Maine is ramping up its efforts to educate the public on the importance of vaccinations and is updating doctors on recognizing and treating measles after an outbreak of the disease at Disneyland that has sparked a national debate about immunizations.

Meanwhile, lawmakers in Augusta are considering legislation to make it more difficult for parents to opt out of having their children vaccinated.

Maine hasn’t had a measles case, but the state is considered vulnerable to contagions because of its high percentage of unvaccinated children.

“We have to be alert. We have to be diligent. It’s just an airplane ride away,” said Dr. Sheila Pinette, director of the Maine Center for Disease Control and Prevention, referring to the outbreak that started in California and has spread to 14 states and sickened more than 100 people.

The increased efforts in Maine include working to improve the collection of school-level data on unvaccinated children, which will help better identify where disease outbreaks might occur, Pinette said.

With 5.2 percent of children entering kindergarten without all of their required immunizations, Maine has the fifth-highest vaccination opt-out rate in the nation, behind Oregon, Idaho, Vermont and Michigan. Maine has seen a spike in pertussis, or whooping cough, cases since 2012, which has been attributed in part to low vaccination rates.

The Maine Legislature will hold hearings this session on a bill by Democratic Reps. Linda Sanborn and Richard Farnsworth that would require parents to consult with and obtain a signature from a health professional before being permitted to opt out of vaccinations for philosophic reasons.

Pinette said the Maine CDC does not yet have a position on the bill, which has a title but no detailed language. A spokeswoman for Gov. Paul LePage did not respond to requests for comment on the governor’s stance on the measure.

PARENTAL RIGHTS VS. PROTECTING ‘HERD’

State Republican leaders have not made public statements on vaccination, but Rep. Deb Sanderson, a Republican from Chelsea who serves on the Legislature’s Health and Human Services Committee, said “vaccines are important” and she’s “not opposed to people vaccinating their children.” But she opposes the state expanding its role in the doctor-patient relationship.

“I’m against the government mandating that parents would have to ask permission before deciding whether to vaccinate their children,” she said.

Sanderson said she’s heard from many parents who claim their children were injured by vaccines, and she “has concerns” about vaccine safety.

But public health experts say vaccinations differ from other parental decisions, because unvaccinated children threaten “herd immunity” and endanger others with diseases – including children who are not old enough to receive vaccinations, or who are receiving cancer treatment or have other medical conditions that prohibit vaccination.

Maine is one of 20 states that permit parents to opt out of vaccinations for philosophic reasons, and it has one of the weakest laws in the nation, requiring only a parent’s signature before a child is permitted to forgo vaccines.

“This is a real concern. Our vaccination rates are dropping,” said Sanborn, one of the bill’s sponsors. “I don’t want us to wait until we have a death.”

VACCINATION PART OF PRESIDENTIAL POLITICS

As the measles outbreak keeps spreading – including Thursday to five babies at a suburban Chicago day care who are too young to be vaccinated for the disease – vaccination policy has entered the 2016 presidential contest and made the national news every day.

Kentucky Sen. Rand Paul, a potential Republican presidential candidate, initially seemed to side with anti-vaccination advocates who contend that vaccinations are unsafe, saying that people are at risk for “profound mental disorders.” Severe reactions to vaccines are extremely rare, according to the U.S. Centers for Disease Control and Prevention.

Paul has since changed his position, had his picture taken getting a vaccine, and was quoted Thursday as saying that vaccines are “overwhelmingly” beneficial.

New Jersey Gov. Chris Christie, another Republican presidential hopeful, argued this week that parents should have a choice to leave their children unvaccinated. But other Republican leaders, such as Senate Majority Leader Mitch McConnell and Speaker of the House John Boehner, have made statements praising vaccines.

Hillary Clinton, a former secretary of state and the Democratic front-runner for the 2016 presidential nomination, tweeted that “the Earth is round, the sky is blue and vaccines work.”

Surveys have shown that anti-vaccine sentiments cross ideological lines, with Democrats on the far left and libertarian Republicans most likely to oppose vaccination.

TWO SENATORS ENCOURAGE IMMUNIZATIONS

Numerous studies have concluded that vaccines are completely safe for the vast majority of people, and a 1990s study that some cited as proving a link between autism and vaccines has been debunked and retracted.

Sen. Susan Collins of Maine, a moderate Republican, said in a statement to the Portland Press Herald that she wouldn’t comment on the pending state bill, but she supports vaccines and does not believe in parents opting out except under narrow circumstances.

“Every state and the District of Columbia has a law requiring children entering school to meet the state’s immunization requirements. I believe that these vaccinations should continue to be mandatory, but recognize that there may be situations – for instance, for a child whose immune system is compromised or who is allergic to the vaccine – when an exemption may be necessary. In general, however, parents who choose not to vaccinate their children are not only putting their own children at risk, but also potentially jeopardizing the health of others,” she said.

Sen. Angus King, a Maine independent, said in a written statement that vaccination policy is a state decision, but he remembers when polio sickened thousands.

“For myself, I have always had my children vaccinated and encourage other parents to vaccinate their children because I firmly believe it is in their best interest and that of the collective health, safety and well-being of communities,” King said.

STATES REVERSING COURSE ON OPT-OUTS

Vaccinations were not controversial until the late 1990s and 2000s, and few people opted out of them, said Indiana University’s Ross Silverman, a professor of health policy and management who has researched state public health policies on immunization.

But after the autism report came out, and even though it was later discredited, more people started questioning the value of vaccines, Silverman said. Also, with diseases like measles a distant memory from the 1960s, the threat of infections did not seem real to people, he said.

“The vast majority of Americans recognize the value of vaccinations,” Silverman said. “What happened at Disneyland is a fairly high-profile event, and a chance for people to support and boost the public health system.”

In reaction to the Disneyland outbreak, California and Washington state legislators have introduced bills that would eliminate all philosophic and religious exemptions to vaccines, leaving only medical exemptions in place. Only Mississippi and West Virginia have such strict vaccination requirements.

Pinette, the Maine CDC director, said that within the next year the agency will start collecting school district-level information on vaccination rates, so that researchers and public health experts can better target messages to those who are resisting vaccines.

Maine now collects information from all schools but does not delineate it by district.

SIGNS OF MORE VACCINATION ACCEPTANCE

Yarmouth pediatrician Dr. Laura Blaisdell, a vaccination advocate, said that since the Disneyland measles outbreak, she has had many more conversations with patients about vaccines, with some people starting to see the value of immunizations. “I had one of my most vaccine-hesitant patients come in and get the (measles, mumps, rubella) vaccine,” Blaisdell said. “I am really quite encouraged that we are having a national conversation about this.”

For South Portland parent Bethany Hickey, measles reports in the news have made her more mindful of keeping her children up-to-date on their vaccines. She’s worried about giving her children too many vaccinations at once, but she nevertheless believes in them. The federal CDC says there is no risk in giving children multiple vaccinations at one time. However, many parents are concerned about the possibility of adverse reactions when a number of vaccines are given at one appointment, and pediatricians tend to comply rather than risk having the children go without the vaccines.

“It (Disneyland) has made me extra sure to be current on everything,” said Hickey, who was taking her 6-month-old son for a vaccination at her South Portland pediatrician. “If enough people go without vaccinations, it’s a health risk to the general population.”