The $1.9 million in pandemic aid would have gone a long way in Cochise County, a rural borderland where a winter of infections swamped hospitals. There was money for tracking cases. Testing in remote ranching towns. Funds fortifying the Arizona county’s strained health department.

But the county’s Republican-controlled board of supervisors stunned many residents and health care workers by voting last month to reject the federal money, becoming one of the rare places in America to turn down COVID-19 assistance from Washington.

“We’re done,” said Peggy Judd, one of two Republican supervisors who voted against accepting the money. “We’re treating it like the common cold.”

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The vote transformed what would usually be a rote line on a government agenda into an emotional flashpoint in this county of 125,000 people where life is shaped by the southwestern border, rhythms of ranching and, now, a pandemic that has killed 522 residents.

To conservatives, rejecting the money felt like a high-desert declaration of independence, even if their rural county does rely on a host of other federal spending and jobs provided by the Fort Huachuca Army base.

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Doctors and hospital officials, generally reluctant to plunge into divisive debates in their largely conservative county, started speaking out after they saw news of the 2-1 vote in The Herald/Review, the local newspaper. Some criticized the supervisors for reinforcing local vaccine resistance with a welter of anti-vaccine misinformation.

“It’s insanity,” said Dr. Cristian Laguillo, who has been treating a crush of COVID-19 patients at Copper Queen Community Hospital in the old copper-mining town of Bisbee. “It was a decision made without thought, without care. That’s maddening.”

More than 200 small rural towns across the country have declined pandemic funds from the Biden administration, according to a survey from the National League of Cities, representing a tiny fraction of the hundreds of billions of dollars pouring into cities and states.

The Treasury Department has already sent out $245 billion to local, state and tribal governments through the American Rescue Plan. A vast majority have eagerly taken the money, including some elected Republican leaders who had opposed the measure. The money has flowed toward schools, health care systems and affordable housing as well as non-COVID projects such as prison construction, highway projects and tax cuts, according to the Center on Budget and Policy Priorities.

Some tiny towns say they have no use for the coronavirus relief as the pandemic trudges into a third year. And other conservative rural officials are turning down the money as a public repudiation of vaccine mandates, the $30 trillion national debt and a persistent pandemic that is killing 2,500 people each day even as new cases ebb and Democratic states lift pandemic restrictions like mask rules.

In Cochise County, critics said they were particularly stung by the timing. The January vote rejecting the money came as omicron cases surged across the county, with the federal government sending in a 15-person strike team at the request of the county’s largest hospital, Canyon Vista Medical Center.

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Since there are few intensive care beds in the county, doctors said they were spending hours on the phone pleading with crowded hospitals in Utah, Texas or Phoenix to take patients too sick to stay in Cochise County. State data shows that about 70% of the county’s residents are vaccinated, but health workers say those numbers may be inflated by Mexican citizens who cross the border to get vaccinated.

The Cochise supervisors who voted against the $1.9 million have raised doubts about the safety and reliability of the vaccines, despite no evidence. Judd said she and her family had recovered from COVID-19 in November after drinking orange juice spiked with ivermectin, a drug commonly used to treat animal parasites that has become a go-to remedy for vaccine opponents. She said she and her family remain unvaccinated.

“We’re those people,” she said in a telephone interview, coughing occasionally — a lingering sign of the infection.

The fight in Cochise County is one skirmish in a larger battle that conservative governors and local leaders are having with the Biden administration over how to hand out billions of dollars in COVID-19 money, echoing fights over whether states would expand Medicaid under Obamacare.

Thirteen mostly Republican-led states sued the Biden administration over restrictions in the coronavirus relief law that would have prevented them from using federal money to offset tax cuts. The Treasury Department has also fought with Republican governors in Florida and Arizona who have sought to deny federal funds to schools with mask mandates.

Two dozen states cut off expanded unemployment benefits last summer, saying the extra money from the federal government was deterring unemployed Americans from seeking work. And a handful such as Idaho and Iowa have rejected or not spent millions in pandemic aid for school testing and rental assistance. Alicia Thompson, Cochise County’s director of health and social services, applied for the disputed money more than a year ago with the hope of, among other things, more testing in rural areas, assessing how COVID-19 had affected the community and hiring a finance director.

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In the intervening months, she has lost one cousin to the virus and had another hospitalized on a ventilator. She still goes to work masked up to try not to bring home the virus to her husband, who has chronic lung disease. When the vote on the money arrived, she expected that the county would accept it.

“It was a shock to me,” Thompson said. “I’ve been scrambling to figure out, what are other ways? How can we still get those services to community members?”

Judd said she had voted to accept other federal funds for housing, law enforcement, fighting the opioid crisis and addressing other economic and health tolls of the pandemic. But she said she rejected the $1.9 million — which originated with the U.S. Department of Health and Human Services — because she was dubious about doing contact tracing, public health surveys and hiring a security guard at the health department.

The other Cochise supervisor who voted against the money, Tom Crosby, compared COVID-19 vaccines to Agent Orange, the cancer-causing herbicide that killed and maimed hundreds of thousands during the Vietnam War. He said he wanted “to get the county out of the vaccine business.” As the board weighed whether to take the money at a meeting, Crosby reminded the county’s public health director that he had supported anti-COVID efforts earlier in the pandemic. But now?

“The overall government trend is toward threatening and eroding constitutional rights,” he said.

It was not the first time Cochise County’s leaders have drawn attention for what critics call their dangerous views on vaccines or democracy.

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The county’s Republican Party chair was one of 11 Republicans who falsely claimed to be the state’s true electors despite President Joe Biden’s win in the state. And Judd and her family traveled to Washington in January 2021 to join the rally against certifying the presidential election. (She later told The Tucson Sentinel that she never entered the Capitol building and posted a statement on Facebook condemning the rioters and violence.)

Ann English, an 80-year-old rancher and retired school administrator, was the lone “yes” vote for taking the $1.9 million. English, a Democrat, said the vote and the anger catalyzed by COVID that is swirling through the country reflected how deeply misinformation and divisions were now sown into the soil of local politics.

“I don’t understand why anyone would want us to turn down money that would help keep people safer,” English said. “This is health we’re talking about.”

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