be fine.’ ”

But within a day or so, he was on a ventilator. A few days after that, doctors said his heart and lungs needed help from a machine they didn’t have. The family had him flown to VCU Medical Center in Richmond.

On New Year’s Day, he died there, just across Broad Street from the state Capitol where he’d served since 2014. Northam ordered state flags lowered in his memory.

The two candidates running for Chafin’s seat in a special election Tuesday — Republican and Democrat alike — advocate for wearing masks and getting vaccinated.

Travis Hackworth, the Republican candidate who proclaims himself “Pro-God, Pro-Business, Pro-Guns, Pro-Life, Pro-Family, Pro-Police, Pro-Coal, Pro-Veterans, Pro-America First” is also pro-vaccine.

Hackworth initially objected to Northam’s mask mandate and business restrictions, but he had an epiphany after becoming seriously ill with the virus in the summer. As he recovered in July, he took to Facebook to urge “all the hardliners out there that rant and rave about them taking our liberties and freedoms away” to change their ways.

“I have seen folks, families that were just anti-mask until one of their loved ones was in the ICU on a ventilator, and then suddenly they want everybody to wear a mask,” he said in an interview last week.

The Democrat seeking Chafin’s seat is Laurie Buchwald, a nurse practitioner and former member of the Radford City Council. She says the senator’s death has probably encouraged some people to get vaccinated, but she thinks a sizable share of the population will wind up resisting.

“I think that shocked a lot of people, but probably not enough,” she said. “I would say that there’s that subset of the population, unfortunately a big one, about 30 percent, that’s not going to believe anything.”

'We were ready to go'

As Virginia prepared to receive its first shipments of vaccine in December, health officials across the state faced two potential challenges — figuring out the logistics of distribution and persuading skeptics to take it.

Despite the southwest’s winding mountain roads, scant public transportation and far-flung hospitals, the logistics piece went better here than in many parts of the state. Precisely because transportation can be such a challenge, regional leaders already had systems in place to bring health care to the patients — from mass flu vaccinations at schools and factories to the Health Wagon, a mobile medical clinic that got rolling in 1980, when a Catholic nun started providing health care out of her red VW.

“We’ve done drive-through clinics for flu shots . . . for 15 years or more,” Cantrell said. “And I think that laid the groundwork for staff just knowing how to do this.”

Karen Shelton, director of all three health districts since Cantrell’s retirement, said they’ve administered flu shots in every elementary, middle and high school in the region since the H1N1 influenza pandemic in 2009.

“When it came time to give the covid vaccine, we were ready to go,” she said.

It also helped that the local health districts and hospitals had a long history of working cooperatively. Hospitals across the state received the first shipments of vaccine doses, and Ballad Health, a regional hospital system, offered it not only to its own health-care workers, but also to those employed elsewhere in the region.

In other parts of the state, some hospitals were more reluctant to share, hanging on to excess to use for their staff’s second dose, said Danny Avula, who is leading Virginia’s vaccine distribution effort.

“Our philosophy generally has been that vaccine on the shelf isn’t doing anybody any good,” said Alan Levine, Ballad’s president. “We want to push it out as soon as possible.”

Health officials also seem to be making headway on the other challenge: persuading people to get the shot. Early on, Levine said, there was pushback about the very existence of the pandemic. It became only too real after the post-holiday surge — although some doubters persisted, accusing Ballad of setting up mobile morgues as a scare tactic.

For now, at least, demand for vaccinations is outstripping supply. When the Health Wagon advertised a small number of vaccine doses on Facebook, “we had 500 in no time on our waiting list,” said Teresa Tyson, the organization’s president.

But the post drew blowback, too.

“I had some comments, ‘You shouldn’t take this. It’s the mark of the beast,’ ” Tyson said. “People are truly skeptical of the government, Big Pharma. . . . Some of it’s just out of ignorance, and fear, and conspiracy theories and things like that. But we just have to continue on marching forward with the truth that this is scientific based.”

The vaccines were developed under Trump’s Operation Warp Speed, but some Trump supporters say it can’t be trusted if it’s manufactured under President Biden.

“They couldn’t pay me to take that shot,” said Dorothy Taulbee, 83, who grew up in a family with 10 children in a Southwest Virginia coal camp. Diagnosed in 2008 with lung cancer that she attributes to chemical exposure from mountaintop mining, she pulled out the Bible in her cramped mountainside trailer in Coeburn and raised a finger heavenward to explain why she doesn’t want the vaccine.

“God didn’t send that plague,” she said. “Man made it.”

But as she spoke that morning, 500 people were gladly taking the vaccine on the other side of Wise County, at Mountain Empire Community College.

“I feel so much relieved,” Scott Maines, 70, a retired tree trimmer, said after getting his shot. “It don’t even make sense not to take this.”

Peggy Duncan, a 78-year-old hairdresser and Trump supporter from Washington County, was reluctant to get her shot at first, but she began to come around after Chafin died.

“He was a sweetheart,” she said last week at PJ’s Hair Center in Meadowview, as she rolled a customer’s gray hair around blue rods for a perm. Chafin had been her lawyer years ago after a friend left her his entire estate and the man’s grandson challenged the will.

Although Chafin’s death gave Duncan a nudge, Duncan’s relatives still had to do some arm-twisting. They told her she needed to get the shot if she wanted to continue visiting her 86-year-old sister. The sister has dementia and lives with her daughter and son-in-law.

“Aunt Peggy, here’s how this is going to work out,” Mark Nelson, a bank chief executive who is married to Duncan’s niece, recalled telling her. “We love for you to come see your sister. I need you to reconsider this vaccine so we can all protect each other.”

Once Duncan relented, Chafin-Vance, who works for Nelson at First Bank & Trust, helped line her up with an appointment through a friend at Food City’s pharmacy.

She’s been helping others navigate the sign-up process and helped the bank organize a blood and plasma drive in Chafin’s memory. Ballad, which has been studying the use of convalescent plasma with the Mayo Clinic, will use it to treat covid-19 patients.

For Chafin-Vance, getting Southwest Virginians vaccinated would be another tribute to her father. She’s coaxed or scheduled nearly 30 so far, and she figures she can navigate the tricky politics to convince more.

“I think there are some Republican outliers who are choosing not to get the vaccine,” she said. “I’m a Trump supporter, but I believe the reason Trump lost the election was his getting covid and getting on national television and saying, ‘It’s not that bad.’ [For] people who’ve lost loved ones, it’s bad.”