当...的时候健康宾夕法尼亚荷兰中心的关怀组织领导人开始制定分发新冠肺炎的策略疫苗他们知道这对阿米什人来说是一个艰难的推销，他们往往对预防性的射击和政府干预保持警惕。

早期，他们在农场供应商店和拍卖场张贴传单，那里的阿米什人出售手工家具和被子。他们向笃信宗教和保守的教派成员寻求建议，后者告诉他们不要咄咄逼人。他们要求三份被阿米什人广泛阅读的报纸刊登宣传疫苗的广告。两个拒绝了。

到5月份，两个农村疫苗接种诊所已经在消防站和社会服务中心开业，这两个地方对兰开斯特县的阿米什人来说都很熟悉。在前六周，有400人出现。只有12个是阿米什人。

在过去一年里，一波病毒爆发席卷了美国许多阿米什社区的教堂和家庭，疫苗接种运动远远落后于这些社区。俄亥俄州的霍姆斯县是全国最大的阿米什人聚集地，该县总人口中只有14%的人接种了全面疫苗。

虽然他们的宗教信仰不禁止他们接种疫苗，但阿米什人通常不太可能接种麻疹和百日咳等可预防疾病的疫苗。虽然疫苗的接受程度因教会地区而异，但阿米什人通常依赖家庭传统和教会领袖的建议，他们基督教信仰的核心部分是在生病或死亡时接受上帝的旨意。

许多人认为他们现在不需要新冠肺炎疫苗，因为他们已经生病了，并且相信他们的社区已经达到群体免疫卫生保健俄亥俄州、宾夕法尼亚州和印第安纳州的供应商是美国约345，000名阿米什人的近三分之二的家园

“这是我们听到的第一个原因，”由医院和诊所组成的宾夕法尼亚医学兰卡斯特总健康中心的社区健康执行主任爱丽丝·约德尔说。

专家说，接种率低反映了阿米什人的本性和该国许多农村地区对疫苗的普遍犹豫。

因为许多阿米什人和他们的邻居一起工作和购物，并雇佣他们作为司机，他们听到了来自他们周围的“英国人”或非阿米什人世界对疫苗副作用的怀疑、担忧和错误信息，尽管他们避开了大多数现代便利设施。

“他们没有从媒体那里得到这些。他们不是在看电视或在网上阅读。他们是从他们的英国邻居那里得到的，”阿米什人的主要专家唐纳德·克雷比尔说。"在许多方面，它们只是反映了美国农村和同样的态度."

在一个案例中，一个反疫苗组织拿出了一整版报纸广告，展示了一辆被撞毁的童车，上面写着“疫苗可能会产生意想不到的后果。”

试图克服这种困惑和犹豫的公共卫生官员在阿米什人乘坐马车旅行的地方竖起了广告牌，给主教们发了信，并提出将疫苗带到他们的家中和工作场所，但都没有取得多大成功。

“这不是因为缺乏努力，”俄亥俄州霍姆斯县卫生专员迈克尔·德尔说。“但这件事充满了政治色彩。”

一些为阿米什人服务的诊所对推动这个问题犹豫不决，因为担心这会让他们无法进行血压检查和常规检查。

德尔说，一家当地企业和一项社区活动的组织者告诉霍姆斯县的卫生部门，如果它给他们带来疫苗，将不再受欢迎。

该诊所的管理人员艾伦·胡佛说，为宾夕法尼亚州兰开斯特县的阿米什人和门诺派教徒服务的教区医疗中心的工作人员鼓励患者接种疫苗，但许多人对病毒几乎没有恐惧。

“他们中的大多数人都在倾听并尊重他人，但在你说完之前，你可以看出他们已经下定决心了，”他说。

他说，该诊所去年秋天每天处理多达五个病例，现在几乎看不到任何病毒病例。“我怀疑我们获得了某种免疫力。胡佛说:“我知道这有待商榷，但我认为这就是为什么我们现在只看到飞溅的原因。”。

