Children played softball on a postcard-beautiful day. Business owners sold homemade doughnuts and fresh apple cider. And students studied on grassy lawns outside Westminster College.
The daily activities of life continued unabated in Pennsylvania, which is in the throes of a widespread measles outbreak that has killed four and hospitalized 150 since April.
The surge of cases has been met by a surge in vaccinations, with an 84 percent increase in August, state health officials say. But there has also been defiance and resignation, as the state becomes the latest to contend with the once-eradicated disease.
As the virus spreads through Pennsylvania, so have political and community tensions, stoked by a distrust of vaccines long proven safe and a disconnect between state and federal health agencies.
More than 3,400 measles cases have been reported this year across 45 states, with Pennsylvania at the top of the list. Measles has been reported in 38 of the state’s 67 counties.
Still, many remained undaunted about the spread of the highly contagious disease.
In Lancaster County, about 60 miles west of Philadelphia and the center of the outbreak, hundreds of people filled a farmers market on Friday. On the streets was a steady flow of horse-and-buggy carriages, a primary mode of transport for many of the area’s Amish and Mennonite communities.
“I’m not scared of measles,” said Mervin Zook, 37, an Amish dairy farmer in Gordonville, Pa., who was selling his wares at the market. He said his brother and several nieces and nephews had gotten measles but had all recovered. “My family is not vaccinated because I don’t feel that there is an advantage.”
Neither the Amish nor Mennonite groups have a universal rule prohibiting vaccines, but their adoption has not been widespread.
According to one survey from 2022, 30 percent of Amish families in Lancaster County had their children vaccinated and believed vaccinations were safe and effective. Pennsylvania has the largest number of Amish in the country, according to the Young Center at Elizabethtown College.
“People are overloaded with all of the vaccinations coming at once,” said John Riehl, 65, an Amish business owner who said he was vaccinated but added that outsiders do not understand the community’s lifestyle. “They feel like they can’t trust medicine anymore.”
More outbreaks as vaccine rates decline
Declining vaccination rates across the country since the Covid-19 pandemic have helped fuel dozens of outbreaks of measles, a respiratory illness that can cause serious health complications including pneumonia and brain swelling. Vaccination coverage among U.S. kindergartners declined to about 92.4 percent in the 2025-2026 school year, below the 95 percent needed to obtain herd immunity.
The United States has recorded more measles cases in 2026 than in any other year since the virus was declared eliminated in 2000, toppling last year’s record, when measles infected more than 2,200 Americans and killed three people.
A large outbreak in South Carolina took root in a close-knit evangelical Slavic community earlier this year, and outbreaks are ongoing in several other states.
The largest and deadliest outbreak is now in Pennsylvania, where measles had sickened 767 people as of Friday, including 93 over the past week.
Those case numbers, reported by the Pennsylvania Department of Health, are most likely an undercount, since many people with mild symptoms do not get tested, and some areas with high case counts are home to large Mennonite and Amish communities that tend to avoid modern medicine.
“What worries me about the outbreak is just how widespread it is,” said Dr. Holmes Morton, who has worked with the Amish and Mennonite communities of Pennsylvania for decades. He warns people that if they call him seeking help for a child suffering the effects of measles, he will be blunt: “All I can say is, ‘Too late. I will call the emergency room and tell then you’re coming,’” he said.
A political disconnect
The outbreak has become political, with Health Secretary Robert F. Kennedy Jr. disputing whether measles directly caused the deaths reported by state health officials. The Centers for Disease Control and Prevention did not include those deaths in the national tally, a departure from the typical practice of accepting data reported by states.
Dr. Debra Bogen, Pennsylvania’s health secretary, said in a letter to the director of the C.D.C. last week that the agency’s choice not to publicly recognize the deaths “undermines our response.” She said the state would accept emergency aid from the C.D.C. only if the agency recognized the four deaths — two infants in Lancaster County, a 40-year-old in Jefferson County and an 18-year-old in Mifflin County, all of whom were unvaccinated.
