Gov. Ralph Northam at a vaccination event earlier this year. Courtesy of the governor's office.

As he prepares to leave office, Gov. Ralph Northam voiced his frustration with COVID-19 vaccine hesitancy in rural Virginia, especially in the Southwest. “We have three effective and safe vaccines, but the one thing I really don’t get about rural Virginia is why they are reluctant to get a shot. If people want to be safe and put this pandemic behind us, they’re going to have to roll up their sleeves,” Northam said in an interview with Cardinal News on Wednesday, just one day before the new omicron variant was first detected in Virginia.

The Southwest and Southside regions currently have the lowest vaccination rates in the commonwealth. While a total of 66% of eligible Virginans were fully vaccinated as of Friday, the number decreases the further one goes to the west. With just 39.3% of fully vaccinated residents, Patrick County was at the bottom of the list last week. Other localities in the area average between 40% and 50%, such as Lee County with 41.1%, Wise County (43.8%) and Scott County (45.2%). With 63.7%, only Roanoke County is above the statewide average.

Deaths from COVID-19 complications are proportionate to cases in unvaccinated patients, Northam said. “If you look at the numbers, especially in Southwest, our vaccination rate is low out there,” Northam said. “And if you look at the deaths – today we reported 40 additional deaths in Virginia, the great majority of them are in rural Virginia, specifically in the Southwest, and they are all avoidable.”

For example, in Patrick County, the locality with the highest vaccine hesitancy, 60 of the 2,373 patients that have tested positive for the virus have died so far – that’s 2.53%. In Roanoke County, where more people are vaccinated, 186 of 13,079 patients – or 1.42% – did not survive the disease. 

Dr. Cynthia Morrow, director of the Roanoke City and Alleghany Health Districts, said that there are many reasons for some people to not get vaccinated. “Vaccine hesitancy is neither monolithic nor immutable,” Morrow said in a phone interview. “It’s really important to understand why an individual has concerns, so we can address that concern in a compassionate way that takes into account where they are coming from. But it’s imperative that all of us who work in public health will continue and try to encourage people to get vaccinated, despite the low rates.” 

In Morrow’s districts, Craig County has the lowest vaccination rate with 42.4% of all eligible residents. “Craig has been particularly hit hard by COVID,” Morrow said. But a recent increase of fatalities in this small community of just 5,100 has resulted in a spike of vaccinations. “Everybody in Craig knows each other, and that has motivated some people to get vaccinated,” Morrow said. “But other people do not, because their belief system is such that they either believe the threat of COVID is less than the threat of the vaccine, or they believe it is purely political, despite the reality that this is a global phenomena.”

Like most health districts in Virginia, the Roanoke and Alleghany districts went through three phases of inoculating residents. The first phase began in January, when the vaccines were first made available. “Back then, we started with a general public education campaign,” Morrow said, adding that “we didn’t have the supply to meet the demand.” 

A drive-through vaccination event at the Berglund Center in Roanoke earlier this year. Courtesy of Roanoke-Alleghany Health District.

Phase two was launched a few months later, when initial demand began to wane. “That’s when our supply exceeded demand, because some people are vaccine complacent.” To counter the hesitancy, health officials took a more targeted approach. “We began taking the vaccine to the people, like to churches or block parties, trying to increase access to the vaccine,” Morrow said. “That’s where we had significant success in late spring, early summer.”

When the delta variant caused another spike in infections, hospitalizations and deaths later in the summer, health workers entered the next phase. “Now we are shifting focus from large-scale public education to one-on-one, that individual level,” Morrow said. A team of community outreach approach trusted members of the community “to make sure people get the facts, not the myth, and use that trusted partner in a way that we can together, hand in hand, address concerns that community members may have.” Such leaders include pastors or local politicians, anyone who has the trust of the community. 

And the arrival of the omicron variant has renewed interest in the vaccines, Morrow said. “We saw a nice uptick in interest in booster shots last week, and we have vaccinated 15,000 people in one week,” she said. Most of those were boosters, but several hundreds were first doses, mostly in children. 

The biggest enemy, besides the virus, remains misinformation spreading on social media. “We talk about the pandemic and the infodemic,” Morrow said. “Are there people who have been infected by misinformation? Yes, but we are not giving up.”

Northam, who is a pediatric neurologist by occupation, said that once he leaves office, he will continue to treat and educate patients. “I, as a doctor, I’ll be glad to sit down and listen to people’s concerns and help them know the facts,” he said in the interview. “There is so much misinformation out there, people are scared. But I would just hope that we could stick to the facts, and people can understand that this is a dangerous virus, especially for those individuals that have underlying health conditions, and especially if they are older.”

Northam said that he has friends and colleagues in rural communities who have lost family members to the virus but they still refuse to get vaccinated. “It’s one of those things that has been frustrating me, I have worked so hard, and so did my administration, to make sure that people have access to these vaccines and the testing and all other things that we have done,” he said. “If any of these folks in the Southwest stepped on a nail, I bet they’ll go get a tetanus shot. It’s just that simple,” he said. 

In the end, getting vaccinated is a patriotic thing to do, Northam said. “As someone who is proud to be an American, I hope for the country to come together when this country is at war, and we are fighting a biological war now, just not between us versus them, but it’s us versus the virus, a very deadly virus,” he said. “So let’s all get aboard and be part of this country, be part of Virginia and the solution and roll our sleeves up and get a shot.”

Markus Schmidt is a reporter for Cardinal News. Reach him at or 804-822-1594.