费城德雷克塞尔大学公共卫生准备和交流中心主任埃丝特·切尔纳克说，在阿米什人中很少进行测试的情况下，依赖可能的群体免疫是有风险的。

“这不是一个生活在岛上的社区，不与他人互动，”她说。“他们与外界没有零互动，所以他们仍然暴露在外。”

此外，人们在感染新冠肺炎病毒后多久仍保持免疫还不清楚，许多专家建议接种疫苗，因为它能带来更高水平的保护。

近1.8亿美国人——占总人口的54%——至少接种了一剂新冠肺炎疫苗。专家表示，低疫苗接种率可能会让病毒变异并卷土重来。

宾夕法尼亚伊丽莎白镇学院再洗礼派和圣贤研究青年中心的学者史蒂文·诺尔特说，在大流行的头几个月，阿米什人遵循社交距离准则，停止聚集在教堂和葬礼上。

但他说，当非阿米什邻居和地方民选官员开始反对州和联邦政府的授权时，他们就恢复了集会。诺尔特说，接下来是去年夏天的疫情爆发。

阿米什人马克·拉伯是印第安纳州戴维斯县一个定居点的成员，该县是该州疫苗接种率最低的州之一。

“只要一切保持不变，我不认为我会得到它，”他说。

疾病控制和预防中心在去年一份关于这些社区疫情的报告中说，改变这些观点需要与阿米什人建立信任关系。

卫生保健提供者说，行不通的是用统计数据和疫苗彩票轰炸阿米什人，因为他们普遍不信任和拒绝政府帮助。阿米什人不接受社会保障福利。

特雷弗·塞恩在印第安纳州北部拥有托皮卡药房，那里有25，000名阿米什人，他与疾控中心合作弥合拉格朗日县的沟通差距，那里只有18%的居民接种了全面疫苗。

他说，自从疫苗问世以来，他们已经为4200人进行了免疫接种，其中可能只有20人是阿米什人。

几周前，他发布了传单，提供私人预约或在家中分发药物。塞恩说，只有少数阿米什人做出了回应，其中包括一名提出要求的人:“不要告诉我的家人。”

Amish put faith in God's will and herd immunity over vaccine

Whenhealthcare leaders in the heart of Pennsylvania Dutch country began laying out a strategy to distribute COVID-19vaccines, they knew it would be a tough sell with the Amish, who tend to be wary of preventive shots and government intervention.

Early on, they posted flyers at farm supply stores and at auctions where the Amish sell handmade furniture and quilts. They sought advice from members of the deeply religious and conservative sect, who told them not to be pushy. And they asked three newspapers widely read by the Amish to publish ads promoting the vaccine. Two refused.

By May, two rural vaccination clinics had opened at a fire station and a social services center, both familiar places to the Amish in Lancaster County. During the first six weeks, 400 people showed up. Only 12 were Amish.

The vaccination drive is lagging far behind in many Amish communities across the U.S. following a wave of virus outbreaks that swept through their churches and homes during the past year. In Ohio's Holmes County, home to the nation's largest concentration of Amish, just 14% of the county's overall population is fully vaccinated.

While their religious beliefs don’t forbid them to get vaccines, the Amish are generally less likely to be vaccinated for preventable diseases such as measles and whooping cough. Though vaccine acceptance varies by church district, the Amish often rely on family tradition and advice from church leaders, and a core part of their Christian faith is accepting God’s will in times of illness or death.

Many think they don't need the COVID-19 vaccine now because they've already gotten sick and believe their communities have reached herd immunity, according tohealth careproviders in Ohio, Pennsylvania and Indiana, home to nearly two-thirds of the estimated 345,000 Amish in the U.S.

“That’s the No. 1 reason we hear,” said Alice Yoder, executive director of community health at Penn Medicine Lancaster General Health, a network of hospitals and clinics.

