Listen to article \u2022\u00a00:00 min<\/p>\n
LANCASTER \u2014 Amish families peer into Roberta Devers\u2019 Honda Passport as she drives between prenatal checkups along the rolling hills of Lancaster County. They ask her increasingly frequent questions about the vaccine: Do you have some measles in your car?<\/p>\n
Devers, 63, works as a traditional midwife in communities at the epicenter of Pennsylvania\u2019s largest measles outbreak in more than 30 years. She belongs to a class of midwives <\/a>who follow age-old practices and are unregulated by the state, unlike the state-licensed midwives one may find in a hospital. She received the full childhood vaccination schedule but, as an adult, chose not to vaccinate her son and is part of the rising number of people in Pennsylvania refusing to get vaccinated against preventable diseases due to unfounded concerns about their safety and necessity. <\/p>\n But with the growing outbreak now linked to the deaths of two Amish infants and two adults in Pennsylvania<\/a> \u2014 the first measles-related deaths in the state, and the most in the nation in more than three decades \u2014 Devers thinks everyone who can should get vaccinated against measles.<\/p>\n And she thinks she should be able to offer the vaccine to her patients, as a trusted caretaker among Amish residents.<\/p>\n \u201cBabies are dying,\u201d said Devers, who is not Amish but has been a traditional midwife for 38 years. She says she fears that Pennsylvania\u2019s Amish community, one of the oldest and largest in the country, cannot wait to reach herd immunity. \u201cYou\u2019re going to lose too many babies,\u201d she said.<\/p>\n Devers occupies a unique vantage point from the front lines of the nation\u2019s largest measles outbreak this year. State health officials said the deaths of two local Amish infants were measles-related, sparking a clash between Democratic Gov. Josh Shapiro<\/a> and President Donald Trump<\/a>\u2019s Health and Human Services secretary, Robert F. Kennedy Jr., over how to report the outbreak\u2019s death toll<\/a>. An 18-year-old from Mifflin County and a 40-year-old woman from Jefferson County also died from measles-related illnesses in recent days, according to the counties\u2019 coroners<\/a>.<\/p>\n \u00bb READ MORE: Josh Shapiro\u2019s measles response \u2014 and its backlash \u2014 reignites COVID-19 fury<\/a><\/p>\n As of Wednesday, the state had reported 731 cases in 38 counties. Lancaster has recorded the highest number of known cases in Pennsylvania, as the highly contagious disease has spread among the area\u2019s significant number of unvaccinated people, including many from communities beyond the county\u2019s Amish population. <\/p>\n Traditional midwives like Devers \u2014 also known as lay midwives or direct-entry midwives \u2014 broadly oppose being regulated<\/a> by the modern medical system and often do not receive the medical and scientific training or college-level education required of certified nurse midwives and midwives. Because of this, top medical associations like the American College of Obstetrics and Gynecology oppose traditional midwives from being able to practice at all. State law also prohibits traditional midwives from practicing medicine, such as administering vaccines or sutures. <\/p>\n Until this summer when it was quietly repealed in state budget documents, an unenforced 1929 law allowed traditional midwives to practice in Pennsylvania. Devers is part of a group of midwives who have sued the state<\/a> to formally recognize them, but that would still not permit them to practice medicine, including administering vaccines. <\/p>\n \u00bb READ MORE: Why Pennsylvania quietly repealed its 1929 midwifery law \u2014 and is now getting sued for it<\/a><\/p>\n Yet, traditional midwives are the main care providers who oversee home births in certain Amish communities, or for people who want their help with a personal and private birth experience. Their influence is particularly prominent in Pennsylvania, which has one of the nation\u2019s highest rates of home births. Devers\u2019 practice, Mount Laurel<\/a> Midwifery, delivers about seven babies per month across south-central and Southeastern Pennsylvania, with a number of student midwives studying under her.<\/p>\n In Lancaster, Devers\u2019 clients are not talking about the political debate. Rather, their conversations center on the spread of measles \u2014 did she hear about the recent baby deaths, what should they do if they were exposed, does she have a vaccine with her?<\/p>\n Two doses of the measles, mumps, and rubella vaccine have proven 97% effective at preventing the disease, the Centers for Disease Control and Prevention says. Nine in 10 unvaccinated people exposed to measles will acquire the disease.<\/p>\n Pregnant people are not eligible to receive the vaccine.<\/p>\n In her daily prenatal checkups, she is seeing moms who have the infection\u2019s signature bumpy, red rash and fever, and families who have watched the sickness move through one family member to the next.<\/p>\n About three in 1,000 children who contract measles will die, according to the CDC. Measles can cause severe complications, especially in young children, including pneumonia and brain swelling. And measles during pregnancy can lead to pregnancy loss, premature delivery, and low birth weight, according to the CDC<\/a>.<\/p>\n Devers said she recently saw a case in which a mother lost her baby at 17 weeks. The Amish woman was recovering from an active measles infection at the time of the miscarriage, in addition to at least one other underlying medical condition, Devers said.<\/p>\n Amish families traditionally have funerals for stillborn babies or miscarried fetuses, sharing obituaries in the local newspaper. Devers attended the funeral for one such death, involving the 17-week-old fetus, last month.<\/p>\n During previous public health emergencies, state and federal governments have used limited emergency approvals to expand who is allowed to administer vaccines, though the authority was not extended to unregulated groups like traditional midwives. <\/p>\n Now, Devers wants state or federal health officials to extend approval to allow traditional midwives to administer the measles, mumps, and rubella vaccine. <\/p>\n But the Pennsylvania Department of Health says it does not have the authority to allow traditional midwives to administer vaccines, because they are not certified healthcare providers. Currently, state law allows licensed healthcare providers like doctors and certified nurse midwives to administer vaccines, and any expansion of the list would require an amendment to state law, spokesperson Stephanie Nojiri said in a statement. <\/p>\n \u00bb READ MORE: Pa. reports measles cases in 4 vaccinated residents. These rare cases account for less than 1% of the spreading outbreak.<\/a><\/p>\n HHS and the CDC did not respond to requests for comment. Devers said she recently accepted an invitation from the CDC to participate in a paid interview to discuss how midwives serving Plain communities are approaching the measles outbreak. She sees the outreach as a signal of the agency\u2019s interest in working with midwives. <\/p>\n The Amish and vaccines<\/p>\n Vaccination rates among Pennsylvania children have been falling for years. The spread of misinformation about vaccine safety reached the highest echelons of the U.S. government after Trump picked Kennedy, a longtime anti-vaccine activist, to lead the nation\u2019s health agencies. <\/p>\n