The floats were ready, public officials gathered, and the parade had begun—a lively procession of colorful vehicles moving slowly through the heart of town.
Fire trucks rolled past grandmothers lounging in lawn chairs and excited kids squealing as they scrambled for candy tossed from the floats.
It was Goose Day in Mifflin County, a celebration of an animal believed to signify good luck and prosperity for the upcoming year, and geese were everywhere: ceramic geese at intersections, inflatable ones on parade floats, and even bowls of goose meat soup at the Square Cafe selling for $6.29 a cup.
However, the festive atmosphere masked a dire situation.
Mifflin County, a rural area housing around 46,000 residents nestled in the rolling hills of central Pennsylvania, recently earned the unsettling distinction of having the highest infection rate of measles in the state amid a severe outbreak.
As the measles spread rapidly across the nation—once eliminated in the U.S. thanks to the MMR vaccine—public health officials grew increasingly alarmed, issuing warnings and media outlets reported on the rising numbers of cases and fatalities.
Just under a mile and a half from the parade assembly point is Geisinger Lewistown Hospital, where an 18-year-old Amish girl had been treated for measles before dying from a rare complication of the illness last month. She was the fourth reported measles-related death in the state; soon after, two additional deaths were reported in Lancaster and Franklin Counties.
Despite the serious circumstances, when visiting Mifflin County earlier this month and speaking with both Amish and non-Amish residents, there appeared to be little concern. There was no evident panic, nor were there state held press conferences like those conducted in Lancaster County to promote vaccination.
At the center of the outbreak, many in the community reacted with apparent indifference.
This included non-Amish locals who seemed to perceive the outbreak as not their issue.
Elected officials hesitated to address the public health crisis publicly.
Moreover, members of the Amish community, heavily affected due to lower vaccination rates, have expressed that they view the virus as just a part of life.
While cases continue to climb, many seem unconcerned.
“My dad would say, ‘Worry is from the devil,’” shared Mose Yoder, a local Amish resident.
“We still have to do our part.”
A community on the brink
Approximately 5,500 Amish individuals reside in Mifflin County, a community historically skeptical of various modern advancements, including healthcare and vaccinations. The Amish communities here are more conservative than those in nearby Lancaster County, known for its higher number of measles cases.
This region maintains a predominantly Republican demographic, which tends to harbor greater vaccine skepticism. The measles vaccination rates for seventh graders—which encompass both Amish and non-Amish students—hover around 77%, ranking among the lowest in Pennsylvania, compared to Philadelphia County’s 97%.
It remains uncertain how extensive the outbreak is beyond the Amish population.
However, it is evident that the infection has spread significantly among the local Amish.
Efforts to increase vaccination rates are complicated by the Amish communities’ views on technology and interactions with outsiders, noted Steven Nolt, a historian and director at the Young Center for Anabaptist and Pietist Studies.
“You can’t just impose ‘it’s the law,’” said Helge Hartung, a physician at Central Pennsylvania Clinic, which serves many Amish patients. “That approach doesn’t resonate.”
Since July, Mifflin County has confirmed 193 measles cases, with 76 new cases reported within the last two weeks—suggesting a significant underreporting of actual numbers.
Still, during a visit to Mifflin County earlier this month, life appeared to carry on as normal.
At the Sharp Shopper grocery store in Belleville, horse-drawn buggies parked alongside modern SUVs.
At the Wednesday livestock auction and farmers market, attended by many, Amish men in straw hats mingled with patrons in pickup trucks and humorous T-shirts (“My wife says I only have two faults: Don’t listen and something else.”).
Conversations in the shops and restaurants of downtown Lewistown revolved around mundane topics like the weather and local sports—nothing regarding the swiftly spreading virus.
“I haven’t heard a single customer bring it up,” commented Deb Guard, owner of the Lemon & Lime craft shop in Lewistown. “Not a soul.”
“Not a soul.”
Public discussions on local vaccine safety and efficacy seem rarely to surface, according to residents.
At radio station WMRF-FM 95.7, morning host Rocco Pallotto often engages his listeners on light-hearted subjects. “You ask them to choose between apple, pumpkin spice, or caramel, and oh boy!” he said.
But when he recently sought feedback on the local measles outbreak, he received no responses.
“There’s just nothing to draw from,” he shared.
When asked about rising cases, Amanda Haines, a home health aide and mother of two vaccinated boys, shrugged her shoulders as she sipped her coffee outside the East End Coffee Co.
For her, the more pressing concern was, “I’m more worried about my kid [catching] lice.”
Amish community displays little concern
In Belleville, where many of Mifflin County’s Amish inhabitants reside, the effects of the measles outbreak have been palpable.
Bennie Peachey has seen the situation unfold in his own family, with two of his five children—aged 9 and 7—bedridden and covered in rashes.
He himself has so far avoided it. “Unless I have it now,” remarked Peachey, a 33-year-old man, while attending to a tractor outside his barn. If he does, it’s “not too bad.”
His Amish community has banded together in support.
