Amish and Mennonite shoppers in traditional dress browsed alongside members of the wider public at a large outdoor market in Ephrata, Pennsylvania, on a recent Friday. Vendors sold pumpkins, mums, fry pies, squash, sports jerseys and Barbie accessories. Scenes like this are routine in Lancaster County, which has the largest Amish population in the country and is now the epicenter of the nation's worst measles outbreak in 35 years.
Although the Amish avoid many forms of civic participation for religious reasons, they are not truly separate from their neighbors. "We are all interconnected," said Dr. Diego Hijano of St. Jude Children's Research Hospital. Vaccination rates among the general public are now slipping, and rates have long been low among the Amish, creating conditions in which the virus, declared eliminated from the U.S. in 2000, can spread.
Pennsylvania has recorded more than 1,350 measles cases this year, more than a third of them in Lancaster County, according to state figures. Community leaders say that is a significant undercount because many people with measles never see a doctor. The state has reported three measles-associated deaths in Lancaster County and two in other counties. Case numbers have fallen since a September peak, though some doctors expect an increase as winter pushes people indoors.
The outbreak has hit the Plain communities of Amish and conservative Mennonites especially hard. Vaccination rates and attitudes vary widely, but overall these groups are less likely to be vaccinated than the general population, a pattern tied more to culture and habit than to religious doctrine. Steve Nolt of the Young Center for Anabaptist and Pietist Studies at Elizabethtown College said nothing in Amish theology or historic documents specifically opposes immunization. About 45,000 Amish and 6,000 Old Order Mennonites live in and around the county.
Reactions to the outbreak differ. Amish farmer Ephraim Zook still opposes vaccines even after he and his wife nursed their young twins through measles, saying they viewed it as "a natural thing." Another Plain farmer chose to be vaccinated after his adult siblings fell ill, worried that an infection would derail his harvest. A Mennonite market vendor said his largely vaccinated community has had no infections. Allen Hoover, an Old Order Mennonite and former administrator of the Parochial Medical Center in New Holland, said many people simply reasoned that they never vaccinated before and came through fine. He said gentle encouragement works better than pressure, and that outside professionals need about 20 years to build trust.
The nonprofit Union Community Care has held small vaccine clinics aimed at Plain residents, resulting in about 450 measles shots. Chief medical officer Dr. Anne-Marie Derrico said Plain patients travel to the city, and unvaccinated city residents attend schools and programs with other children, so the outbreak cannot be contained to one community. The clinics also offer early vaccination for infants, as experts advise during outbreaks. Dr. D. Holmes Morton, founder of the Central Pennsylvania Clinic, said vaccine days are meeting with more success now.
The risk extends well beyond Lancaster County. The CDC reports that 92.4% of U.S. kindergarteners received required MMR shots in 2025-26, down from 95.2% in 2019-20. Pennsylvania's kindergarten rate fell to 93.2% last year, while Lancaster County's is 88%, lower in religious and other private schools than in public ones. An outbreak is considered unlikely when a community reaches 95%. Berwood Yost of Franklin & Marshall College noted that kindergarten vaccination rates have fallen in every central Pennsylvania county since 2020 and urged the public not to blame the Amish or any group.
Anti-vaccine messaging has also played a role. Nolt said some groups targeted the Amish, and in 2021 Robert F. Kennedy Jr., now the U.S. health secretary, spoke at a Lancaster County fair alleging the government was trying to force the Amish to vaccinate. County Commissioner Alice Yoder said officials should unite behind the message that the vaccine is safe and effective, an approach she said worked during the state's last measles outbreak in 1991. Hijano called vaccination "an act of love to your community," because it protects the people around you as well as yourself.
