Pennsylvania measles outbreak kills four as health workers door-knock Amish communities

Pennsylvania has given nearly 4,300 MMR vaccines at pop-up clinics since late April

For the past several months, clinical supervisor Dale Weiser has been making home visits across rural Pennsylvania, sometimes driving 30 miles to reach an Amish household where she administers measles vaccines around the kitchen table. As part of a county and state push to contain the deadliest U.S. measles outbreak in more than three decades, Weiser has vaccinated around 100 people in private homes since the outbreak began in late April.

The strategy reflects access barriers in a community whose regular contact with the western medical system is limited. “A lot of people that I encounter, they don’t have health insurance. They don’t have a lot of interaction with the health system, and they just haven’t seen the need to get these vaccines,” Weiser said. “When you start talking and you answer their questions, and build that trust, a lot of times they will make a different decision.” The Amish, Weiser added, cannot be reached through the channels public health teams usually rely on: “They’re not a community that’s as easy to reach — we can’t just put up a social media post. They are suffering at the moment, and we’re trying to reach out and make connections.”

Pennsylvania has reported four measles-related deaths during the outbreak — two newborns, an 18-year-old and a 40-year-old woman, according to state officials — making it the deadliest in the United States since 1992. The state health department told the BBC it has administered nearly 4,300 measles-mumps-rubella vaccines at pop-up clinics near the outbreak’s epicenter since late April.

Lancaster County, where the first Amish community settled in Pennsylvania, has been at the center of the outbreak. Amish people began coming to the U.S. in the early 1700s, with the first community settling in Lancaster. Known as the “Plain People” for the simple clothes they wear, the Amish are a devout Christian community that does not use many forms of technology, relying on horse and buggies instead of cars. About 90,000 Amish people live in Pennsylvania, and estimates suggest only around a quarter of Amish in the Lancaster area have had the MMR vaccine, according to Braxton Mitchell, a genetic epidemiologist at the University of Maryland School of Medicine who runs a research clinic studying the Amish in Lancaster. There is no particular religious text advising against vaccines, but Amish people do not have regular contact with the western medical system, or have a way to easily travel to appointments, experts said.

“A lot of people who haven’t gotten vaccinated, it’s not because they have a strong stance against getting vaccinated for measles. It’s just that they haven’t gotten around to it. It’s not convenient,” Mitchell said. He added that the Amish are extremely social, so when the virus reaches one church group, it spreads to everyone who is unvaccinated. Mitchell said the community has been especially concerned about the dangers to babies. “Measles is rampant in the Amish community,” Mitchell said. “People are concerned about it.”

Chester County, which shares a border with Lancaster County, has administered 538 MMR vaccines since the outbreak began, with 340 doses given in private settings. Jeanne Franklin, the county health department’s director, said officials have been using some of the strategies they used during the Covid pandemic — knocking on doors in the community to alert residents to the outbreak and offering private settings, including people’s homes, for immunizations. “There is the classically-defined anti-vaxer, versus people who are unaware or their culture feels differently,” Franklin said. “The thinking and the willingness to discuss and possibly change your mind is different between those two bookends.”

“People have called up and said, ‘I can’t get to your clinic, or, I don’t want people to know I’ve changed my mind,’” Franklin said. “‘If you can come to us, that’s a lot easier.’”

In recent years, childhood vaccination rates have fallen across the country as false theories about the safety of the measles vaccine have proliferated on social media. Those theories have found roots even in an insulated community with limited access to computers, Weiser said. She has heard residents ask whether vaccines contain heavy metals that can make them magnetic or whether the shots contain computer chips. “You’re clearly getting information from that hard-core group that is promoting that misinformation and disinformation,” she said. People in that hard-core group, who are staunchly against vaccines, are unlikely to be swayed, experts and officials themselves said.

But now, local health officials said, many affected by the Pennsylvania outbreak are seeing their neighbours fall seriously ill and asking thoughtful questions. Weiser said many are parents who are unfamiliar with the shots and are scared to make the wrong choice for their children.

The outbreak has produced tensions between state and federal health leaders. After the state health department announced the first two deaths — both in infants — Kennedy, the Health and Human Services Secretary, took to social media to dispute at least one of them. Governor Shapiro, a Democrat, said he told Kennedy that Kennedy was spreading misinformation that was worsening the outbreak. Those politics are back of mind in the Amish community, where people are growing fearful of more deaths as they watch their friends and family fall sick with the disease, which for decades has been eliminated in the United States.

Lancaster County coroner Stephen Diamantoni, a Republican, has said one of the two infants died of a ruptured spleen rather than measles itself. Measles can cause the spleen to enlarge, making it more likely to rupture, and several doctors have said the measles infection made the child vulnerable. “I think the measles very much contributed to that child’s demise,” said William Moss, a pediatric infectious disease specialist at the Johns Hopkins Bloomberg School of Public Health.

Public health experts said actions by Kennedy and the Trump administration have sown doubts about vaccine safety and worsened outbreaks. Last month, Trump signed an executive order recommending the combined MMR shot be split into three separate shots, a move doctors said was costly and unnecessary for a vaccine that is already safe. Moss said the executive order cast doubt on the vaccine’s safety. “He basically said the vaccine could be dangerous in its current combined form,” Moss said.

Health workers have said they worry about the start of the school year, which they said will provide more opportunities for the highly contagious virus to spread. “I think we’re in this for six to 12 months. It does feel like it’s spreading and accelerating,” Weiser said. “We’re in community transmission now. We can’t stop it easily.”