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(The Center Square) – The Amish man who was hard at work at his outdoor food business in Lancaster County in early October had heard that measles was going around.
As wisps of smoke and a tantalizing aroma rose from chicken roasting on his portable grill, the 36-year-old Manheim resident – undesiring of having his name in a news article – shrugged off a question about vaccination.
“If your immune system is good, do you need it?” he asked.
His mindset is not uncommon in the southeastern Pennsylvania county that is heart of the largest Amish settlement in the United States. They are faith-centered, averse to technology, travel by horse-drawn buggy, and believe fiercely in the rewards of hard work. That lifestyle and culture has helped define a county that is a national leader in agriculture and a billion-dollar tourist draw.
Now, it has a less fortunate distinction. On Aug. 25, Gov. Josh Shapiro appeared there to announce what he described as the state’s first two measles-associated deaths in 35 years.
Since then, the state has seen as many as four other measles-associated deaths. And, as of Thursday, Lancaster County remained at the heart of a still-spreading measles outbreak.
Data showed the county had by far the largest share of the state’s 1,222 cases so far this year, with 443. Many Amish people have not been vaccinated against the disease, but many have.
“I think it’s okay to get vaccinated. Absolutely,” said Christian Lapp, a 56-year-old Amish roofing and siding business owner in Leacock Township. “It is not like we have a religious belief against it, that I know of.”
Vaccination data slim
The Amish are members of a church and can be termed a religious group, but not an ethnic group or other government-defined category.
Hence, said Steven Nolt, director of the Young Center for Anabaptist and Pietist Studies at Elizabethtown College, reliable data on vaccination rates is far from complete. As an indicator, he pointed to a 2022 study led by a Franklin & Marshall College professor in which only 30% of Amish respondents said their children were vaccinated.
“The Amish population here has been under-immunized, historically,” Nolt said.
However, he said, there have been “catch-up moments” in times of an outbreak.
According to the Journal of Lancaster General Hospital, the last outbreak of polio – a killer virus that took 6,000 lives during a 1916 epidemic – was in 1979 in Amish communities. Eight of the 17 type 1 polio cases nationwide occurred in Pennsylvania and “a majority of these were unvaccinated Amish in Lancaster County.”
A three-day mass immunization program stopped the outbreak.
The extent of any “catch-up” vaccination phenomenon in 2026 may be tamped down by what happened in Lancaster County during the COVID-19 pandemic.
Memories of 2020
The medical and vaccine-related mandates that began in March 2020 left a deep and often negative impression.
An Amish man who runs a fresh produce cannery in Lancaster County recalled that a 70-year-old Amish deacon was hospitalized and then isolated during COVID. “He pleaded for someone to be in with him. And they wouldn’t let anybody in with him,” the cannery operator said. “I heard lots of stories like that.”
Lapp called the government response “terrible.”
Republican state Rep. Dave Zimmerman of Lancaster County said that among his many constituents who are Amish or Mennonite – a distinct religious group with a similarly “plain” lifestyle – there was great concern about the government COVID response.
Now, during the measles outbreak, sick Amish and Mennonite patients are being treated with IV’s in non-traditional local medical facilities, according to Zimmerman. Their care is overseen by doctors who were forced out of the traditional medical system during the pandemic because they challenged government-ordained medical protocols.
“They are doing it themselves,” Zimmerman said of Amish dealing with measles.
Shapiro galvanized attention on the outbreak during his late-August announcement in Lancaster County regarding the two deaths.
Zimmerman said there was a feeling among some in the “plain community” that Shapiro exaggerated the connection of the deaths to actual measles. The governor, a Democrat, got pushback from the county coroner and a Republican county commissioner, and also got into a political war of words with Robert F. Kennedy Jr., health secretary in the Republican administration of President Donald Trump.
The disease, the governor said at the press conference, was going after “all who are unprotected” and, he added, “Thanks to science, we have a vaccine that can keep us safe from measles and provide a lifetime of protection.”
On the ground, state government measles vaccination efforts have continued, with the Health Department saying more than 5,900 measles, mumps, and rubella – or MMR – vaccinations have occurred at 202 “pop-up” clinics.
As of Thursday, the second-highest measles case total in the state was the 183 in Mifflin County, the core of the state’s second-largest Amish settlement. There, an 18-year-old Amish woman died recently with a rare complication of measles called acute disseminated encephalomyelitis, according to Coroner Andrea Alcalde.
She had not been vaccinated.
The woman had been healthy and with no known susceptibility to the disease. Alcalde said she “just caught measles and started to deteriorate.”
Agricultural powerhouse
There are more than 400,000 Amish people nationwide. The Lancaster-region settlement of about 46,000 is the largest in the country, according to information from the Young Center.
October is harvest time for many crops in Lancaster County, whose $1.8 billion in agricultural products sold ranks first among Pennsylvania’s 67 counties and 20th among 3,000-plus counties nationwide. It ranks seventh in the nation in poultry and egg sales and 16th nationwide in milk from cows.
The Amish work ethic is deeply connected to those statistics.
Horse- and mule-drawn farm equipment makes its way across vast stretches of rich soil. Children work alongside adults, women in long yet simple mono-color dresses mow grass outside farmhouses, there is the clop of hooves on paved public roads.
The vast majority of Amish children attend their community’s own, tiny schoolhouses, and are done after eighth grade. Their parents pay taxes but generally shun health insurance. Computers and cell phones are avoided.
Mary Fisher, a 59-year-old Amish co-owner of a housewares store, said her two daughters had their shots but she knew nothing about the Shapiro administration’s push against measles.
“You’ve got to stay in prayer and give it all to God,” she said.
Some sleepless nights
Nolt pointed out that the 30% Amish children-vaccinated figure from the 2022 survey was a steep decline from 52% measured in a similar study eight years earlier. That, he said, showed the pandemic experience isn’t the only thing shaping Amish feelings about vaccination.
There is evidence that several non-Amish anti-vaccine groups have been active in the community in recent years, Nolt said. He said they are spreading “a message that vaccines are very dangerous.”
The public health and medical people who have contacted the Young Center, Nolt said, have been “deeply committed to learning about and working sympathetically and effectively with Amish concerns, values, and patterns of healthcare decision making.”
Some county leaders, he said, have said – incorrectly – that Amish have a religious opposition to vaccines.
“They just don’t think about this as a church matter,” he said. “It is a family matter.”
Mel Stoltzfus, a Lancaster County resident who grew up in an Amish household, now has a wife and 11 children. Three have moved out of the house, but all the rest – along with Stoltzfus and his wife – got sick with measles during a five- or six-week stretch this spring, he said.
It was not a “big deal” in his way of thinking.
“It was a couple of nights of not much sleep.”