AUGUSTA, Maine (AP) — Maine has moved one step closer to ending the state's religious and philosophical exemptions to vaccines with the Democratic-led Senate's 18-17 vote on a bill Tuesday.

The bill to end the exemptions now faces a round of procedural votes in both chambers before heading to Democratic Gov. Janet Mills' desk. The bill narrowly moved forward with a vote from Democratic Sen. James Dill, who had previously backed an effort to protect Maine's religious exemptions.

The governor's administration has supported the bill to end all non-medical vaccine opt-outs by 2021 for schoolchildren, as well as nursery school and health care facility employees. Maine has one of the highest rates of non-medical vaccine exemptions in the nation. Whooping cough, which is commonly vaccinated against, is more prominent in Maine than most other states.

Maine would join three states — California, Mississippi and West Virginia — that lack both philosophical and religious exemptions for vaccines, according to the National Conference of State Legislatures. Connecticut is also weighing whether to prevent individuals from claiming exemptions on religious grounds. Washington state has ended philosophical exemptions while retaining religious opt-outs.

An effort to preserve Maine's religious exemptions has floundered amid concerns that parents could simply opt out of vaccines on religious grounds instead of philosophical grounds. Health officials say Maine's exemptions rates are rising and could endanger children who can't be vaccinated for medical reasons.

Democratic Sen. Heather Sanborn said that opponents of the bill lack the scientific evidence to support claims about vaccines, including the debunked claim that the public is at risk from recently vaccinated individuals. She said that vaccines are safe and that Maine's bill to eliminate all non-medical exemptions protects young children and others with compromised immune systems.

"I think that they're the kids who really prevailed today," she said.

The percentage of kindergarten students with religious and philosophical exemptions from vaccines rose from 5% in the 2017-2018 school year to 5.6% in the 2018-2019 school year, according to the Maine Center for Disease Control and Prevention. Medical exemptions increased from 0.3% to 0.6%.

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Meanwhile, the measles, mumps and rubella vaccination rate among kindergarteners has dropped from 94.3% in the 2017-2018 school year to 93.8% this school year. State officials say this means half of kindergarten classes are below the "herd" immunity level of 95% immunization.

Opponents say the bill would infringe on parental rights and stigmatize children who could face removal from school if they remain unvaccinated. Such critics say the bill, which applies to public and private schools and universities, is far too broad.

The state doesn't know exactly how many students are not vaccinated for religious or philosophical reasons, but the Department of Education has estimated that as many as 5% — or 9,032 students — may have non-medical exemptions.

Megan Spencer, of Bucksport, said the legislation would threaten her job in the health care industry. Spencer said she's worried her family will have to leave the state to afford bills.

"We were born with the immune system we were supposed to have," said Spencer, who describes herself as a Christian.

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