They are aware of which neighboring families are struggling with the infection and often exchange home remedies—like blackberry juice and yarrow tea to help with symptoms. Some avoid bathing while sick out of a belief that it would draw the virus deeper into the body.
“We want to take care of each other,” said one Amish woman, choosing to remain anonymous. “But we feel God is in control.”
There has been a notable scarcity of information, both within the Amish community and externally, regarding the outbreak.
One local Amish publication, Die Botschaft, decided against publishing any case numbers or addressing the outbreak, including potential vaccine recommendations.
“We don’t delve into those matters,” stated David Lapp, the owner and editor of the Millersburg-based paper. “It’s not our focus.”
A spokesperson for the Pennsylvania Department of Health mentioned that their strategy to reduce the spread in Mifflin County includes distributing educational materials and information about vaccination clinics. They are collaborating with local healthcare providers to foster trust and outreach.
State Secretary of Health Debra Bogen has visited Mifflin County to engage with local healthcare providers and ensure they are equipped with resources for vaccination efforts.
Local officials, however, have shown reluctance to discuss the subject, which often becomes politically charged.
“We believe we cannot contribute significantly to your inquiry,” Robert Postal, one of three county commissioners, wrote in an email.
In the meantime, some Mifflin County residents have filled the information void with rumors, particularly following the tragic death of the 18-year-old.
The county coroner, a Republican, issued a statement on Facebook attributing the young woman’s death to acute disseminated encephalomyelitis, a rare complication of measles.
However, false speculation began to swirl, suggesting the girl had underlying health issues that exacerbated her situation, even though her father later described her as “perfectly healthy” in an interview.
“I heard she had West Nile and Lyme disease,” shared Randy Wilsoncroft, a local vendor at the market.
‘I see a lot of fear’
During her medical training, Katie Mascia regarded measles as a relic of the past.
“It felt almost like a historical lecture—like, ‘This is how measles used to be in grandparent times,’” remarked Mascia, now the director of clinical services at the Central Pennsylvania Clinic. “I never expected to encounter a measles case after medical school.”
However, since summer when the first patients appeared with coughs and fevers, she, along with other healthcare workers, find themselves facing an outbreak affecting over 1,200 people statewide.
“I never expected to encounter a measles case after medical school.”
While most people recover from measles, about one in five reported infections in Pennsylvania has led to hospitalization. In severe cases, patients struggle to breathe or might need to be airlifted from Lewistown to larger medical facilities. There have also been instances where infected mothers transmitted the virus to newborns, with two infants in Lancaster County tragically losing their lives.
In the sterile environment of clinics and hospitals, the atmosphere shifts rapidly from stoicism to panic.
“I see fear,” noted Alexander Haines, an inpatient nursing manager at Geisinger Lewistown Hospital, which has handled 72 measles cases thus far. “A lot of fear.”
At the Central Pennsylvania Clinic, clinics have strived to counter the hesitance toward a vaccine that has proven to be 97% effective in preventing the disease.
Amish individuals have expressed various views, sometimes differing even within a single household. Some believe the decision not to vaccinate is religious, while others worry that potential side effects of the vaccine could outweigh the risks of infection. There are also those who may have only received one dose of the MMR vaccine, despite the recommendation for two doses for optimal protection.
“It’s a personal choice,” remarked Aaron B. Kanagy, a father of eight in Belleville who had measles as a child, thus now possessing immunity.
Interestingly, it seems that resistance to vaccination may be diminishing.
In August and September alone, nearly 800 MMR vaccinations were administered in Mifflin County, a notable increase from the typical monthly rate of 50 to 75.
Last month, the Central Pennsylvania Clinic organized a local vaccination clinic. Initially, only 15 people registered; however, just a few days after the death of the 18-year-old on September 11, 73 individuals showed up for vaccinations.
Nonetheless, a significant portion of the Amish community—and many local residents—likely remain vulnerable to this airborne disease that infects nine out of ten unvaccinated individuals exposed to it.
As Mascia reflected on the heartbreak of the ongoing spread, she expressed concerns about the upcoming cold-and-flu season and the additional strain it might place on local healthcare resources.
At that moment, the clinic’s executive director walked in, noting, “A van with a big 6 on it just pulled in.”
Mascia turned to see an out-of-town television news truck arriving.
“We’re quite trendy nowadays,” she remarked.
On a plot of land in Belleville, the Kanagy family has a designated dark room for their sick.
When 12-year-old Lizzie first caught the virus last month, her family worked hard to keep her isolated while preparing for a potential outbreak within the household.
By early October, Lizzie’s twin siblings—Lomie and Lena, both 8—started feeling unwell but managed to keep moving. During Lizzie’s illness, her younger brother Aaron Jr. spent time at her side, offering her drinks and sharing stories.
“I’m kind of expecting it,” admitted Katie Kanagy, Lizzie’s mother.
The Kanagy family remembers the significant measles outbreak of the late 1980s, which affected their community and caused temporary closures of at least three Amish schools across neighboring counties.
They managed to navigate that incident well, they assert.
If they must face the infection again, Aaron Kanagy expressed a desire for it to happen sooner rather than later.
“Then,” he concluded, “it would be over.”
