Pennsylvania uses home visits to boost measles vaccination among Amish families

Pennsylvania reports six deaths and more than 1,500 measles cases

Pennsylvania has confirmed six measles-related deaths and more than 1,500 measles cases so far, though NPR reported the true count is likely much higher because many people who get sick do not seek medical care. NPR described the state’s Amish community as particularly hard hit by “the country’s worst measles outbreak in 35 years,” and reported that measles spreads incredibly fast. Surveys cited by NPR suggest that only about a third of Amish families in the region vaccinate their children, leaving the community especially vulnerable to measles, which NPR described as one of the most contagious diseases.

NPR’s accompanying coverage included a Short Wave segment carrying the promotional headline “Vaccinated or not, we’re on the brink of a measles epidemic” and a Health segment carrying the promotional headline “As diseases loom, CDC’s response to measles deaths stirs fears about agency’s reliability.”

Dale Weiser, clinical services supervisor for the Chester County Health Department in south-central Pennsylvania, has driven to Amish homes since August to vaccinate people against measles, administering more than 400 doses of the measles, mumps and rubella vaccine there. The house calls are part of a Pennsylvania strategy that departs from traditional public-health messaging: rather than advertising vaccinations loudly, health officials have launched a quiet word-of-mouth campaign designed to win the trust of the state’s Amish community. Requests for home visits usually begin with a phone call, and Weiser’s number has circulated for the last few months.

Weiser described a typical request from an Amish family: “I was at a house, like, at 4:30 in the afternoon, and I had a phone call at 8 the next morning saying, ‘hey, I heard you were down the street. Can you come do that at my house?’”

On some days, Weiser has vaccinated a single family in their kitchen; at other times, she has found dozens of people gathered for shots. “When I arrive at their home, there’s usually a small child that will run from the back of the house to the barn to tell the men that there’s somebody strange in the driveway, or that the nurse is here,” she said.

Weiser has fielded many questions from families. Some, like what’s in the vaccine and potential side effects, are things anyone would ask, she said. She also fielded a question about tracking chips: “But I was caught off guard when I was asked if there were tracking chips in the vaccine, and I was like, whoa. Flashback to COVID. Where did you hear that?” she recalled. NPR reported that, as with the general population, vaccine misinformation has made its way into the Amish community, and Weiser said she takes the time to explain why the rumors are false.

Chester County Public Health Director Jeanne Franklin said this kind of patient, personalized approach helped build trust among the local Amish. NPR described the Amish, along with conservative Mennonites, as the Plain community because of “their simple way of life.” “That’s why we said it has to be boots on the ground in the communities. It’s not just because they were a Plain community, it was because we needed to be seen as caring people,” Franklin said.

Instead of relying on traditional top-down, rigid public-health messaging, Franklin’s staff spent a lot of time quietly visiting Amish church leaders and businesses, introducing themselves and asking community leaders if they would hand out flyers advertising vaccine clinics. Franklin said one of them told her, “Come on back with a clinic” at his restaurant, and that he helped spread the word.

The Pennsylvania Department of Health hosts pop-up clinics in Lancaster three or four times a week, all advertised by word of mouth, Dr. Jennifer Wallace said. As medical director for the department’s Bureau of Community Health Systems, Wallace oversees pop-up clinics and outreach to vulnerable communities across Pennsylvania. At one recently hosted at the Christiana Fire Company in Lancaster County, the state health department said 30 people attended and 24 were vaccinated, including a father and his three sons who arrived for their second doses. Wallace said many who come are families with multiple children, and tables set up around the firehouse were strewn with crayons, coloring books and bubble wands to keep young ones entertained while parents filled out paperwork.

There is no religious edict against vaccination among the Amish, Weiser said, and the decision is very much seen as a family and individual choice, often driven by practical and cultural factors. “They don’t have health insurance. They’re not interacting with the mainstream medical society. And measles wasn’t a problem for 30 years, so there was no real risk to not being vaccinated, at least for measles,” she said.

At Honey Brook Barbecue in Honey Brook, Pa., an area with a sizable Amish community, NPR found a manager grilling chicken in an outdoor tent. Like many Amish people NPR spoke with, he spoke on the condition of anonymity, in keeping with his community’s tradition of not drawing attention to itself. He said 24 people showed up to get vaccinated at his restaurant in August, all drawn by word of mouth. He said he decided to host the clinic for two reasons, to protect the general public and to protect his own community, and that he did not want people blaming the Amish for spreading measles.

The manager said other people in the Amish community who do not regularly interact with the public were not getting vaccinated, for some because of cultural reasons and for others because of concerns about what they had heard was in the MMR vaccine. “In my community, a lot of it has to do with what people think is in it,” the manager said.

One concern the manager has heard repeatedly is that the MMR vaccine contains parts of aborted fetuses. NPR reported that the claim “is a myth often repeated by anti-vaccine forces,” and that it is one heard in conversations with Amish people in Lancaster County, home to around 45,000 Amish people. Lancaster County also accounts for a third of the state’s measles cases — more than 500 confirmed cases, NPR reported.

At the Amish-owned Gordonville Book Store, where a buggy was parked outside, NPR met shopper Lydia Esh. She said she, her husband and six adult children had all previously been vaccinated against measles, but that none of her 13 grandchildren have gotten the shot because their parents had heard the MMR vaccine had changed and now contained aborted fetus parts — which is false.

There is some evidence that anti-vaccine groups have targeted the Amish in recent years, said Steve Nolt, a professor at Elizabethtown College who has written numerous books about Amish history and culture. Nolt pointed to an advertisement questioning the safety of childhood vaccines published in The Pennsylvania Busy Beaver, an advertising publication with a large Amish readership.

Concerns like these often surface at pop-up vaccine clinics such as the one recently hosted at the Christiana Fire Company in Lancaster County, where people arrive with questions of their own. As measles cases piled up in Pennsylvania, many Amish families changed their minds about getting the MMR vaccine, Weiser said, and when they do she hops in her car and brings the shots to them.

Wallace described how the department handles people who come with questions: “We’re here to give them that information and then let them ponder it. They can ask any questions they want to and then let them either get vaccinated if they choose or take that information home. Think about it. Talk with their bishops. Talk with their community. They almost always come back,” she said.

NPR also found evidence that the outreach efforts were working. In conversations around Lancaster, a visibly pregnant member of the Plain community, outside an Amish-owned hardware store, said her husband and two children had recently been vaccinated to protect her and their unborn child; she asked NPR not to use her name. An Amish man working at a produce stall in an Amish market, who also asked NPR not to use his name, said he had recently been vaccinated because “measles is scary.”

Linda Beth Fisher, an 18-year-old Amish woman behind the counter at the Gordonville Book Store, said she was concerned that several Amish people in her area had died in the measles outbreak, but that she was not sure what to believe about the MMR vaccine. “Personally, I’m kind of leery of it. I’m not sure why,” Fisher said. “I guess I’ve just kind of heard that they’re not good, but I’ve also heard that they are good. So I just feel like it’s two sides of the story. Would you encourage people to get it?”

Wallace described what she sees once a family decides: “And then you see the kids get vaccinated and you can almost see the mother’s shoulders relax over time as each child gets that shot,” she said. “We’ve had some mothers cry afterwards because they’re just so relieved.”