Pennsylvania measles cases reach 1,398 amid vaccine debate in Amish communities

State outreach accompanies disputes over emergency assistance and death counts

Pennsylvania’s Department of Health reported 1,398 measles cases as of Nov. 2, 2026, in an outbreak centered in Lancaster County that The Guardian described as the nation’s worst. The Guardian said the outbreak had continued for a year or more. Democratic Gov. Josh Shapiro’s administration mounted pop-up clinics, mailings and other intensive outreach to encourage immunization.

Since Aug. 1, Pennsylvania had administered 150,000 doses of MMR vaccine, including more than 50,000 in October. The state also had sent 300 health department staff to the area and administered nearly 6,000 vaccinations.

Pennsylvania had recorded five measles-associated deaths, including two infants and three adults with underlying health conditions. The Philadelphia Inquirer reported that all five involved people who were unvaccinated by choice or too young to receive the vaccine. Almost two-thirds of Pennsylvania’s cases were among adults, a distribution The Guardian described as the reverse of how measles is typically transmitted. CDC data recorded three deaths nationwide among 4,588 confirmed cases in 2026 and did not reflect Pennsylvania’s five deaths.

Photographs by Jessie Wardarski/AP showed doctors at the non-profit Union Community Care clinic in Lancaster, the MMR vaccine at the clinic and children from the Plain community playing on a trampoline in Intercourse, Pennsylvania. The Guardian said the attention placed on Amish residents had not always been welcome.

Kennedy and Shapiro dispute the outbreak’s cause and response

In November, Robert F. Kennedy Jr., the health secretary and head of the vaccine-skeptic Maha movement, said the “people of Pennsylvania suffered” because Shapiro’s administration had politicized the state’s measles outbreak. Kennedy also said a “global measles outbreak” had been caused by a decline in the number of people receiving the measles vaccine during Covid. He noted that Pennsylvania had 27% of U.S. cases but had only begun applying for CDC emergency assistance in September.

Shapiro claimed the CDC would not correctly acknowledge the measles-related deaths “because it doesn’t fit their phony narrative. I think RFK is doing great destruction in this country by stoking this vaccine skepticism.”

Vaccination politics reaches Smucker and Mannion

Vaccination politics had also reached Pennsylvania’s 11th congressional district, where five-term Republican representative Lloyd Smucker was being challenged by Democrat Nancy Mannion. At a town-hall-style debate the prior week, Smucker, who was raised Amish until he was five years old, said Amish residents were making decisions they thought best for their families.

Smucker said, “The role of government should be to do research and development on vaccines and be open and transparent about what that means. It was disappointing to me to see the governor using the measles to score political points.” He also said, “It turns out that the first two deaths really weren’t caused by measles at all.”

Mannion, a former emergency nurse and international healthcare leader, told The Guardian: “The Amish aren’t anti-vaccination, but they don’t access the healthcare system in the same way. It’s not just the Amish that are part of this outbreak because of the skepticism has brought to vaccines I would tie directly back to Robert Kennedy Jr.” She also said measles “is completely preventable and had been eradicated, but now we’re living in a surge.” She added: “I’d say there is a link between his anti-vaccine stance generally and what were seeing now.”

Community experience complicates blanket descriptions

Steven Nolt, a professor of history and Anabaptist studies at Elizabethtown College, said Amish decisions to accept or decline immunizations often followed family tradition rather than religious instruction. He said there was some evidence that vaccine-skeptical groups had been doing outreach to the Amish since 2015.

Accurate information was hard to obtain, Nolt said. “We don’t have good data but it’s clear they are under-vaccinated, but by how much we don’t know.” He said governments were not allowed to track the information because the Amish are a religious group, leaving their immunization rates no better known than those of Anglicans or Presbyterians.

The Guardian reported no broad Amish religious opposition to vaccines, but cited a study finding that less than a third of Amish residents had been immunized against measles, mumps and rubella.

The Lancaster settlement is a term used to describe the Amish population that settled there in 1760. The Guardian described the community as descended from German-speaking religious conservatives and said the modern world was largely kept at bay. At the New Holland auction house, Christ Stoltzfoos stood outside a barn of horses, miniature ponies and donkeys that were also up for auction.

