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The Amish communities of northeastern Ohio engage in textbook communal living. Families eat, work and go to church together, and through the pandemic, mask-wearing and physical distancing have been spotty. That has meant that these communities bore a high rate of infection and death.

Despite this, health officials are struggling to encourage residents to get vaccinated against covid-19. Holmes County, where half the population is Amish, has the lowest vaccination rate in Ohio, with just 10% of the population fully vaccinated.

“About less than a percent [of Amish] are coming in,” said Holmes County health commissioner .

Marcus Yoder, who was born Amish and is now Mennonite, said the few Amish who are getting the shots are doing so privately through doctors’ offices and small rural clinics — and, they generally 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.

Many Amish do not want to get vaccinated because they’ve already had covid and believe the area has reached herd immunity, he said.

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“I think one of the main driving forces is the misinformation about covid itself — that it’s not more serious than the flu,” said Yoder, who lives in Holmes County and still has close ties to the religion and community. “They’re saying, ‘Well, it didn’t affect me that much. Look at all these old people who survived.’”

Anti-vaccination conspiracy theories also have spread throughout the community, and there is a lack of awareness about the more contagious variants spreading across the country, Yoder said.

“I think we’re going to see some more cases in our community, unfortunately, because of this,” he 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.”

Health officials in Indiana and Pennsylvania are also ramping up outreach in heavily Amish areas. Local health departments in Lancaster County, Pennsylvania, home to the largest Amish population in the country, are connecting with Amish bishops to try to spread the word about the vaccines.

The widespread reluctance to be vaccinated in Amish communities is not surprising to West Virginia University sociologist , who studies Amish populations across the country.

“We as non-Amish are more on board with preventative medicine,” Stein said. “They certainly don’t have that mindset that we need to do things to stop this from happening.”

Instead, she said, there’s an acceptance that people will get sick and get better — or not. While childhood vaccinations have increased in Ohio’s Amish communities in recent years, adults are still more 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, . Even after this experience, many Amish residents chose not to vaccinate their children against other diseases.

The low vaccination interest in Holmes County also follows national trends showing .

A recent from �鶹Ů�� found 3 in 10 rural residents will “definitely not” get a covid vaccine or will get vaccinated only if it is mandated.

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.

“I think that hammering people for not doing it will not get us anywhere,” Yoder said. “Some of the local business leaders have done very, very well at saying, ‘Look, let’s get the vaccination so we don’t have to wear masks in the future, so we don’t have to worry about social distancing as much in the future.’ And they’ve used that tack and that has been a healthy way to approach it.”

Derr is trying to get business owners who employ Amish workers to encourage their staffers to get a shot. Health officials hope to eventually hold vaccine clinics at these 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 could see a spike in cases long before then.

This story is part of a partnership that includes , and KHN.