More Maine children entered kindergarten last year with school-required vaccinations, as fewer parents claimed religious or philosophical exemptions to immunizations for diseases like measles, mumps, chickenpox and whooping cough.

The statewide rate of philosophical and religious opt-outs for students entering kindergarten was 4.1 percent in 2020-21, representing about 450 students statewide. That’s down from 5.6 percent in 2019-20. However, in some schools the opt-out rate was far above the state average.

A database published last week by the Maine Center for Disease Control and Prevention shows that a dozen schools reported at least one out of five kindergarten students were forgoing vaccinations. A few schools had exceptionally high kindergarten opt-out rates for philosophical or religious reasons, including Community Regional Charter School in Cornville at 39.1 percent, Fiddlehead Center of Arts and Sciences in Gray at 35 percent and Maine Coast Waldorf School in Freeport at 20.7 percent.

State public health officials warned that because many schools had incomplete vaccination records as a result of the pandemic, it’s difficult to draw accurate comparisons between the past two years.

It’s also not clear yet how Maine stacked up last year against the rest of the nation, because data from many other states isn’t available until October. However, the national opt-out rate generally hovers around 2 percent, and historically Maine’s opt-out rate has been among the highest.

Maine parents who enroll their children in school this fall will no longer be able to claim religious or philosophical exemptions to childhood diseases, under a state law passed in 2019. Maine joins California, New York, Connecticut, West Virginia and Mississippi as states that now forbid non-medical exemptions.

All of the states that now ban non-medical exemptions did so in response to the return of preventable childhood diseases, like measles and pertussis, that was caused by high opt-out rates. Most of the opt-outs are for non-medical exemptions, with medical opt-outs accounting for 0.5 percent or less of all students.

The law, which survived a recall referendum effort in March 2020, is expected to eliminate the chronically high rate of religious and philosophical opt-outs from vaccinations at some schools.

Carroll Conley, executive director of the Christian Civic League of Maine, said the organization supports parents being able to opt-out, and the new law is making it difficult for those who are used to exercising that choice. He said some want to home school their children or move out of state to avoid being forced to vaccinate, but many can’t afford to do so.

“Parents should have the right to raise their children in line with their religious beliefs,” Conley said.

But when higher percentages opt out of vaccines, school outbreaks are more likely, and public health advocates argue that the safety of children makes a mandate necessary.

“We should see a reduction in disease outbreaks (not related to COVID-19) in a school setting,” said Tonya Philbrick, director of the Maine CDC’s Maine Immunization Program. “Our goal is to have a safe environment for kids to learn in.”

Although vaccines for COVID-19 are not mandated for schoolchildren or approved yet by the FDA for children under age 12, many schools will be offering clinics this fall to improve school vaccination rates against COVID-19. Schools will be required to keep records of which students are immunized against the virus.

The Maine CDC’s vaccine database shows that 50.5 percent of youth in the 12-19 age group have received their final dose of the COVID-19 vaccine.

Drawing firm conclusions about last year’s opt-out rate is difficult because the number of parents who failed to submit vaccination records or request an exemption for their children more than doubled, from 1.2 percent of students in 2019-20 to 2.6 percent in 2020-21. If a record is missing, it’s impossible to know whether parents opted the student out of childhood vaccinations or whether the student was vaccinated and the parent simply neglected to turn the forms in.

When records are missing, school officials are supposed to track down parents and get the forms turned in, but that likely happened less during the pandemic.

“These children could have been immunized or had an exemption, but when the records are missing, neither one is on file,” said Jessica Shiminski, health program manager for the Maine Immunization Program.

Shiminski said the high number of missing records likely was caused by the pandemic, which forced school officials to confront many logistical challenges as they dealt with remote learning, social distancing, masking and other issues. For some schools, tracking down parents who didn’t fill out vaccination forms may have fallen by the wayside.

Parents will be required to get their students up-to-date on vaccines this fall, although Philbrick, at the Maine CDC, said grace periods will be established to give parents a chance to catch up.

In a scene that’s playing out across Maine in the run-up to school, Jayson Forgues of Brunswick brought his daughter, Monroe-Claire Forgues, 5, to get the shots she needs to start kindergarten at Mid Coast Medical Group Pediatrics on Friday. Monroe read “Baabwaa and Wooliam” to distract herself while receiving vaccines for a number of childhood diseases, like measles, mumps, rubella and pertussis.

Dr. Lynne Tetreault, a pediatrician with Maine Medical Partners in Saco, said from what she’s seen at her practice, some parents who were choosing to opt their children out of vaccines experienced a change of heart during the pandemic.

“What science has taught us and brought to the forefront this year is the value of vaccines, and the value has been shown to parents who were opting out,” Tetreault said. Other parents may not have changed their views on vaccines but are being pragmatic about the requirements of the new law.

“Some are just accepting that this is now the law and if they want their children back in school, this is what they have to do,” Tetreault said.

Tetreault said as those 12 and older have come in to get immunizations required at the middle school level for the fall, her office is also offering the COVID-19 vaccines for those who have yet to get their shots.

“We have been very pro-active about this, asking if they want to get them a COVID shot during their appointment, and many have been taking us up on that,” she said.

Dr. Laura Blaisdell, a pediatrician from South Portland, said parents who have opted their children out of school-required vaccinations were not all adamantly opposed to immunizations. Some may have been hesitant, but could be persuaded, while others may have checked the opt-out box as a matter of convenience. She said with the new law going into effect, plus more family conversations about vaccines during the pandemic, some parents may have been pushed over the line to get their children immunized.

“Many parents who previously refused to get their children vaccinated are now saying, ‘OK, I guess now is the time to start vaccinating,'” Blaisdell said. “The pandemic pushed these conversations to the front.”