Making hay was more than a figure of speech last week at the New Holland auction house in Pennsylvania last week, where a ton of top quality hay bales were going for upwards of $400, up about 20% from last year.

For members of the Lancaster settlement, a term used to describe the Amish population that settled here in 1760, the price of hay was only part of the discussion: the price of horses, donkeys and milk were also topics of conversation and, as it has been for year or more, a potentially deadly outbreak of measles.

In the most recent count, 1,398 cases had been detected, according to the Pennsylvania department of health. Since 1 August, 150,000 doses of MMR vaccine had been administered, with more than 50,000 given in October alone.

The outbreak, and the politics surrounding it under Robert F Kennedy Jr, the health secretary, has focused on Lancaster county, placing the Amish under a spotlight. While there is no Amish religious opposition to vaccines broadly, a study found that that less that a third of Amish residents had been immunized against measles, mumps and rubella.

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The attention the Amish have received while experiencing the worst outbreak in the nation has not always been welcome. But the state, under Josh Shapiro, the Democratic governor, has mounted an intensive outreach of pop-up clinics and mailings to encourage the community to get protection.

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