Measles-stricken Amish hit hard amid US vaccine misinformation fight

In a rural corner of the US state of Pennsylvania, crop fields, maple trees and colonial-era barn farmhouses dot a patchwork landscape of rolling grassy hills.

At the foot of the Appalachian Mountains, Lancaster County is less than 300 kilometres from New York City and home to the country's oldest and largest Amish community.

But it has also become the focus of a heated political row amid a scramble to contain one of the US's worst measles outbreaks in recent history.

The most vulnerable infiltrated

Measles is a highly contagious illness that can lead to the hospitalisation or death of a person, with up to nine out of 10 people who are not vaccinated likely to fall sick, the Australian Centre for Disease Control says.

Authorities in Pennsylvania say the outbreak there began in late April, west of one of the state's largest cities, Philadelphia.

Cases have since ballooned above 1,300 in what has become Pennsylvania's largest spread of the disease in more than three decades.

At least six people have died, including two infants — one of which was a newborn — and a 20-year-old from Lancaster County, an 18-year-old resident of Mifflin County, a 40-year-old woman from Jefferson County and a 39-year-old female from Franklin County.

The Pennsylvania Health Department said none of the victims was vaccinated, and Franklin County officials reported the 39-year-old had a previous measles diagnosis and "several underlying conditions".

Authorities say the disease has mostly impacted people aged between 18 and 49, who account for about 800 of the state's cases, and at least 251 people — or about one in every five — have been hospitalised.

Low vaccination rates, mostly in vulnerable Amish communities, remain the biggest challenge according to officials. 

At least five who died were from Amish communities, local media reported.

The Amish are insular, religious people who associate piety with surrendering to strict rules for the greater good of their community, and reject modern-day technologies.

They came to the US from Europe in the 1700s, and more than 410,000 still live across the country, including at least 40,000 in Lancaster County.

Braxton Mitchell, co-director of the University of Maryland's Amish research program, says their communal way of life creates a unique risk of rapid virus spread.

"Amish are very social. The Amish families have a lot of kids — the average [has] seven or eight, so a lot of people in the household," he said.

"The Amish get together with their neighbours, with their relatives; they have church services on Sundays which tend to be at somebody's house and the whole church district shows up."

He said they were sceptical of government intervention and do not see the need to engage with modern medicine.

"They don't like governments telling them what to do … Amish don't subscribe to the national health insurance," Professor Mitchell said.

"With some diseases, the Amish [believe] 'if we get sick, if God's will is that we're meant to survive, we'll survive'."

Steve Nolt, a professor at Elizabethtown College, has lived in Lancaster County for most of his life and said he loves the area's reputation for diversity, manufacturing, picturesque nature and pleasantness of local life.

"There's a strong sense of Lancaster heritage and Lancaster identity … [The county] is special, especially in the minds of people with deep roots here," he said.

But he said while the majority of the non-Amish population live with them harmoniously, there is still concern about the spread of measles.

That worry has extended to non-Amish residents warily monitoring transmission alerts naming schools, stores or other popular locations where the virus has spread outside of Amish areas, Mr Nolt said.

Fears of deadly under-reporting

In the neighbouring Chester County, 93 cases have been reported this year, but there is concern around unreported infections.

Jeanne Franklin, the county's public health director, said officials were aware of people who fell ill and did not feel the need to access medical care or alert authorities.

She said by the time some patients present to hospitals or other medical clinics, they were significantly ill.

"What we're seeing is the worst of the worst," she told the ABC.

"It is definitely bigger than we are able to report because it is moving very quickly … Statistically speaking, we're likely going to see more deaths."

Ms Franklin described the Amish as "vaccine hesitant", but does not treat them as unique from the non-Amish who choose not to be vaccinated according to political or religious beliefs.

"What we want to remind people is, regardless of whether you're Amish or an anti-vaxxer … reassess the decision in the light of today," she said.

"Thirty years ago you may have said: 'Why do I need that? Measles isn't an issue.' Well, guess what, it's an issue."

She said Chester County adopted a word-of-mouth approach to promoting vaccination and dispelling common myths about measles.

"We have a whole team … painting the picture [of the disease's spread]. Where is it? Is it in our adults? Is it in our youth?" she said.

"We're a health department; we can't be everywhere, but we know the church on Main Street, the food pantry on South Street, and the hardware store are trusted business owners and community members.

"We are going out to meet them, educate them, so if they get questions, they know how to direct to us … Some of them are like, 'give me 100 [flyers], I'm going to put it in everyone's grocery bag.'"

White House clash clouds vaccine efforts

With more than 4,500 reported cases, the US is enduring its worst year for measles since 1991, the Centers for Disease Control (CDC) said.

Rural Pennsylvania is not the only area under strain — large outbreaks have been reported in Texas, Utah, South Carolina, Wisconsin and Florida.

In New York, Governor Kathy Hochul this month declared a disaster emergency because of rising cases in neighbouring states.

The US eliminated the domestic spread of measles in 2000 by maintaining high vaccination rates.

But the CDC said rates have fallen recently to below the 95 per cent coverage needed to prevent outbreaks.

Following Pennsylvania's first two deaths, a political clash erupted between the state's vaccine-promoting Democratic Governor Josh Shapiro and the Trump Administration's Health Secretary Robert F Kennedy Jr — known for raising alarms about vaccines.

Mr Kennedy suggested Mr Shapiro's office may have "altogether fabricated" the deaths and accused the governor of "fearmongering, misinformation, finger-pointing, and the weaponisation of infectious disease fears for political gain."

For weeks, the CDC did not record the measles-related deaths on its public disease-tracking dashboard, saying it was seeking more information to prove their validity.

Mr Shapiro condemned Mr Kennedy for those comments, and other claims he made that the US's MMR vaccine — which protects people against measles, mumps and rubella — included traces of fetal tissue.

"Unfortunately at a time where I needed the top 'health expert' in the nation to responsibly work with us to deal with this outbreak, he instead chose to go down a rabbit hole of conspiracy theories and false claims," Mr Shapiro said in a post on X.

"The correlation is clear: Secretary Kennedy has stoked confusion amongst parents and others — and the result has been less protection from measles and more cases."

The Pennsylvania Health Department said at least 6,500 MMR vaccines have been administered at 226 pop-up clinics in affected communities since April.

Paul Griffin, the director of infectious diseases at Mater Health Services, said that while the vaccine was "incredibly effective", Mr Kennedy's comments undermine public health efforts.

"We need the advice to come from people that have a very good understanding of what [measles] is and what we need to do to address it," he said.

Ms Franklin said she had seen no evidence of Mr Kennedy's comments impacting how frontline CDC health staff, who were aware of the urgency of addressing the outbreak, operate.

"They are still core passionate public health professionals … They're not misleading; they're being told what they can and cannot publish [and] how they define things," she said.

She says the outbreak is now a race against time.

"It's either how many people can get vaccinated and protected, or how many people are going to get the disease," she said.

"Pennsylvania is too far into this, by the numbers only, to outrace it. Now it's, how do we stay the course with as many people as we can in the hopes of minimising the impact and deaths?"