It was early Sunday morning and Dr Annie Andrews was far from the political fray, dropping her youngest daughter off at a summer camp, when she heard the news.

“It was shocking and unbelievable,” she says of the death of Lindsey Graham, a Republican senator who defined South Carolina politics for a generation aged 71. “It’s a profound moment for the whole state of South Carolina.”

For more than a year Andrews, a Democrat, had been building a formidable grassroots campaign designed to unseat Graham in the midterm elections. The 45-year-old paediatrician had pitched herself as the antithesis of the veteran senator she never met – an outsider running a campaign “powered by people, not Pacs [political action committees]”.

Now Andrews, who had been aiming to become South Carolina’s first female senator, has seen the honour bestowed instead on Graham’s sister, Darline, who was appointed to serve out the remainder of his term and will compete in a primary next month to decide the Republican nominee in November.

So everything has changed – and yet nothing has changed. “The problems that South Carolinians are facing did not change over that weekend,” Andrews says by phone from her base in Mount Pleasant. “My opponent will change but my mission remains the same and that’s what I’m staying focused on.”

That mission was galvanised by the two decades that Andrews spent on the frontlines of what she describes as America’s “broken” public healthcare system, including 15 years at a children’s hospital in Charleston. The experience ultimately compelled her out of the medical ward and into the political arena.

“Over those years, I started to understand that the problems my patients and their families were facing were policy problems. These were systemic problems with systemic solutions and what we needed to do was start electing people who inherently care about South Carolina’s kids and families and care about solving those problems.”

Her initial foray into politics – a 2022 congressional run against Republican representative Nancy Mace – ended in a 14-point defeat. After that loss, Andrews stepped away from her practice at the Medical University of South Carolina and founded a political organisation focused on the climate crisis, gun violence and childhood poverty.

But it was the darkness of Trump’s second term that pulled her back on to the ballot for the Senate, in particular the nomination of Robert F Kennedy Jr to lead the Department of Health and Human Services (HHS).

She recalls: “In the aftermath of Trump being re-elected, the day that I decided to consider this seriously was the day RFK Jr was nominated to lead HHS because, as a paediatrician, that’s the worst-case scenario for America’s public health system.”

For Andrews, the elevation of Kennedy – who spent decades amplifying baseless anti-vaccine views – is not merely a political affront but a direct threat to the lives of the children she treats.

“Doctors are trained, when they take a history from a patient, to ask if their immunisations are up to date. Twenty years ago, when I started asking that question, the answer was almost universally yes.

“Now when I ask that question, I brace myself for the response because bad actors like RFK Jr, grifters and conspiracy theorists have been peddling in these anti-vaccine conspiracy theories for decades and it has seeped into the consciousness of many parents in America who now don’t know who they can trust for solid evidence-based medical information about decisions for their children’s health and it’s deeply frustrating to watch as this has evolved.”

The consequences are brutal. Measles cases in the US have hit a 35-year high, according to data from Johns Hopkins University, with more than 90% of reported infections occurring among the unvaccinated or those whose vaccination status is unknown.

Andrews adds: “It is pervasive across sociodemographic groups now. People do not know who they can trust and sadly right now, when I talk to patients, I say: ‘You cannot necessarily trust the health information that we are receiving from the federal government.’”

The Covid-19 pandemic, she believes, acted as “kerosene on the fire”, catalysing an anti-science movement that has now fully entrenched itself within the Republican party.

Indeed, for Andrews, the triage urgently required in Washington is clear. She views the impending Medicaid budget cuts signed into law by Trump as a devastating threat to rural South Carolinians. She advocates for defending Medicare, lowering prescription drug costs through federal negotiating power, and gradually introducing a public option to force private insurers into offering more competitive, less profit-driven plans.

And her definition of the public health emergency extends to gun violence. She speaks with the authority of a doctor who has “cared for children with bullet holes in them” and “stood at the bedside of a child who has been shot and held the parent’s hand, understanding that these are preventable injuries, these are policy choices that have been made by our lawmakers”.

While acknowledging that gun control may not be the primary issue driving voters to the polls in 2026, she insists: “I will not stand on the sidelines as gun violence continues to be the leading cause of death for kids in South Carolina and kids all across this country. But the good news is the vast majority of Americans agree with me. Over 90% of Americans believe we need commonsense solutions like universal background checks.”

Andrews views the broader landscape of Trump’s second term with profound alarm. She sees a state and a country buckling under the weight of “chaotic” economic and social policies.

“I’m deeply concerned about the direction this country is moving in,” she says. “Gas prices are high. Grocery prices are high. There’s an affordability crisis in housing and in childcare. We don’t have jobs to meet the needs of folks who are graduating from technical colleges or from four-year universities and, on top of that, we’re witnessing unprecedented corruption in the federal government.”

Her proposed remedies to break the fever include ending partisan gerrymandering, implementing term limits, banning members of Congress from trading stocks or becoming lobbyists and overturning the Citizens United supreme court ruling to purge dark money from politics.

Andrews has spent a year building a statewide campaign apparatus, raising funds and recruiting more than 2,000 volunteers. This week, she gained the endorsement of Her Bold Move, a national support network for women running for political office. But even in the absence of Lindsey Graham, a close Trump ally who served four terms, she faces a monumental structural disadvantage.

South Carolina is a stronghold for Republicans with state elections historically decided by double-digit margins. In 2020, the Democratic challenger Jaime Harrison shattered national fundraising records, amassing a war chest of more than $100m, yet still lost to Graham by a crushing 10 percentage points.

“I’m used to fighting fights that are uphill battles,” Andrews admits. “That does not make the fight any less important and what I’ve seen over the past year is a growing sentiment that everyone on both sides of the aisle recognises that Washington DC is broken.”