VIRGINIA CITY, Mont. — Emilie Sayler’s roots run deep in southwestern Montana. She serves on a nearby town council and the board of the local Little League. She went to college in a neighboring county and regularly volunteers in the schools of her three kids.

Just a few months into her new job as public health director for Madison County, she had hoped that those local connections might make a difference, that the fewer than 10,000 residents spread out across this agricultural region would see her familiar face and support her efforts to curtail the covid-19 pandemic raging here.

That largely hasn’t happened. School boards have rebuffed even minor measures to prevent outbreaks, vaccination rates languish and the Centers for Disease Control

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