Signaling support for several New York Amish families, the Supreme Court recently vacated Miller v. McDonald and remanded it to district court for further review. The named families, as administrators of private rural Amish schools, are challenging $118,000 in state fines for not enforcing New York’s 2019 requirement that all schoolchildren, public or private, receive vaccinations regardless of parents’ religious convictions. While some Amish selectively vaccinate, others pursue no vaccinations.
Leading up to the 2019 law’s passage, little evidence suggests New York legislators had a particular concern with the Amish. Rather, travelers from Israel had brought measles to New York ultra-Orthodox Jewish neighborhoods, where a segment had adopted religiously informed teaching against vaccinations.
The more recent Amish focus is no less relevant, though. Amish populations are growing exponentially through high fertility. They also periodically experience outbreaks of vaccine preventable diseases, including rubella, pertussis, and others, and Amish vaccination rates likely declined in recent years. Even as the Miller case went through courts, Amish measles cases arose across different states, likely coming from contact with similarly under-vaccinated “Low German” or “colony” Mennonite populations (found in west Texas, rural Canada, and Latin America).
I’m a social scientist of population health and also identify with the broader “plain Anabaptist” religious tradition (which includes Amish). I have exhaustively synthesized studies about the Amish health culture and appreciate the depth of conviction informing both religious and scientific thinking on health. As religious exemptions to vaccines continue to be debated in the context of measles outbreak, most recently in South Carolina, I think that it’s valuable to examine how Amish have responded at the intersection of vaccination and faith.
From the perspective of mainstream scientific medicine, the choice between vaccination and potentially fatal diseases seem obvious. So are religious motivations an attempt to cover for cultural or political motives, personal rationalizations, or misinformation? What, exactly, is “religious” about refusing vaccination?
The answer matters not only because the Constitution protects religious free exercise but also because understanding others’ perspectives is important for humanizing people with whom we disagree and, thus, having more productive idea exchanges.
For many religious objectors, including Amish, vaccination rejection is a situational interpretation of religious doctrine, not a direct theological mandate. By today’s Western standards, the Amish are a doctrinally conventional Christian group. No central Amish religious tenant governs health practices directly.
Move much deeper into Amish theology, though, and it becomes abstruse. Representations of Amish religiosity frequently reduce it to somewhat sweeping generalizations and imprecise terminology, namely, Amish as a total system of religiosity emphasizing separation, nonconformity, and tradition/(non-)modernity, where everything they do is religious — certainly a reductionist view of any human’s existence, no matter one’s piety. Understanding specific aspects of Amish religious thinking, however, is key to weighing whether objections are religious, especially when no religious command directly forbids vaccinations.
The Amish belief system privileges the notion that when individuals highly esteem certain innovations, religious purity may erode. For example, people first making a change, such as getting vaccinated, may also prefer other changes — work tools, behavioral practices, or new representations of identity in dress, transportation modes, or home styles. Thus, OKing vaccines may inadvertently embolden individuals to make further changes and cajole co-religionists to condone those changes for the whole group. This triggers a slippery slope toward apostasy — that is, de-prioritizing mindedness toward church vetted preoccupations. Whether a given innovation triggers a slippery slope or not is incredibly localized, contextual, sometimes even arbitrary, but nonetheless real and consequential. Depending on context, for some Amish, vaccination is a private matter; for others, “we” together do not vaccinate because “we” never have. What is it worth to rock the boat? Yet others change their position when persuaded by circumstances.
A second relevant Amish mindset is discomfort with unfamiliar contexts. The disagreeable opinions of a co-religionist neighbor are actually quite comfortable compared to a distant institution claiming to serve your best interests by injecting you with an unknowable substance: “What all am I really signing up for when I engage with this system and trust them with their recommendations? Perhaps I should just avoid the unknown.” I sat in an Amish church once where whooping cough was making rounds; the group preferred this over the unknowns of vaccination.
Other possible reasons for vaccine hesitation exist. While Amish selectively use scientific medicine, many heavily lean on trusted in-group advice first and highly esteem generational precedent. Other Amish oppose vaccines because they, for example, echo what they hear from neighbors and co-workers. In these cases, it is challenging to untangle whether being an ethnic-religious people with objections to vaccinations makes those objections religious.
Religiously informed vaccine hesitancy goes beyond Amish, Mennonites, and ultra-Orthodox Jews. In a recent study, co-authors and I found that evangelical Protestant presence in counties is associated with under-vaccination for Covid-19, while mainline Protest and Catholic presence was associated with higher vaccination rates. But across religious traditions, associations are in opposite directions, suggesting no single “religious” perspective on vaccines. Amish, too, had variations in opinions. Two people in the same local assembly may share similar doctrines but be at odds over the efficacy of modern scientific medicine, especially vaccines.
