Attitudes and Beliefs of COVID-19 and Vaccine Uptake among Amish Women

Abstract

The Amish, a Christian religious group living in rural areas with distinct beliefs about remaining separate from the outside world, have communities in 31 states and four Canadian provinces with just over 600 settlements. Their access to health care and technology is often limited. Several studies have noted low vaccination rates for preventable diseases among the Amish, often due to lack of knowledge about efficacy and safety of vaccines. To gain an understanding of beliefs surrounding COVID-19 and attitudes toward vaccine uptake, we surveyed 863 Amish and Mennonite women throughout Ohio who participated in rural mobile health clinics between 2015 and 2019 at two time periods: before and after the 2020 election. We received 372 completed surveys, 252 of which were completed by respondents who identified themselves as Amish. While 100% of the Amish respondents had heard of COVID-19 and 90% reported knowing someone who had contracted the disease, a mere 1.7% (4) indicated a willingness to get vaccinated. In terms of COVID-19 diagnosis, post-election participants were two times more likely to report having a positive test than pre-election respondents (p = .011). Qualitative analyses revealed significant differences in keywords used to describe COVID-19. Post-election respondents were less likely to use words like "evil" and "bad" and associate COVID-19 with the flu. A notable shift in vaccine hesitancy among Amish participants centered on the perceived politicization of the pandemic and safety/efficacy of the vaccines. Public health efforts should center on raising awareness of the severity of COVID-19 and the benefits of vaccine uptake for distinctive subcultures like the Amish.