EPHRATA, Pa. (AP) — Conservatively dressed Amish and Mennonite shoppers mingled with general public shoppers on a recent Friday at a sprawling outdoor market here, where vendors sold colorful pumpkins and mums, chip pies and squash, sports jerseys and Barbie accessories.
Such interactions are common in central Pennsylvania’s Lancaster County, home to the largest Amish population in the United States — and the epicenter of the nation worst measles epidemic in 35 years. Although they avoid many types of civic engagement for religious reasons, the Amish — like many other groups vulnerable to measles across the country — are not truly segregated.
“We are all interconnected,” said Dr. Diego Hijano of St. Jude Children’s Research Hospital.
Robust vaccination rates once protected Americans much better.
But the rates among the general public are falling nowand rates have long been low among the Amish, creating the perfect conditions for the contagious virus — officially considered “eliminated” from the United States since 2000 — to spread here and beyond.
Pennsylvania has the highest number of cases in the United States, with more than 1,350 this year. more than a third in Lancaster County aloneaccording to state figures. That’s a vastly underestimated figure, community leaders say, because many people with measles never see a doctor.
The state recorded three deaths associated with measles Lancaster and two in other counties.
In Amish Country, Measles Surge Raises Questions About Vaccine Acceptance
The outbreak has particularly affected “Plains Communities” made up of conservative Amish and Mennonites – so named because of their modest dress and limited use of technology. Vaccination rates and attitudes toward vaccines vary widely. But overall, they are less likely to be vaccinated than the general population, due more to culture and habits than doctrine.
Many are now showing a new openness to vaccines, while the general public is also taking extra precautions.
All of this underscored the interdependence of the Plains populations and broader “English” populations.
Ordinary people avoid areas of civic participation such as holding public office. Yet they regularly shop and do business with neighbors in this growing county of half a million people, where an urban core is surrounded by suburban subdivisions adjoining Amish farms.
“There’s no way to imagine that this will be an isolated community,” said Dr. Anne-Marie Derrico, chief medical officer of the nonprofit Union Community Care. It has clinics in the city of Lancaster and outlying towns, as well as a mobile unit that runs a “Plain Healthy” outreach program to the Amish and Mennonites.
“We have Plain patients who come to town, we have patients in town who don’t get vaccinated, who go to school, who participate in other programs with other kids,” Derrico said.
Measles rates in Pennsylvania have declined from their September peak, but some doctors expect them to increase as winter brings more indoor gatherings.
Although most cases are mild, measles can cause serious and even fatal complications, such as pneumonia and encephalitis.
The Union held small-scale vaccination clinics to reach the populations of the Plains, resulting in approximately 450 people being vaccinated against measles. “We hope this has had a significant impact,” Derrico said.
Union clinics are also offering vaccinations for infants earlier than expected, as health experts advise in areas affected by measles outbreaks.
Lauren and Mason Spence recently brought their 10-month-old son, Bowen, to a clinic to receive his first dose of the MMR vaccine, short for measles, mumps and rubella. The “English” family frequently frequents public places, particularly farmers’ markets.
“It’s scary,” Lauren Spence said. “It’s spreading quickly.”
Opinions on vaccines vary among ordinary people
Attitudes toward vaccines in Plains communities have alternately warmed and cooled over time — most recently cooling in reaction to strict measures. COVID-19 public health measures, according to community leaders and academics. The measles outbreak is prompting many people to accept vaccines, while increasing skepticism about vaccination among others.
An Amish farmer, Ephraim Zook, still opposes vaccines even after he and his wife nursed their young twins through the illness. “We just thought measles was a natural disease,” he said.
A Mennonite market vendor said his largely vaccinated community has had no infections.
A Plain farmer said he got vaccinated after his adult siblings started contracting measles. With vegetables to harvest and tobacco leaves to pick, “I thought if I could do this, I would be done,” he said.
Most of those interviewed by the AP asked not to use their names, in keeping with the Plains tradition of not calling attention to themselves.
Those who avoid vaccines are generally not motivated by ideology, community leaders and experts say.
