Ohio’s idyllic Amish country, which includes several northeast Ohio counties, looks like a snapshot from the past.
Cars navigate around buggies traveling on the winding roads while large billboards lure tourists with homemade cheeses and expertly sewn quilts.
But many in this community are resistant to modern medical interventions and are also hesitant to get the COVID-19 vaccine, even as the pandemic has sickened and killed local residents.
Holmes County, where half of the population is Amish, has the lowest vaccination rate in the state, with just 10 percent of the population fully vaccinated.
The county was hit hard by the virus. Hospitals filled up during a fall surge, and the county recorded one of the highest mortality rates in the state, said health commissioner Michael Derr.
“We had to open up extra wings in our hospital to kind of cover that,” Derr said. “Our most fatal month was November and December, right after the holidays.”
Conspiracy theories, beliefs in herd immunity are pervasive
The Amish engage in communal living. Families eat, work and go to church together. It has been difficult to enforce mask-wearing and social distancing in these circumstances, Derr said.
And, because many residents did not get tested for the virus, health officials do not know the full extent of the spread, he said.
“We do have such a large population that were sick and didn’t report it, and that’s apparent in our death rate,” Derr said.
Despite grueling numbers, health officials are struggling to encourage residents to get vaccinated, he added.
It’s been especially difficult to reach the Amish community, Derr said.
“About less than a percent [of Amish] are coming in,” he said.
Holmes County resident Marcus Yoder, who was born Amish and is now Mennonite, said Amish who are getting the shots are doing so privately, through doctors’ offices and small rural clinics – and they are keeping it to themselves.
“There were Amish people getting the vaccination the same day I was… and we all kind of looked at each other and smiled underneath our masks and assumed that we wouldn't say that we saw them,” Yoder said.
Yoder is closely tied to the Amish community, and many of his friends and family still belong to the religion. Many Amish do not want to get vaccinated because they already had COVID-19 and believe the area has reached herd immunity, he said.
“I think one of the main driving forces is the misinformation about COVID itself — that it’s not more serious than the flu,” he said. “They're saying, ‘Well, it didn't affect me that much. Look at all these old people who survived.’”
Anti-vaccination conspiracy theories spread throughout the community, where there is already a lack of awareness about the more contagious variants driving the spikes across the country, he added.
“I think we’re going to see some more cases in our community, unfortunately, because of this,” Yoder said. “There simply is a lot of COVID news fatigue. They simply do not want to hear about it, and that’s really unfortunate.”
While some sort of herd immunity could explain why Holmes currently has a low incidence of new cases, Derr at the health department is concerned that those who previously had the virus may not be protected.
“As a region, we definitely surged over the winter, and we know that that happened about 90 days ago,” Derr said. “We're primed and ready for another surge because we're not vaccinating enough.”
Geauga County plans horse and buggy drive-thru clinic
In Geauga County, where the Amish make up 25 percent of the population, health officials are reaching out to Amish bishops to spread the word about the safety of the vaccines, said health commissioner Tom Quade.
“A lot of this is really going to need to be word-of-mouth, essentially, because there's going to need to be some probably some back and forth dialogue,” Quade said. “I think that it's going to be more effective if we have some of the Amish leaders pushing it… it's more meaningful coming from their own leadership.”
The Geauga health department plans to eventually open up a horse-and-buggy lane in its mass drive-thru vaccination clinics, but Quade does not think there is enough interest yet.
In Holmes County, Yoder thinks the best path forward is to encourage Amish residents who did get the vaccine to talk openly about their positive experience getting the shots.
“Historically, our community… we’ve been hesitant to embrace everything around us, but at some point, when we see the positiveness of it, the good it brings us, the strength it brings our values, we’re going to move that direction,” he said. “I think that that hammering people for not doing it will not get us anywhere.”
Derr is trying to get Holmes County business owners who employ Amish workers to encourage staff to get the shot. Health officials hope to eventually hold vaccine clinics at such businesses and take the shots to them, but not every business owner is on board with that yet, he said.
“People are going to listen to their friends and their family, people who they interact with more, and it's going to be that telephone effect,” he said. “The more and more people we tell about it and the better experiences they have, word will get around.”
Derr expects more Amish will get vaccinated in the fall, after the shots have been around for some time but worries that the community will see a deadly spike in cases long before then.
Not just a local concern
Health officials in Indiana and Pennsylvania are also ramping up outreach in heavily Amish areas. Local health departments in Lancaster County, Pa., home to the largest Amish population in the country, are connecting with Amish bishops.
But the widespread reluctance to the vaccine in Amish communities is not surprising to West Virginia University sociologist Rachel Stein, who studies the U.S. Amish population.
In general, the Amish are hesitant to get vaccines because many do not believe they are necessary, Stein said.
“We as non-Amish are more on board with preventative medicine,” she said. “They certainly don't have that mindset that we need to do things to stop this from happening. So like, people get the flu, and they get better, or not.”
While childhood vaccinations have increased in Ohio’s Amish communities in recent years, most adults are still hesitant, she added.
“There's oftentimes frequent breakouts of whooping cough in a settlement, and it’s just like… ‘This is happening now, we're in whooping cough season, and so it's time to deal with this sort of thing,'" she said.
In 2014, a measles outbreak spread rapidly through Ohio’s largely unvaccinated Amish communities and soon became the most prominent U.S. measles outbreak in recent history. But even after that scare, many Amish residents still chose not to vaccinate their children against other diseases.
The low vaccination interest in Holmes County also follows national trends showing residents of rural areas are less likely to consider getting vaccinated.
A recent poll from the Kaiser Family Foundation found three in 10 rural residents will “definitely not” get the COVID-19 vaccine unless it is mandated.
“The Amish aren't a whole lot different from the English when it comes to not wanting the vaccine,” Stein said. “There are certainly things about the Amish community that make them different and make them unique... but you also see some similarities across the Amish that you see in the English, like the conspiracy theories and the misinformation.”
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