In short:
The US state of Pennsylvania is grappling with its worst measles outbreak in three decades, with more than 1,300 cases reported since April.
asserted
cases → grapple → April
Amish communities have been directly impacted due to low vaccination rates, leading to the deaths of six people.
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communities → impact → people
The outbreak is the largest of multiple outbreaks across the US, happening amid an uproar over Health Secretary Robert F Kennedy Jr's controversial vaccine stance.
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outbreak → happen → stance
In a rural corner of the US state of Pennsylvania, crop fields, maple trees and colonial-era barn farmhouses dot a patchwork landscape of rolling grassy hills.
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fields → dot → hills
At the foot of the Appalachian Mountains, Lancaster County is less than 300 kilometres from New York City and home to the country's oldest and largest Amish community.
But it has also become the focus of a heated political row amid a scramble to contain one of the US's worst measles outbreaks in recent history.
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it → become → history
The most vulnerable infiltrated
Measles is a highly contagious illness that can lead to the hospitalisation or death of a person, with up to nine out of 10 people who are not vaccinated likely to fall sick, the Australian Centre for Disease Control says.
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Centre → lead → Control
Authorities in Pennsylvania say the outbreak there began in late April, west of one of the state's largest cities, Philadelphia.
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outbreak → say → cities
Cases have since ballooned above 1,300 in what has become Pennsylvania's largest spread of the disease in more than three decades.
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what → balloon → decades
At least six people have died, including two infants — one of which was a newborn — and a 20-year-old from Lancaster County, an 18-year-old resident of Mifflin County, a 40-year-old woman from Jefferson County and a 39-year-old female from Franklin County.
The Pennsylvania Health Department said none of the victims was vaccinated, and Franklin County officials reported the 39-year-old had a previous measles diagnosis and "several underlying conditions".
Authorities say the disease has mostly impacted people aged between 18 and 49, who account for about 800 of the state's cases, and at least 251 people — or about one in every five — have been hospitalised.
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people → die → five
Low vaccination rates, mostly in vulnerable Amish communities, remain the biggest challenge according to officials.
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rates → remain → officials
At least five who died were from Amish communities, local media reported.
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media → die → communities
The Amish are insular, religious people who associate piety with surrendering to strict rules for the greater good of their community, and reject modern-day technologies.
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who → associate → technologies
They came to the US from Europe in the 1700s, and more than 410,000 still live across the country, including at least 40,000 in Lancaster County.
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410,000 → come → County
Braxton Mitchell, co-director of the University of Maryland's Amish research program, says their communal way of life creates a unique risk of rapid virus spread.
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way → say → spread
The Amish families have a lot of kids — the average [has] seven or eight, so a lot of people in the household," he said.
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he → have → household
"The Amish get together with their neighbours, with their relatives; they have church services on Sundays which tend to be at somebody's house and the whole church district shows up."
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district → get → house
He said they were sceptical of government intervention and do not see the need to engage with modern medicine.
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they → say → medicine
They don't like governments telling them what to do …
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governments → like → what
Amish don't subscribe to the national health insurance," Professor Mitchell said.
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Mitchell → subscribe → insurance
"With some diseases, the Amish [believe] 'if we get sick, if God's will is that we're meant to survive, we'll survive'."
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we → believe → diseases
Steve Nolt, a professor at Elizabethtown College, has lived in Lancaster County for most of his life and said he loves the area's reputation for diversity, manufacturing, picturesque nature and pleasantness of local life.
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he → live → life
[The county] is special, especially in the minds of people with deep roots here," he said.
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he → say → roots
But he said while the majority of the non-Amish population live with them harmoniously, there is still concern about the spread of measles.
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majority → say → measles
That worry has extended to non-Amish residents warily monitoring transmission alerts naming schools, stores or other popular locations where the virus has spread outside of Amish areas, Mr Nolt said.
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Nolt → extend → areas
Fears of deadly under-reporting
In the neighbouring Chester County, 93 cases have been reported this year, but there is concern around unreported infections.
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cases → report → infections
Jeanne Franklin, the county's public health director, said officials were aware of people who fell ill and did not feel the need to access medical care or alert authorities.
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who → say → authorities
She said by the time some patients present to hospitals or other medical clinics, they were significantly ill.
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they → say → hospitals
"What we're seeing is the worst of the worst," she told the ABC.
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she → see → ABC
"It is definitely bigger than we are able to report because it is moving very quickly …
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it → report → ?
Statistically speaking, we're likely going to see more deaths."
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we → speak → deaths
Ms Franklin described the Amish as "vaccine hesitant", but does not treat them as unique from the non-Amish who choose not to be vaccinated according to political or religious beliefs.
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who → describe → beliefs
"What we want to remind people is, regardless of whether you're Amish or an anti-vaxxer … reassess the decision in the light of today," she said.
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she → want → today
"Thirty years ago you may have said: 'Why do I need that?
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I → say → that
Well, guess what, it's an issue."
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it → guess → what
She said Chester County adopted a word-of-mouth approach to promoting vaccination and dispelling common myths about measles.
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County → say → measles
"We have a whole team … painting the picture [of the disease's spread].
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We → paint → spread
Is it in our youth?" she said.
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she → say → youth
"We're a health department; we can't be everywhere, but we know the church on Main Street, the food pantry on South Street, and the hardware store are trusted business owners and community members.
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church → know → Street
"We are going out to meet them, educate them, so if they get questions, they know how to direct to us …
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they → go → us
Some of them are like, 'give me 100 [flyers], I'm going to put it in everyone's grocery bag.'
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I → give → bag
…and 17 more, not listed.
The Aporia