Experts say the low vaccination rates are a reflection of both the nature of the Amish and the general vaccine hesitancy found in many rural parts of the country.

Because many Amish work and shop alongside their neighbors and hire them as drivers, they hear the skepticism, the worries about side effects and the misinformation surrounding the vaccine from the “English,” or non-Amish, world around them even though they shun most modern conveniences.

“They're not getting that from the media. They're not watching TV or reading it on the internet. They're getting it from their English neighbors,” said Donald Kraybill, a leading expert on the Amish. “In many ways, they are simply reflecting rural America and the same attitudes.”

In one case, an anti-vaccine group took out a full-page newspaper ad showing a smashed buggy with the words “Vaccines can have unintended consequences.”

Public health officials trying to combat the confusion and hesitancy have put up billboards where the Amish travel by horse and buggy, sent letters to bishops and offered to take the vaccines into their homes and workplaces, all without much success.

“It’s not due to lack of effort,” said Michael Derr, the health commissioner in Holmes County, Ohio. “But this thing is so politically charged."

Some health clinics that serve the Amish are hesitant to push the issue for fear of driving them away from getting blood pressure checks and routine exams.

One local business and the organizers of a community event told the health department in Holmes County that it would no longer be welcome if it brought the vaccine to them, Derr said.

Staff members at the Parochial Medical Center, which serves the Amish and Mennonites in Pennsylvania’s Lancaster County, encourage patients to get the vaccine, but many have little fear of the virus, said Allen Hoover, the clinic’s administrator.

“Most of them listen and are respectful, but you can tell before you’re finished that they’ve already made up their mind,” he said.

The clinic, he said, hardly sees any virus cases now after dealing with as many as five a day last fall. “I would suspect we’ve gained some kind of immunity. I know that’s up for debate, but I think that’s why we’re seeing only a spattering right now,” Hoover said.

Relying on possible herd immunity when little testing has taken place among the Amish is risky, said Esther Chernak, director of the Center for Public Health Readiness and Communication at Drexel University in Philadelphia.

“It’s not a community living on an island, not interacting with other people,” she said. “They don’t have zero interaction with the outside world, so they’re still exposed.”

Also, how long someone remains immune after having COVID-19 isn’t clear, and many experts advise getting vaccinated because it brings a higher level of protection.

Close to 180 million Americans — 54% of the population — have received at least one dose of a COVID-19 vaccine. Experts say low vaccination rates could allow the virus to mutate and make a comeback.

During the first months of the pandemic, the Amish followed social distancing guidelines and stopped gathering for church and funerals, said Steven Nolt, a scholar at the Young Center for Anabaptist and Pietist Studies at Elizabethtown College in Pennsylvania.

But when non-Amish neighbors and local elected officials began pushing back against state and federal mandates, they resumed the gatherings, he said. What followed was a surge of outbreaks last summer, Nolt said.

Most now say they have already had the virus and don’t see a need to get vaccinated, said Mark Raber, who is Amish and a member of a settlement in Daviess County, Indiana, which has one of the state's lowest vaccination rates.

“As long as everything stays the same, I don’t think I’ll get it,” he said.

Changing those opinions will require building trusting relationships with the Amish, the Centers for Disease Control and Prevention said in a report looking at outbreaks in those communities last year.

What won't work, health care providers say, is bombarding the Amish with statistics and vaccine lotteries because of their general mistrust and rejection of government help. The Amish don't accept Social Security benefits.

Trevor Thain, who owns Topeka Pharmacy in northern Indiana, where there are 25,000 Amish, worked with the CDC on bridging communication gaps in LaGrange County, where just 18% of all residents are fully vaccinated.

Since the vaccine became available, they've immunized 4,200 people, perhaps only 20 of them Amish, he said.

A few weeks ago he put out flyers offering private appointments or doses dispensed inside homes. Only a few Amish people responded, Thain said, including one who came with a request: “Don’t tell my family.”