In this Jan. 23, 2020, photo, a syringe with influenza vaccine inside heads for its mark during a flu vaccination at Eastfield College in Mesquite, Texas. Credit: LM Otero | AP

PORTLAND, Maine — Debate over a referendum aimed at nullifying a Maine law that eliminates religious and philosophical exemptions for childhood vaccinations is intensifying during the countdown to a statewide vote.

A group that supports the elimination of most opt-outs launched a television ad campaign in opposition to the referendum question last week, and critics of the law will begin airing ads this week, as well.

“The message is very simple: We have to protect our kids, and schools need to be a safe place for our kids,” said Dr. Laura Blaisdell, a pediatrician and co-chair of Maine Families for Vaccines, which supports the law.

Every major medical organization in Maine supports the law, she said. Removal of nonmedical exemptions for vaccines protects community health, prevents infectious disease outbreaks and protects people with impaired immune systems, she said.

But groups that want to restore philosophical and religious exemptions contend that parents, not lawmakers, should be responsible for making medical decisions for children.

Mainers will get the final say on March 3 on a law that ends nonmedical vaccine opt-outs by September 2021 for students at public and private schools and universities, including nursery schools, and for health care facility employees. It’s part of a trend of states tightening rules on vaccine exemptions in response to growing numbers of unvaccinated children.

The campaign mirrors the emotional debate in the Maine Legislature.

Fighting the medical establishment with the so-called “People’s Veto” referendum is a multipartisan assortment of Democrats, Republicans, Libertarians, Green Independents and others, including parents who believe in vaccines but also support “medical choice.”

“This is the only issue that we all exclusively agree on,” said Cara Sacks, campaign manager of Yes on 1 Maine to Reject Big Pharma.

Much of the messaging from groups that support the right to opt out of vaccinations has focused on criticism of the pharmaceutical industry. Critics say linking the vaccines to big pharma is disingenuous because vaccines account for a small fraction of pharmaceutical revenues even though they account for billions of dollars in sales across the globe.

The pharmaceutical industry contributed to the major ad buy to encourage people to support the changes. The TV ads backfired by raising concerns about pharmaceutical meddling, Sacks said.

The Legislature’s action last year came against the backdrop of a spike in whooping cough cases in Maine.

Maine has one of the highest rates of nonmedical vaccine exemptions in the nation, and officials warned that the measles, mumps and rubella vaccination rate among kindergarteners had dropped below 94 percent. That means half of kindergarten classes are below the “herd” immunity level of 95 percent immunization, state officials said.

Rep. Ryan Tipping of Orono, who sponsored the bill, said no one wants to see a situation like the one on Samoa where a measles epidemic swept across the island last year because of low vaccination rates. The nearby U.S. territory of American Saomoa began mass immunizations in response.

“We know what kind of trouble that can happen with measles outbreaks. There are places that have been completely devastated by it. A lot of people don’t want to see that happen in Maine,” he said.