“The major reason had nothing to do with being against vaccination,” said Allen Hoover, an Old Order Mennonite and former administrator of the New Holland Parish Medical Center. “It was just, ‘Well, we’ve never done it before, and we did well with it.'”
Hoover said the most effective strategy for medical staff is to encourage vaccination — not aggressively push it.
It takes time for outside professionals to build trust in Plain’s communities, he said.
Approximately how long?
“Twenty years,” he said.
A group of Amish schools and individuals in New York are asking the U.S. Supreme Court to require their state to allow exemptions from school vaccination requirements for religious reasons, as Pennsylvania and most states do.
But Amish leaders at large have not framed this as a religious issue, according to Steve Nolt, director of the Young Center for Anabaptist and Pietist Studies at Elizabethtown College in Lancaster County.
“There is nothing in Amish theology or historical records that one can find that specifically addresses or opposes vaccination,” he said.
About 45,000 Amish and 6,000 Old Order Mennonites live in and around Lancaster County, according to the Young Center. Many resort to traditional remedies and rarely see the doctor, Nolt said.
This year’s outbreak follows those of 2025 in Mennonite communities in Texas and elsewhere in North America.
Contagious virus poses growing threat to everyone
Measles spreads easily when people who have it breathe, cough or sneeze, or through contaminated surfaces.
“Measles is really the lion king of infectious diseases in terms of transmission,” said Michael Osterholm, who directs the Center for Infectious Disease Research and Policy at the University of Minnesota. “No person in the United States of America who is susceptible to the measles virus, whether they have not been vaccinated or have not already had it, should feel safe from measles. No one.”
The risk increases as vaccination rates decrease.
According to the Centers for Disease Control and Prevention, 92.4% of kindergartners in the United States in 2025-2026 received the required MMR injections. This is down from 95.2% in 2019-20.
“While Plains communities are an easy and recognizable target, the decline in childhood vaccination rates in our county is not limited to the Amish,” Berwood Yost, director of the Center for Opinion Research at Franklin & Marshall College in Lancaster, wrote in a recent commentary. “Kindergarten vaccination rates have declined in all central Pennsylvania counties since 2020.”
A 2022 survey by the center found that the vast majority of Mennonite families reported having their children vaccinated, compared to about 3 in 10 Amish families.
Yost urged the public not to blame the Amish, or any other group, for the outbreak. “Each of us is susceptible to misinformation and confusing messages,” he wrote.
Vaccination hesitancy, which increased among populations during the pandemic, still persists.
This erodes “herd immunity,” which occurs when enough people in an area are immune to measles that it no longer spreads easily. Although less than 100% immunity ensures that the virus will not spread, an outbreak is considered unlikely if a community has an MMR rate of 95%.
The MMR vaccination rate in Pennsylvania kindergarteners fell to 93.2% last year.
Lancaster County’s rate is 88 percent, with lower rates at the county’s religious and other private schools than at public schools, according to an AP review of state data.
Across the county and state, the percentage of students with religious or philosophical exemptions from at least one required vaccination has increased significantly.
Nolt said some anti-vaccine groups are targeting the Amish with their messages.
In 2021, Robert F. Kennedy Jr., who helped lead the anti-vaccine movement for years, spoke at a Lancaster County fair, alleging that the government was trying to force the Amish to vaccinate.
Now US health secretary, Kennedy recently clashed with Pennsylvania’s Democratic governor, Josh Shapiro, over the scale of the outbreak. Further controversy ensued when the county coroner attributed the death of a measles-infected infant to a ruptured spleen, not the disease itself.
After a drop in confidence, some minds change
Lancaster County Commissioner Alice Yoder said public officials should unite behind the message that the vaccine is safe and effective and should encourage people to receive it.
This approach was successful during the last measles outbreak in Pennsylvania in 1991.
“There were lines of people in the Plain community coming to get vaccinated,” she said.
Dr. D. Holmes Morton, who founded the Central Pennsylvania Clinic in Mifflin County — which treats patients with genetic diseases — said the same thing is happening now.
“We are doing better at organizing vaccination days,” he said.
Ultimately, this will make everyone safer, St. Jude’s Hijano said.
Getting vaccinated is “an act of love for your community,” he said. “You yourself will be protected. But in truth, you protect everyone around…
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