“Instead of leading with facts and reality, R.F.K. Jr. has sowed distrust in science, stoked anti-vaccine sentiment by baselessly questioning their effectiveness and misled the American people with his phony narrative,” a statement from the state’s health department read. “Pennsylvanians have died because of it.”
On X, Mr. Kennedy accused the governor of Pennsylvania, Josh Shapiro, of “fabricating” the measles deaths. He later seemed to attribute the state’s measles outbreak partly to the governor for “refusing to cooperate with the C.D.C.”
In a statement, the C.D.C. said it was working with the Council of State and Territorial Epidemiologists to establish a standardized definition for measles deaths “to ensure consistent reporting across jurisdictions.” The C.D.C. also said it had supported the state with outbreak epidemiology, vaccination and contact tracing.
Bill Wolfe, 73, from Douglassville, Pa., said that the Covid pandemic had politicized the debate about vaccinations in an already divided country.
“I thought everybody had the common sense to get their child vaccinated, but now there is too much negative stuff on the internet about it being unsafe,” Mr. Wolfe said. “For anybody who isn’t vaccinated yet, I say rethink yourself before your child is lying in the hospital or in the morgue.”
Cases reported across the country
Warnings of possible exposures to measles are surfacing well beyond Pennsylvania.
California health officials said on Friday that an unvaccinated passenger who traveled on trains and buses through at least six counties was hospitalized with measles, potentially exposing hundreds of commuters to the virus. In Colorado, health officials said an unvaccinated out-of-state visitor who tested positive for measles could have also exposed people.
The Indiana Department of Health reported six confirmed cases in Wayne County, Ind., which houses an Amish “daughter settlement” with close ties to Lancaster County, where 324 cases were recorded.
Philadelphia health officials warned that people may have been exposed to measles at a children’s hospital last week; health officials said they were working to protect infants in the hospital from the virus.
Measles is particularly worrisome for babies and young children, who are more likely to be unvaccinated and suffer from complications. The first dose of the measles, mumps and rubella vaccine is typically given at 12 to 15 months and the second dose at 4 to 6 years. But Pennsylvania health officials are encouraging children as young as six months in counties affected by the outbreak to get vaccinated.
State health officials said they had seen a surge in interest in the vaccine since the outbreak started in late April. Typically, state health care providers administer about 25,000 doses of the M.M.R. vaccine in a month; in August, more than 46,000 vaccines were administered.
Worry over vaccines
But some remain steadfast in their position to avoid vaccines.
Jason Yoder, 33, an Amish man in Lawrence County, about 50 miles northwest of Pittsburgh, incorrectly claimed there had been more deaths from the measles vaccine than from measles.
“I won’t get the vaccine, no way,” he said. “The vaccine is worse than the measles. I’d rather get the measles.”
The M.M.R. vaccine is widely considered safe and effective, and there are no documented cases of it causing death in healthy individuals.
Tammy Martz, a reflexologist with a busy practice in the heart of the Amish community in Hazen, Pa., said the Covid-19 pandemic had cast a shadow over this rural slice of Pennsylvania. Some people said they suffered harm after getting Covid shots and were therefore wary of other vaccines.
Others wondered if the vaccine was necessary, having seen neighbors recover from measles.
“The Amish tell me that they’re down for three days with it and then they get on with their lives and it’s just like the flu,” said Ms. Martz, who is not Amish.
George Retherford, 64, who was selling fruits and vegetables at the farmers market, said that although he was vaccinated as a child, he had not vaccinated his daughter. He doubted the vaccines were effective and said eating healthy would ward off illness.
“You want my advice about measles?” he said. “Eat more beets. Eat more peppers. Eat more watermelon. Nothing is going to kill me.”
Campbell Robertson and Teddy Rosenbluth contributed reporting.
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