This potpourri of religious perspectives is no surprise given religion’s long history of influencing thinking toward health, carrying incredible physical and emotional power for people facing illness and even death, to the point of seemingly miraculous healing. The Christian New Testament recounts story after story of cognitive pathologies, chronic infections, sensory and mobility impairments, and other debilitations cured through — or caused by — ceremonial anointing, divine intervention, faith/belief (or lack thereof), prayer, and ingestion (e.g., communion). Should healing not come, Christian doctrine asserts that the mortal body’s demise is not the end of consciousness.
In this light, the utility of struggling against mortal death is of some value but conditioned by life-after-death. Judaism, Islam, Buddhism, and Hinduism similarly frame health interventions via consciousness after bodily death.
For Amish as with other religions offering networks of care, health care received from kin and co-religionists is close, knowable, and frequently coupled with emotional care, a contrast to the rational bureaucracy advancing scientific medicine with its highly technical biochemical architecture so challenging for popular masses to “get” the science behind. The seeming absoluteness of scientific thinking may predispose many medical practitioners or public health workers to assume the populace trust them, that evidential claims naturally validate interventions — no further Q&A needed. For Amish living through the Covid-19 pandemic, the more they heard relationally distant medical authorities asking for unqualified trust on vaccination, the more it triggered suspicion. The more their family and co-religionists were suspicious, the more suspicious they became, and so forth.
Unlike religion, modern scientific medicine has been mainstream for only a little over a century. And across that century, we’ve witnessed extraordinary abuses against humanity at the hands of modern scientific medicine’s practitioners, right up to mass genocide. Many of today’s scientists would rightly decry their disciplinary forefather’s abuses: eugenic policy, patient/study participant non-consent, and others. But they still ask for — even expect — trust because science is “right,” aligning with the authority of empirical evidence citizens cannot generally verify themselves.
The effectiveness of scientific health is indisputable for the many who benefited from, say, interventions for traumatic injuries. But at the center of today’s culture wars, certain groups of religious people decry medical practices perceived to elbow in on God’s prerogatives over life-and-death and the world’s order, such as abortion, elective body-modification surgeries, reproductive practices, and cloning. For them, suspicion of medical abuses continues, even as no doctrinal mandate per se rejects modern medical interventions.
These religious frameworks are important to understand because they have constitutional protection rooted in America’s founding. The U.S. Constitution’s First Amendment offers protections for religious free exercise, arguably including health practices. The Miller case itself will be reconsidered in light of SCOTUS’s recent decision expanding Maryland public school parents’ right to object to content on religious grounds. This pits certain public health interests and certain religious interests against each other. Are protecting religious beliefs really worth risking public health crises?
James Madison, the U.S. Constitution’s architect, regarded citizen’s religious conscious as more than something to grudgingly tolerate but as an inalienable human right. Madison argued that people weigh their own evidence about a Creator, then are loyal to a governing power higher than civil society. For the state to violate one’s religious liberty risks violating a range of civil rights: freedom of press, trial by jury, suffrage, and others.
But to protect religious free exercise as an inalienable right, the state cannot establish any given religion as the government’s religion. Such power, Madison argued, would corrupt pure religious ideals of the established group and incentive that group to use state power to coerce their beliefs on the populace.
Like the U.S. itself, modern scientific medicine advances no religious belief, per se, but rather relies on laws of reason. When state authority overrides religious belief on the basis of controlled experiments and public health, it establishes empiricism — in essence, humanistic secularism — as a sort of state theology, the natural law as the law predating civil society. But the Constitution establishes the government as no more a secular state than a religious one (unlike, say, France or Turkey).
While the two approaches can largely harmonize within our framework of participatory governance, we recognize that few areas will trigger more dynamic debates navigating secular-religious tension as the health and well-being of bodies.
During a 2014 measles outbreak in Ohio, many Amish accepted vaccinations as part of a largely successful public health campaign. It’s not a given Amish — or other religious adherents — will reject vaccines. Successful outreach requires making effort to understand how religious adherents think, acknowledging their concerns, and humbly recognizing that medical knowledge is shaped by more than mere empiricism. Even if widespread vaccination is not achieved, this approach opens communication and the possibility of vaccination.
Conflicts between religious free exercise and modern health policy will remain continuous challenges. Health professionals must continue cultivating awareness of how some religious objections will be beneath the surface — difficult even for adherents to articulate — but nonetheless legitimate and motivating. Swift legal action to mandate interventions could backfire. Even then, constitutional protections of religious free exercise remain important to society’s civil liberties on the whole, even the project of science.
This does not mean giving up on health interventions some people may find objectionable but better understanding the conceptual origins of resistance and working with people from there.
Cory Anderson, Ph.D., is a postdoctoral researcher in population health and demography at Pennsylvania State University’s Population Research Institute. He has published widely on issues affecting Plain Anabaptist people, including Amish.
