Vaccine teams in Mexico scramble over measles outbreak rippling out from Mennonite community

CUAUHTEMOC, Mexico — In a rickety white Nissan, nurse Sandra Aguirre and her vaccination team drive past apple orchards and cornfields stretching to the desert horizon. Aguirre goes door to door with a cooler of measles vaccines. In one of Latin America's biggest Mennonite communities, she knows many will decline to be vaccinated or even open their doors. But some will ask questions, and a handful might even agree to get shots on the spot.

''We're out here every single day,'' said Aguirre, pausing to call out to an empty farm, checking for residents. ''To gain trust of the Mennonites – because they're reserved and closed-off people – you have to meet them where they're at, show a friendly face.''

Aguirre's work is part of an effort by health authorities across the country to contain Mexico's biggest measles outbreak in decades, as cases climb not only here but in the U.S. and Canada. In Mexico, cases have been concentrated in the Mennonite community — long skeptical of vaccines and distrustful of authorities — in the northern border state of Chihuahua.

Officials say results of their campaign alongside Mennonite leaders have been mixed — they cite tens of thousands of new vaccinations in Chihuahua, but infections have ballooned and spread past the community to Indigenous and other populations.

Federal officials have documented 922 cases and one death in Chihuahua. Officials, health workers and local leaders say the numbers are likely underestimated, and misinformation about vaccines and endemic distrust of authorities are their biggest obstacles.

Pressed against the fringes of the small northern city of Cuauhtemoc, the Mennonite settlement here spans about 40 kilometers (25 miles). With 23,000 residents, it's one of Cuauhtemoc's primary economic engines, but it's an isolated place where families keep to themselves. Some have turned to social media and anti-vaccine websites for research. Others use little technology but visit family in the United States, where they also hear misinformation — which then spreads through word of mouth.

Chihuahua is a particularly worrisome place, officials say — as a border state, the risk that the preventable disease will continue spreading internationally and affect the most vulnerable is high.

''We have a massive flow of people,'' said Alexis Hernández, a Cuauhtemoc health official. ''That makes things a lot more complicated.''

The spread of measles in Mexico

Mexico considered measles eliminated in 1998. But its vaccination rate against the virus was around 76% as of 2023, according to the World Health Organization — a dip from previous years and well below the 95% rate experts say is needed to prevent outbreaks.

Mexico's current outbreak began in March. Officials traced it to an 8-year-old unvaccinated Mennonite boy who visited relatives in Seminole, Texas — at the center of the U.S. outbreak.

Cases rapidly spread through Chihuahua's 46,000-strong Mennonite community via schools and churches, according to religious and health leaders. From there, they said, it spread to workers in orchards and cheese plants.

Gloria Elizabeth Vega, an Indigenous Raramuri woman and single mother, fell sick in March. Because she's vaccinated, measles didn't occur to her until she broke out in hives. Her supervisor at the cheese factory — who also caught measles — told her she had to take 10 days of leave and docked her pay 40% for the week, Vega said.

It's rare for vaccinated people to get measles, but officials say that may account for up to 10% of cases here, though they're milder.

Vega tucked herself away in the back of her two-room home, hoping her daughter and mother — also vaccinated — wouldn't get sick. She wishes people would think of others when considering vaccination.

''They say, ‘Well, I have enough to be fine,''' she said. ''But they don't think about that other person next to them, or wonder if that person has enough to live off of.''

Vaccination isn't required in Mexico. Schools can request vaccination records, federal health department spokesman Carlos Mateos said, but they cannot deny anyone access to education.

In Chihuahua, some schools started reaching out to parents for copies of vaccination cards and encouraging shots, said Rodolfo Cortés, state health ministry spokesman.

It's unknown how many in the Mennonite community have gotten the vaccine — which is safe, with risks lower than those of measles complications.

Gabriella Villegas, head of vaccination at a clinic treating Mennonites with measles, estimated 70% of community members are not vaccinated. Other health authorities estimated the vaccination rate around 50%.

Along with measles, misinformation is spreading

Mennonites who spoke to The Associated Press — most on condition of anonymity, fearing backlash — repeatedly cited vaccine misinformation. One man said U.S. Health Secretary Robert F. Kennedy Jr., who has a long record of promoting anti-vaccine views and has called vaccination a personal choice, is a hero.

''I don't accept vaccines; it's that easy. Because that's where freedom of expression comes in,'' said the man, Jacob Goertzen. "If we can't make out own decisions, we don't live in a democracy.''

Hernández, Cuauhtemoc's health director, said outside influences affect community vaccine views.

''The Mennonite population has a lot of access to social media and family members in the U.S. and Canada, where there are a lot of myths that have taken hold and many more ‘anti-vaccine' groups than we have in Mexico,'' he said.

During nurse Aguirre's vaccination drive, one man simply said people here ''prefer to cure themselves in their own way." A mother described getting sick with measles as a "privilege" and spoke of putting her unvaccinated 5- and 7-year-olds in a party so everyone could get sick and recover — a risky tactic doctors have long denounced.

Mexico's lone death from measles was a 31-year-old Mennonite man in the settlement who had diabetes and high blood pressure, underlying conditions that often complicate sicknesses.

Mexico's vaccination efforts

Most people in Indigenous and other communities quickly agreed to vaccinate, officials told AP, but in Mennonite areas crews have to do more vigorous outreach — the door-to-door visits, follow-up calls and conversations, and involvement of local leaders.

In Cuauhtemoc's settlement, that's leaders like Jacob Dyck Penner. As colony president, he and other leaders closed school for two weeks to slow infections, have made a push to show residents they're working with health authorities, and are encouraging vaccination.

Leaders translate health information into Low German, the native language of most of the community. Penner and others are assisting vaccination teams, making sure families know how to access health services.

''We had to find this way, together with doctors, to not pressure people or inspire distrust, so they can take their time and make their own decision to accept (being vaccinated),'' Penner said.

Medics report more people visiting clinics, seeking vaccines for measles and other diseases. Still, Penner said, there a swath of people will always reject vaccinations.

For this mother, life's now paycheck to paycheck

Health officials like Hernández say they're concerned in particular for vulnerable populations including Indigenous groups, many of whom have fewer resources to cope.

Vega, the single mother who got measles, said her job at the cheese factory was once a blessing, providing health insurance and steady pay.

But the forced leave and docked pay left her reeling. She said she's living paycheck to paycheck and wonders how she'll pay the bills — her daughter's school supplies, lunches, tennis shoes.

''I have a daughter to keep afloat," she said. "It's not like I have the option to wait and pay for things, for food.''

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Associated Press videojournalist Martín Silva Rey contributed to this report from Cuauhtemoc, Mexico.