Measles is spreading rapidly. In Pa., some health officials are fighting it quietly

It's Consider This where every day we go deep on one big news story. Today, the U.S. is in the midst of its worst measles outbreak in 35 years. There are nearly 5,200 known cases. That's more than twice as many as last year, according to the Centers for Disease Control and Prevention. Unfortunately, I have been seeing a lot of children and a lot of babies who have been admitted to our hospital and have been very sick. Dr. Evan Shirey is a pediatric infectious disease specialist at Penn State Health in Hershey, Pennsylvania. That state is the epicenter of the outbreak. He spoke to PBS NewsHour earlier this fall. There are a number of complications that can come about for measles. One that we really worry about is encephalitis, and that's when the virus causes infection of the brain. These cases are really, really tragic to see. We see infections where the virus infects the lungs. We've seen babies who have come in who are unable to nurse. They're unable to take bottles. And just all forms of various different kinds of suffering from the manifestations of these infections. The United States eliminated measles 26 years ago. But now the country is at risk of losing its measles elimination status. The virus is back because of a failure to vaccinate. We know the measles virus can spread like wildfire. It is famous for how infectious it is. One person with measles can infect up to 18 others. Consider this. Measles cases in the country. It just hit a 35-year high. In the heart of Pennsylvania's Amish country, health officials are taking a quiet approach to fighting the outbreak. From NPR, I'm Sasha Pfeiffer. It's Consider This from NPR. The U.S. is the only country in the world that has a measles infection. The U.S. is in the midst of its worst measles outbreak in decades. The majority of those affected are kids and teens, and almost all of them are unvaccinated. States have confirmed eight measles-related deaths this year, and six of those deaths are in Pennsylvania. We're going to turn now to a community in Pennsylvania that's been particularly hard-hit by this latest outbreak, the Amish. Health officials in two counties are trying to flip the script on traditional public health messaging. Instead of advertising vaccines. Instead of advertising vaccines loudly, they've launched a quiet word-of-mouth campaign designed to win the trust of the Amish people. NPR health correspondent Maria Godoy visited Pennsylvania to see how that's going and brings us this story. The Amish community is known for their simple style of dress and deliberate separation from modern society. But they often interact with the general public in Amish-run businesses like this indoor market in southeastern Pennsylvania. There are stands selling farm-fresh fruits. There are stands selling vegetables, donuts and pretzels made while you watch, handcrafted wooden furniture, and natural food and supplements. One Amish worker tells me her daughter recently recovered from measles. An Amish man says he's seen measles rip through his community, and it's scary. He recently got vaccinated. Like all but one Amish person I talk with for this audio story, they speak on the condition of anonymity because of their community's tradition, not to draw attention to oneself. The only exception is Linda Beth Fisher, a young Amish woman wearing a simple black dress with a white bonnet. She stands behind the counter at a bookstore in Lancaster County, where about 45,000 Amish people live. And is this your store or are you just working here? It's not. No, I'm just a worker. OK. Fisher agreed to let NPR record her voice for broadcast. She's 18, the eldest of eight siblings. Yeah, there's six brothers and one sister, and then me. So, yeah, we have children. She says, like many Amish families, they prefer to turn to natural home remedies when it comes to illness. Fisher says she is concerned that several Amish people in her area have died in the measles outbreak. But she's not sure what to make of the measles, mumps and rubella vaccine. I don't know. For me personally, like, I'm kind of leery of it, honestly. I'm not sure why. You're a little leery of it? But I guess I've just kind of heard, you know, that they're not good. But I've also heard that they are good. So I just feel like it's two sides. Would you encourage people to get their vaccines? Answering questions like this has become a big part of Dale Weiser's job these days. She's a nurse and clinical services supervisor with the public health department in Chester County, which borders Lancaster. And for the last few months, she's been vaccinating Amish people in their homes. There's no religious edict that says, you know, you shouldn't be vaccinated. It's very much a family's choice. Surveys suggest only about a third of Amish families in the region vaccinate their children. Weiser says these decisions are often 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. But as measles cases have piled up in Pennsylvania, more than 1,500 cases so far, more than a third of them in neighboring Lancaster County. 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 the hospital. 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. Some days, she'll vaccinate a single family in their kitchen. Other times, she'll find dozens of people gathered to get the shot. In the last few months, she's given more than 400 doses in Amish homes. She's also fielded a lot of questions. I'm never surprised. When I'm asked what's in the vaccine, are there any side effects? Is there anything I should be worried about? Weiser says these are questions anyone should be asking. 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's also been asked if the vaccine is made with aborted fetus parts. Just like 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. It's like, okay, you've heard that. I've heard that, too. Let me explain where that rumor comes from or why people might think that. Chester County Public Health Director Jean 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 plain's community. It was because we needed to be seen as caring people. 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. Some of it was, let's introduce ourselves. Are you okay if I leave these flyers here? Would you give every customer a flyer? Things like that. And, you know, one of them said, come on back with a clinic at his restaurant. Really? And he helped spread the word. So I stopped by the restaurant, Honeybrook Barbecue. I find the manager grilling chicken in an outdoor tent. I'm standing outside a tent at Honeybrook Barbecue, an Amish-owned and operated restaurant. I just spoke to the manager here who told me about a vaccine clinic they hosted quietly. About 24 people showed up. To get the MMR vaccine to protect themselves against measles. He says he decided to host the vaccine clinic for two reasons. One, to protect the general public and to protect his own community. He didn't want people to blame 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 cultural reasons. But he says others are concerned about things they've heard are in the vaccine. These types of concerns often come up at pop-up vaccine clinics. Like this one currently being set up at the Christiana Fire Company in Lancaster County. The vaccine will arrive in about 15 minutes because we like to keep it as cold as possible. That's Dr. Jennifer Wallace with the Pennsylvania Department of Health. She oversees pop-up clinics across the state. Oh, we are probably in Lancaster County three or four times a week. All advertised by word of mouth. She says. 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. We've had some mothers cry afterwards because they're just so relieved. I exit the clinic just before it opens at 4 p.m. So my presence won't deter anyone from coming inside. From my parked car, I see a visibly pregnant woman in Plain community clothes exit a minivan with three children and head inside. That was Maria Godoy. Reporting from Pennsylvania. This episode was produced by Alejandra Marquez-Hance and Karen Zamora with audio engineering by Taylor. I'm Sasha Pfeiffer.