By a single vote, the state Senate this week preserved a religious exemption to vaccination requirements for children to enter Maine schools, even though no major religious organizations advocate in favor of skipping vaccinations.

The contentious vaccine bill is expected to be back for debate in the Maine House and Senate next week, at a time when the state has dangerously low rates of vaccination coverage among schoolchildren and parts of the nation are grappling with measles outbreaks.

Four Democratic senators joined all Republicans on Thursday to maintain the religious exemption in current law in an 18-17 vote on an amendment by Sen. David Miramant, D-Camden. The House voted in April for a version of the bill that removes all non-medical exemptions – philosophic and religious – to vaccinations needed to attend school and day care.

The discrepancy between the bills means lawmakers will be grappling with how to handle the little-used religious exemption. Ninety percent of vaccine opt-outs in 2018-19 used the philosophic exemption.

Catholics, Protestants, Jews and Muslims all encourage their followers to be immunized against communicable diseases such as measles, chickenpox and whooping cough. Small subsets of religions, such as ultra-Orthodox Jews in New York City, may cite religious reasons for not vaccinating, although rabbis in New York have been encouraging the population to immunize. New York City has had at least 423 measles cases since October, according to city public health statistics.

Religion was often cited in the news as a reason for the 2015 measles outbreak in Amish communities in Ohio. But a 2017 scholarly article in the American Journal for Infection Control found that religion was not a major factor among parents who chose to forgo vaccines for their children, but rather misinformation about vaccine safety led to low vaccination rates among the Amish in 2015.

Rev. Jim Gertmenian, a retired United Church of Christ pastor from Cumberland, said that mainline Protestant and Catholic church teachings support vaccination. He said using religion as a catch-all reason to avoid vaccines that benefit the health of the community is false logic.

“That would be like saying ‘God doesn’t want me to obey traffic signals, and that is my sincere religious belief,'” Gertmenian said. “At some point, the state needs to step in for the betterment of the community.”

Miramant, the sponsor of the amendment, said in an email Friday night that the religious exemption is important because, for some, there are “reasons that are personal to them and their God. Our Constitution grants the right and freedom of religious practice and I believe we must not start to let others define that intimate connection.”

Carroll Conley, executive director of the Christian Civic League of Maine, made a similar point when he testified against the vaccine bill in March, saying that the “absence of a specific doctrine” by religious groups does not mean the state can infringe upon people’s religious beliefs.

“Our opposition is based on the proposed bill’s disregard for two bedrock foundations of America: religious freedom and parental rights,” Conley said.

If the religious exemption in Maine is retained as it currently stands, parents would be able to forgo vaccines for schoolchildren by checking a box on a form, although another box on the same form – for the philosophic exemption – would be eliminated. Public health advocates fear that parents who were checking the philosophic exemption box on the form will instead check the religious box.

In Vermont, the religious exemption was little used until the philosophic exemption was eliminated in 2015. Religious opt-outs in Vermont jumped from 0.9 percent of all exemptions in 2015-16 to 3.7 percent in 2016-17, the first school year after the philosophic exemption was removed.

Maine’s high rate of parents opting their children out of school-required vaccines – 5.6 percent in 2018-19 for children entering kindergarten – spurred Democratic lawmakers to introduce a bill that would eliminate the philosophic and religious exemptions to vaccines. While the statewide average was 5.6 percent, in some schools the opt-out rate is much higher, which makes those communities more likely to experience the return of preventable diseases. Forty-three Maine elementary schools had kindergarten opt-out rates of 15 percent or more, well above the 5 percent threshold at which public health experts say the “herd immunity” that helps keep the diseases from circulating is threatened.

Maine’s low vaccination rate also is likely contributing to the state’s sky-high pertussis rate, public health experts say. Maine had 446 cases of pertussis, also known as whooping cough, in 2018, eight times higher than the national average, with many of the outbreaks occurring in schools.

While 0.2 percent of the non-medical exemptions in 2018-19 were for religious reasons, public health advocates say keeping the religious exemption creates a loophole that will let opt-out rates remain high.

“If you retain the religious exemption, you retain the risk. Religious exemptions seems to be a compromise, but in fact they will only compromise our public health as philosophical objectors switch to religious objectors,” said Dr. Laura Blaisdell, a Yarmouth pediatrician and vaccine advocate.

What will happen next with the legislation is unclear. The House could send the original bill back to the Senate for a re-vote, Democratic leadership could try to flip one Democratic senator’s vote, lawmakers could devise another compromise bill, the House could accept the Senate’s version or no bill could be approved.

Sen. Linda Sanborn, D-Gorham, a retired physician, said she fears that as the bill stands after the Senate vote, parents will “switch to the religious exemption” even though it would be “illogical” to do so. But Sanborn said she and other lawmakers will be working on solutions in the upcoming weeks.

“I would like to think that all doors are not yet closed to us,” Sanborn said.