Cara Sacks, who co-chairs a campaign to repeal a new school vaccination law on the March ballot, speaks at a news conference before her group delivered petitions to the secretary of state's office in Augusta in September. Signs for her group urge voters to “Reject Big Pharma,” but pharmaceutical money hasn’t played a significant role in the referendum so far. Credit: Robert F. Bukaty | AP

AUGUSTA, Maine — Signs urging Mainers to “Reject Big Pharma” are going up across the state. Activists trying to repeal a stricter school vaccination law on the March ballot say the message is winning people over. Those who want to save the law worry that it’s working.

It may be savvy politics in a state wracked by the opioid crisis, but the pharmaceutical money that has often poured into political campaigns in Maine hasn’t played a significant role in the referendum so far. Supporters of the law say it’s because the issue is about public health.

The referendum concerns a bill passed last year that tightens immunization requirements by eliminating nonmedical exemptions for required school vaccinations. A yes vote on the people’s veto effort would repeal the law and continue to allow parents to exempt their children from vaccines for philosophical and religious reasons. A no vote would allow the law to stand.

Cara Sacks, the campaign manager for Yes on 1, said that concerns about the industry were a major factor in motivating supporters of the referendum, who question how an industry linked to problems like the opioid epidemic and price increases could be trusted. “Reject Big Pharma” is the name of the group’s website and features prominently on signs and merchandise.

“This same industry produces the vaccines that are being mandated under this law, yet suddenly we are expected to trust the companies,” Sacks said.

Vaccines make up only a small share of the pharmaceutical industry, amounting to about 3 percent of total revenues, and tend to be more highly regulated than other medicines. Just four companies — Merck, Pfizer, Sanofi Paster and GlaxoSmithKline — make and sell vaccines in the U.S. None of those companies were subpoenaed by the federal government last fall as part of an investigation into the role of drug companies in the opioid epidemic.

Dr. Laura Blaisdell, a Yarmouth pediatrician who serves as the campaign chair for Maine Families for Vaccines, said she was concerned that the rhetoric about “big pharma” was designed to confuse voters when it comes to evaluating what the referendum actually is.

She acknowledged that Mainers have legitimate reasons to distrust pharmaceutical companies, pointing to the opioid crisis as an example. But she was quick to point out that opioids and vaccines are two distinct issues. Public health officials see vaccines as an important tool in preventing the spread of disease.

Rep. Ryan Tipping, D-Orono, who sponsored the bill in the Legislature last year, said that focusing the referendum campaign on the pharmaceutical industry, rather than the merits of vaccines, was “playing on people’s fears.”

The law was a response to a rising vaccination opt-out rates among Maine children in recent years, with 5.2 percent of kindergartners opting out of the measles, mumps and rubella vaccine during the 2018-19 school year, mostly for nonmedical reasons. Opponents made personal and religious freedom arguments as well as concerns about vaccines themselves, including a debunked link between vaccines and autism.

Pharmaceutical companies and PACs have tried to influence Maine politics over the years, with more than $1.4 million in campaign contributions since 2008, according to Maine Ethics Commission data. But this referendum hasn’t drawn as much cash as previous ballot measures.

The referendum’s supporters have raised more than $204,000, while opponents have raised just over $58,000, according to the most recent filings with the Maine Ethics Commission. Blaisdell pointed to small-donor fundraising and the group’s reliance on volunteers as evidence that the committee defending the vaccine law is a grassroots effort.

Sacks, however, questioned the role of nonprofit associations. She pointed to the Maine Medical Association, which supported the bill in the Legislature and has contributed to Maine Families for Vaccines, as an example. The association’s corporate affiliates include pharmaceutical companies such as Novo Nordisk, according to its website, which she argued is evidence that the the group is acting on behalf of the industry, rather than patients.

In the Legislature, the bill did attract some lobbying from three pharmaceutical companies — Pfizer, Merck & Co. and Johnson & Johnson — as well as one insurance company, Cigna, according to records filed with the ethics commission. The lobbying efforts were small, however, compared to the overall scale of lobbying in Augusta.

The lobbyists working for these companies were paid, in total, just shy of $22,000 for the months when they were working on the vaccine bill, though it wasn’t the only piece of legislation they were working on during that time frame and disclosure records show that none of those lobbyists received more than $1,000 per month in relation to their work on vaccines.

A spokesperson for Pharmaceutical Research and Manufacturers of America, one of the leading pharmaceutical lobby groups nationally, said the group is “not involved in this effort nor have we taken a position on the measure,” though it sees vaccines as “one of the most important and life-saving public health interventions in the history of humanity.”