“It wasn’t that way 50 years ago in our community,” Stoltzfoos said. He did not have a ready explanation for why vaccination had lapsed. He said all of his immediate family had been vaccinated and had not gotten sick, while some unvaccinated cousins had.

Stoltzfoos described people who changed their minds as those who became seriously ill: “I guess you don’t get to change anybody’s mind. The people that changed their mind are the people who got really sick from it. They say now they would have gotten vaccinated. But the people that didn’t really get sick, they still say: ‘Oh, it’s not really that bad.’” The Guardian said vaccines did not necessarily carry the same politicization in the Lancaster community as in the “English” world. “A lot of people now get the shots,” Stoltzfoos said.

Nearby, John Kaufman, 81, said the vaccine was hard on the immune system. “You get the measles and you get over it. People have it once, and it’s over. But if you hurt your immune system with the shots, something else will creep up on. The shot will take care of the measles, but it’ll stir something else up. Then what?” He pointed to reports that Covid shots had been linked to heart attacks and said they had also been linked to cancer. He added, “If you’re strong and healthy you might be able to work the Covid shot off. But if you had a weakness in yourself, it could take over.”

Anna, a young woman at the auction, said she had had measles. “It was miserable,” she said. “My whole family had it, except my dad. He got the vaccine. I wouldn’t get the vaccine now because if you had measles, you’re stronger for it. Why change that?”

The Guardian said thinking around the measles vaccine in the community was, in some ways, a reflection of thinking in the broader “English” world, where health authorities had battled outbreaks in South Carolina and Texas for much of the last year. Those outbreaks primarily affected children.

Upstate New York tests religious exemptions

Similar political forces were playing out in upstate New York, where the state health department was battling three small Amish schools over whether the children fell under immunization rules or should be granted an exemption on freedom of religious practice grounds.

New York Gov. Kathy Hochul had recently declared a statewide health emergency after more than 100 people contracted measles. Epidemiologists believed that outbreak was connected to the Pennsylvania outbreak and another in Ohio. The schools faced fines of $2,000 per unvaccinated student.

Tourism, farming and milk markets frame vaccine decisions

The Lancaster settlement depends in large part on tourism, with coachloads of visitors stopping to buy shoofly pie and other Amish delicacies. In that setting, The Guardian wrote, vaccination was “in part a business decision.”

At the New Holland auction house in Pennsylvania the prior week, a ton of top-quality hay bales was going for upwards of $400, up about 20% from the previous year. Prices for horses, donkeys and milk were also part of the conversation. A separate Jessie Wardarski/AP photograph showed a hay auction at The Green Dragon Farmers Market and Auction in Ephrata, Pennsylvania, on Oct. 9, 2026.

At the auction, the measles question was less pressing than land values, interest rates and the costs of diesel, hay and livestock. Horses used in the fields offered the Amish some protection from fuel prices, but diesel-powered generators, pickers and milking machines also exposed them to those costs. Farming shifted from crops and livestock toward milk and vegetables, while many residents moved away from agriculture into furniture-making and construction.

Dairy prices were way down, but Christ Stoltzfoos and his uncle Amos agreed that organic milk was a good business, with 100 pounds fetching $51. Christ said of the milk companies, “We’re at their mercy but I don’t feel that we’re wrongly used.” Raw milk sales, illegal to consumers in New York, had become an outside political issue.

Christ said, “I think it’s good they regulate raw milk or it will be like the measles soon.” Christ and Amos both said the Amish did not like dealing directly with the government. Christ added, “Most of us don’t even know what’s going on.” He continued, “I read the paper but that don’t tell me much.”

The reporting did not depict a uniform refusal. Stoltzfoos described vaccinated relatives and said many residents now received shots, Mannion said Amish residents were not anti-vaccination, and Nolt said decisions often followed family tradition rather than religious instruction. Nolt also said the scale of under-vaccination remained unknown. Those distinctions coexisted with continuing disputes over emergency assistance, political responsibility and the mismatch between Pennsylvania’s five reported deaths and the CDC’s national count.