Health care leaders have tried different tactics to distribute vaccines to the Amish but the community has not budged. Vaccines don’t follow the Amish’s religious beliefs, making the effort a major challenge.

Vaccination drives around the U.S. are struggling to reach the Amish population. Health leaders tried placing vaccination information in places where Amish people are familiar, like farm supply stores, but those efforts were unsuccessful.

Another outreach effort was to market the vaccine in a popular newspaper read by Amish people, but newspapers refused to allow the marketing.

Ohio's Holmes County, home to the largest Amish community, had only 14% of its residents vaccinated, according to the Associated Press. Health experts from highly populated Amish areas say that communities believe they don't need to vaccine because they may have already had the virus or their communities have reached herd immunity.

Experts believe it’s behind a combination of "the nature of the Amish" and the skepticism that comes from the hesitancy being found in all rural areas.

“They’re not getting that from the media. They’re not watching TV or reading it on the internet. They’re getting it from their English neighbors,” said Donald Kraybill, a leading expert on the Amish.

“In many ways, they are simply reflecting rural America and the same attitudes.”

Health clinics are afraid to push any further with the distribution of vaccines because it could scare their communities away from getting blood pressure checks and routine exams.

Local businesses in Amish counties are warning health departments that if they keep coming with vaccination information, they will not be welcomed any longer, said Michael Deff, the health commissioner in Holmes County, in an interview with Kaiser Health News.

Allen Hoover, the clinic's administrator which serves the Amish and Mennonites in Pennsylvania’s Lancaster County, commented that “many have little fear of the virus.”

“Most of them listen and are respectful, but you can tell before you’re finished that they’ve already made up their mind,” he said.

“Most now say they have already had the virus and don’t see a need to get vaccinated,” said Mark Raber, who is Amish and a member of a settlement in Daviess County, Indiana,

Healthcare providers are concerned that overloading the Amish with vaccine information that they reject will create tension with the community. They must instead form trusting relationships with them.