Measles spreads incredibly fast. For the last few months, so has Dale Weiser's phone number.
Weiser is the clinical services supervisor for the Chester County Health Department in south-central Pennsylvania. Since August, she's been driving out to Amish homes to vaccinate people against measles. She says it usually starts with a phone call.
"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?'" she says of a typical request she gets from Amish families. So far, she's administered more than 400 doses of the measles, mumps and rubella vaccine in Amish homes.
The house calls are part of the state of Pennsylvania's strategy to wage war on measles by flipping the script on traditional public health messaging. Instead of advertising vaccinations loudly, health officials have launched a quiet word-of-mouth campaign designed to win the trust of the state's Amish community, which has been particularly hard hit by the country's worst measles outbreak in 35 years. The state has confirmed six measles-related deaths and more than 1,500 cases so far — though the true count is likely much higher, since many people who get sick don't seek medical care.
Lower vaccination rates
Surveys suggest only about a third of Amish families in the region vaccinate their children. That's left the Amish community especially vulnerable to measles, one of the most contagious diseases.
There's no religious edict against vaccination among the Amish. It's very much seen as a family and individual choice, says Weiser. Often, she says, these decisions are 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," Weiser says.
But as measles cases have piled up in Pennsylvania, Weiser says many Amish families have changed their minds about getting the MMR vaccine. And when they do, she hops in her car and brings the shots to them.
"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 says.
A patient, personalized approach to outreach
Some days, Weiser will vaccinate a single family in their kitchen. Other times, she'll find dozens of people gathered to get the shot. She's also fielded a lot of questions. Some, like what's in the vaccine and potential side effects, are things anyone would ask, she says.
"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 recalls.
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As with the general population, vaccine misinformation has made its way to the Amish community. And when she encounters it, Weiser takes the time to explain why the rumors are false.
Chester County Public Health Director Jeanne Franklin says this kind of patient, personalized approach has helped build trust among the local Amish – who, along with conservative Mennonites, are known 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 says.
Instead of relying on traditional top-down, rigid public health messaging, her staff has 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. "One of them said, 'Come on back with a clinic' at his restaurant. And he helped spread the word," Franklin says.
Vaccine questions and misinformation
When I stopped by the restaurant, Honey Brook Barbecue in Honey Brook, Pa., an area with a sizable Amish community, I found the manager grilling chicken in an outdoor tent. Like many Amish people NPR talked to, he spoke on the condition of anonymity in keeping with his community's tradition of not drawing attention to oneself.
The manager says 24 people showed up to get vaccinated at his restaurant back in August, all drawn by word of mouth. He says he decided to host the clinic for two reasons: to protect the general public and to protect his own community. He said he didn't want people blaming the Amish for spreading measles.
But he says other people in the Amish community who don't regularly interact with the public aren't getting vaccinated. For some, it's because of cultural reasons, but he says others are concerned about what they've heard is in the MMR vaccine.
"In my community, a lot of it has to do with what people think is in it," the manager says of the MMR vaccine. One concern he's heard repeatedly is that the vaccine contains parts of aborted fetuses.
That is a myth often repeated by anti-vaccine forces, and it is one heard in conversations with Amish people in Lancaster County, home to around 45,000 Amish people. It's also the county with a third of the state's measles cases — more than 500 confirmed cases.
At the Amish-owned Gordonville Book Store, where a buggy is parked outside, I meet a shopper named Lydia Esh. She says she, her husband and six adult children had all previously been vaccinated against measles. But none of her 13 grandchildren have gotten the shot, because their parents had heard that the MMR vaccine had changed and now contained aborted fetus parts — which is false.
There is some evidence that anti-vaccine groups have been targeting the Amish in recent years, says Steve Nolt, a professor at Elizabethtown College who has written numerous books about Amish history and culture. For example, he points to an advertisement questioning the safety of childhood vaccines published in The Pennsylvania Busy Beaver, an advertising publication with a large Amish readership.
But in conversations around Lancaster, I also find evidence that public health outreach efforts are working. One member of the Plain community, a visibly pregnant woman outside an Amish-owned hardware store, says her husband and two children recently got vaccinated to protect her and her unborn child. She asked NPR not to use her name, as did an Amish man working at a produce stall in an Amish market. He says he recently got vaccinated because "measles is scary."
Linda Beth Fisher, an 18-year-old Amish woman behind the counter at the Gordonville Book Store, says she is concerned that several Amish people in her area have died in the measles outbreak, but she's not sure what to believe about the MMR vaccine.
"Personally, I'm kind of leery of it. I'm not sure why," Fisher says. "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?"
"They almost always come back"
These types of concerns often surface at pop-up vaccine clinics like one recently hosted at the Christiana Fire Company in Lancaster County. The Pennsylvania Department of Health hosts these events in Lancaster three or four times a week — all advertised by word of mouth, says Dr. Jennifer Wallace. As medical director for the department's Bureau of Community Health Systems, she oversees pop-up clinics and outreach to vulnerable communities across Pennsylvania.
Wallace says when members of the Plain community 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."
Wallace says many who end up coming are families with multiple children. Tables set up around the firehouse are strewn with crayons, coloring books and bubble wands to keep young ones entertained while parents fill out paperwork.
"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 says. "We've had some mothers cry afterwards because they're just so relieved."
The state health department says 30 people attended the Christiana firehouse clinic, 24 of whom got vaccinated. That included a father and his three sons who arrived for their second doses.
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