In Amish Country, a Historic Measles Outbreak Is Softening Vaccine Resistance

In Amish Country, a Historic Measles Outbreak Is Softening Vaccine Resistance

America's Worst Measles Outbreak in 35 Years Centers on Lancaster

Pennsylvania has recorded more than 1,350 measles cases this year, the worst outbreak in the United States in 35 years. Lancaster County accounts for 478 of those infections, more than a third, with 23 added in the past week; statewide, 74 new cases in the past week brought the total to 1,360, home to the largest Amish population in the country. About 45,000 Amish and 6,000 Old Order Mennonites live in and around the county, according to the Young Center for Anabaptist and Pietist Studies. Community leaders say the true count is likely much higher, because many people with measles never see a doctor.

Five Deaths, Mostly Unvaccinated, After a September Peak

The state has recorded five measles-associated deaths, three in Lancaster and two in other counties. In early October, the state health department confirmed the latest death was an unvaccinated person in Lancaster County, without sharing age or other details. Most cases are mild, but measles can cause pneumonia and encephalitis and can kill. Cases have declined from a September peak, though some doctors expect a winter rebound as indoor gatherings increase.

Theology Is Not the Barrier, Doctors Say

There is nothing in Amish theology or historic documents that opposes immunization, said Steve Nolt, director of the Young Center at Elizabethtown College. The bigger factors are reliance on traditional remedies and infrequent contact with doctors. In 2021, Robert F. Kennedy Jr., who had long led the anti-vaccine movement, spoke at a Lancaster County fair, alleging the government was trying to force the Amish to vaccinate.

Vaccines Come to the Doorstep, Quietly by Word of Mouth

Since the outbreak began at the end of April, the state health department has brought vaccines to Amish doorsteps, administering more than 6,500 MMR doses at over 220 pop-up clinics in affected communities. The nonprofit Union Community Care, through its "Plain Healthy" outreach and a mobile unit, has given about 450 measles shots to Plain populations. One state nurse with 27 years of service said the clinics now spread by word of mouth and are not publicized, to avoid drawing hostile attention from vaccine opponents.

Falling Coverage Opens the Door to a "Eliminated" Virus

Pennsylvania's kindergarten MMR rate had fallen to 93.2% by last year, below the 95% level that makes outbreaks extremely unlikely. Nationally, 92.4% of kindergarteners in 2025-26 had the required MMR shots, down from 95.2% in 2019-20, according to the Centers for Disease Control and Prevention. The CDC says one MMR dose is 93% effective and two doses 97% effective, and fewer than 1% of this year's Pennsylvania cases were vaccinated. Measles was declared eliminated in the U.S. in 2000; low coverage in Plain communities plus slipping general rates created ideal conditions for its return.

Some Still Refuse, but More Families Say Yes

Resistance has not vanished. Amish farmer Ephraim Zook still opposes vaccines even after he and his wife nursed their young twins through measles, saying measles felt like a natural thing. But outreach workers report growing openness: more families are willing to listen and roll up their sleeves. That shift matters beyond the Plain community, because Amish and Mennonites mingle constantly with the wider public at markets and clinics. "There is no way to imagine that this is going to be an isolated community," said Dr. Anne-Marie Derrico of Union Community Care.

A Race to Vaccinate Before Winter Gatherings

Lancaster County Commissioner Alice Yoder said officials must press the message that the vaccine is safe and effective. In the first three weeks of October, providers statewide gave more than 39,000 MMR shots, well above the typical monthly pace of about 25,000. "Measles is really the lion king of infectious diseases when it comes to transmission," said Michael Osterholm of the University of Minnesota. Health officials say the next step is closing the coverage gap before winter, or cases could climb again.