Analysis: Pennsylvania's measles outbreak has reached 1,398 cases, by the state health department's count, and it has turned into a proxy fight between Health Secretary Robert F. Kennedy Jr. and Gov. Josh Shapiro. The most basic question, how many Amish residents are actually protected, still has no reliable answer.
Pennsylvania now holds 27% of the nation's cases. The pattern is unusual, too: almost two-thirds of the state's infections are in adults, the reverse of how the disease normally spreads.
Even the death toll is contested. The state has recorded five measles-associated deaths, two infants and three adults with underlying health conditions, while federal CDC data lists only three deaths nationwide among 4,588 confirmed cases this year. Shapiro accuses the CDC of refusing to acknowledge the Pennsylvania deaths because they clash with its narrative.
Kennedy, who leads the vaccine-skeptic MAHA movement, said this month that Pennsylvanians suffered because Shapiro's administration politicized the outbreak, and he blamed a global surge on vaccination rates that fell during Covid. The state did not begin applying for CDC emergency assistance until September.
The dispute has spilled into the race for Pennsylvania's 11th congressional district. Republican Rep. Lloyd Smucker, a five-term incumbent raised Amish until age five, accused the governor of using measles for political gain and claimed the first two deaths were not caused by the disease. His Democratic challenger, former emergency nurse Nancy Mannion, ties the broader rise in vaccine doubt directly to Kennedy.
What the data cannot show
In this reading, each side is arguing about blame while the core facts on the ground remain murky.
Steven Nolt, a history and Anabaptist studies professor at Elizabethtown College, says Amish families accept or refuse shots according to family tradition, not religious teaching; the faith carries no broad objection to vaccines. Because the Amish are a religious group, governments cannot track their immunization rates. One study found fewer than one in three had received the MMR shot.
We don’t have good data but it’s clear they are under-vaccinated, but by how much we don’t know.
Steven Nolt, professor of history and Anabaptist studies at Elizabethtown College
Nolt also points to evidence that vaccine-skeptical groups have been reaching out to the Amish since 2015, a detail that complicates any tidy story about isolation alone.
Where outreach meets doubt
Conversations at a Lancaster County livestock auction show how split the community is. Christ Stoltzfoos said his vaccinated family stayed healthy while unvaccinated cousins fell ill, and that minds changed mostly among those who got very sick. John Kaufman, 81, argued the shots weaken the immune system, and a young woman named Anna said having had measles made her see no reason to get vaccinated.
The people that changed their mind are the people who got really sick from it.
Christ Stoltzfoos, Lancaster County resident
The state has leaned on pop-up clinics and mailings, sending 300 health department staff to the area and giving nearly 6,000 vaccinations there. Since Aug. 1, 150,000 MMR doses have been administered, more than 50,000 of them in October.
The outbreak does not respect state lines. New York Gov. Kathy Hochul imposed a statewide health emergency once that state's measles count passed 100, an outbreak epidemiologists believe is tied to those in Pennsylvania and Ohio. Three Amish schools in upstate New York now face $2,000 fines for each unvaccinated student.
One practical lever may matter more than any national argument: the Lancaster settlement depends heavily on tourism, which makes vaccination partly a business decision for families who rarely deal with government directly.
