Measles outbreak prompts greater vaccine openness in Pennsylvania Amish country

A historic measles outbreak centered in Pennsylvania's Lancaster County is leading some Amish and conservative Mennonite residents to reconsider vaccines, even as skepticism persists among others. The county, which has the country's largest Amish population, is at the center of the nation's worst measles outbreak in 35 years.

Pennsylvania has reported more than 1,350 cases in 2026, the highest total of any state, with more than a third recorded in Lancaster County, according to state figures. Community leaders say the numbers substantially understate infections because many sick residents never seek medical care. The state has recorded three measles-associated deaths in Lancaster County and two elsewhere. Cases have fallen from their September peak, but some doctors anticipate an increase as winter draws people indoors.

The outbreak has particularly affected Amish and conservative Mennonite groups known as Plain communities. Their vaccination rates vary, but generally trail those of the broader population. Community leaders and researchers attribute that pattern more to custom than religious teaching. Steve Nolt, director of Elizabethtown College's Young Center for Anabaptist and Pietist Studies, said Amish theology and historical documents contain no specific opposition to immunization.

Despite religious limits on some forms of civic participation, Plain residents regularly share shops, markets and businesses with their neighbors. Lancaster County has about half a million residents, with suburban development bordering Amish farmland. Dr. Anne-Marie Derrico, chief medical officer at Union Community Care, said its patients include both Plain residents visiting the city and unvaccinated city residents attending schools and other programs alongside children.

Union Community Care has administered about 450 measles shots through small vaccination clinics serving Plain communities. Its clinics also offer infants vaccination earlier than the usual schedule, following expert advice for outbreak areas. Lauren and Mason Spence recently brought their 10-month-old son, Bowen, for his first measles, mumps and rubella vaccine dose. The family frequently visits public places, including farmers markets. "It's scary," Lauren Spence said.

Experiences with the disease have produced different responses. Amish farmer Ephraim Zook remained opposed to vaccination after he and his wife cared for their young twins through measles. Another Plain farmer sought a shot after adult siblings became infected, concerned that illness would prevent him from harvesting vegetables and tobacco. A Mennonite market vendor said his largely vaccinated community had experienced no infections.

Allen Hoover, an Old Order Mennonite and former administrator of the Parochial Medical Center in New Holland, said many families forgo vaccination because they have managed without it before, rather than from ideological opposition. He urged health workers to encourage vaccination without aggressive pressure and emphasized that building trust takes years. Community leaders and scholars said strict COVID-19 measures had contributed to a recent cooling of vaccine acceptance.

Declining vaccination extends beyond Plain communities. CDC figures show that 92.4% of U.S. kindergarteners received required MMR shots in the 2025-26 school year, compared with 95.2% in 2019-20. Pennsylvania's kindergarten MMR rate fell to 93.2% last year, while Lancaster County's rate stands at 88%. An outbreak is considered unlikely where MMR coverage reaches 95%. Measles can cause severe complications, including pneumonia and encephalitis.

Lancaster County Commissioner Alice Yoder called for public officials to consistently encourage vaccination and communicate its safety and effectiveness. She recalled strong participation among Plain residents during Pennsylvania's 1991 outbreak. Dr. D. Holmes Morton, founder of the Central Pennsylvania Clinic in Mifflin County, said vaccine days are again finding greater acceptance among the Plain patients his clinic serves.