As he tracked the growing measles outbreak in Texas, watching with dread as it crossed state lines, Bob Rauner knew there was no time to waste.

Fearful the once common — and life-threatening — virus would eventually reach Nebraska, the physician and Lincoln Public Schools board president began publicly sounding the alarm.

“We have similar holes, just like Texas does,” Rauner said during an April school board meeting. “It’s likely a matter of time before measles spreads to Nebraska.”

He had reason to be concerned. On May 27, Nebraska confirmed its first measles case since 2017. Public health officials said the Sheridan County child hadn’t yet received the full series of shots because of their age. In addition, the child is immunocompromised, which can lead to breakthrough infections.

While announcing the case, the Nebraska Department of Health and Human Services noted that the best way to protect against measles is through immunization.

But Nebraska's childhood vaccination rates are sliding downward even as the threat of measles emerges, according to a new Flatwater Free Press analysis of school data. Driving the decline is an exemption enshrined in state law: religious freedom.

Data indicates religious exemptions — the only nonmedical exemption to school vaccine requirements allowed under state law — have gained popularity in the state. That includes Lancaster County, home to Lincoln, where the percentage of children receiving an exemption roughly doubled in the past five years.

Statewide, parents are opting out of routine vaccines, like the ones targeting measles, chickenpox and pertussis, with increasing regularity. According to a survey conducted by the state at the beginning of the school year, only 11 of Nebraska’s 19 health districts had enough kindergartners who’d had the MMR vaccine to prevent an outbreak.

The trend is not unique to Nebraska, though experts say the state has one of the more lax laws surrounding exemptions for religious reasons. 

In interviews and social media posts, families who claim the exemptions say their opposition to vaccines stems from deeply held beliefs.

But public health officials warn that an increasingly unvaccinated population could bring dire consequences at a time when state and federal funding cuts threaten to hamstring local vaccination efforts.

“I think the biggest misconception is this is a personal choice,” Rauner said. “It's a personal choice and a public choice, because when you choose not to vaccinate against some diseases, you are putting other people at risk.”

A growing trend

Allie Bush is a strong believer in religious exemptions for childhood vaccinations. An outspoken vaccine opponent and founder of Nebraskans Against Government Overreach, Bush sees the exemption as a tool to push back against a state mandate she vehemently opposes. 

“The sincerely held belief that I have is that any pharmaceutical that's intended to outdo or enhance God's design wasn't in his plan for us and isn't necessary,” Bush said. 

Her family relies on home remedies, homeopathic treatments and “things that weren't chemically altered in some lab,” she added.

Bush frequently posts on social media about her concerns regarding vaccines. She was among the most vocal opponents of COVID-19 vaccine and mask mandates in Nebraska.

She cites the pandemic as one explanation for the rise in parents choosing to claim an exemption. 

“Most people thought that all vaccines are always required for public school,” she said, “and (exemptions) are not majorly advertised by the schools.”

Experts say that after 2020, when vaccine disinformation swelled online and in communities across the country, more and more families across Nebraska began reconsidering vaccinations. 

“COVID, I think, has provided an opportunity for parents and guardians to really ask a lot more questions as far as the vaccines that their children are getting, especially those required for school,” said Kerry Kernen, director of the Lincoln-Lancaster County Health Department. 

Of Nebraska’s 19 local health districts, Lincoln-Lancaster has seen one of the most steady climbs in religious exemptions. In the 2020-21 school year, 1.8% of kindergartners across the county received a religious exemption for one or more vaccines. By 2024-25, that number had climbed to 4%.

The impact is especially pronounced when it comes to measles protection. This year, only 89% of kids entering kindergarten in Lancaster County had both doses of the MMR vaccine, down from 94.4% in the 2020-21 school year. That’s well below the 95% that health officials say is  necessary to prevent an outbreak.

Spurred by the data, Rauner said Lincoln Public Schools proactively sent out letters to parents explaining what would happen — three weeks of missed in-person learning — if their unvaccinated child was exposed.

Every LPS school is now at or above the 95% vaccinated threshold for measles, Rauner said, a feat he credits in part to the letters. 

Little oversight

Ostensibly, families claiming religious exemptions in Nebraska have to be just that — religious. The reality is more complicated. 

To qualify for a religious exemption in Nebraska, a family must sign an affidavit before a notary swearing that immunization either:

  • Conflicts with the tenets and practices of a recognized religious denomination, of which the student is a member; or
  • Conflicts with the student’s personal and sincerely followed religious beliefs. 

Oversight of these exemptions ends when the ink dries. There’s no legal process to verify a religious exemption, nor is there a requirement to name the student’s religion.

“It's open ended, and that's why it's really hard to police,” said Dorit Reiss, a professor of law at UC Law San Francisco. “How do you disprove something like that?”

Nebraska’s not alone in allowing these exemptions. Forty-three states and Washington, D.C., allow parents to opt their children out of vaccine requirements for religious reasons. Thirteen of those also allow exemptions for personal or philosophical reasons.

But many of those states require more than Nebraska law does. New Mexico requires parents to provide written affirmation of their religious objections. Nevada requires parents to sign their initials next to statements affirming they understand the risk of contracting and transmitting diseases. 

Wyoming, which has a similar exemption form to Nebraska, includes a list of symptoms and effects of each disease a given vaccine prevents. Parents opting out of the MMR vaccine, for example, are counseled that, “Symptoms and effects of measles include pneumonia, seizures, brain damage, and death.”

Few organized religions outright object to vaccination. While individual Catholics may have concerns about vaccines that use cell lines from an aborted fetus, the church has issued guidance that it is morally acceptable to receive those vaccines if there’s no other option.

In early April, Gov. Jim Pillen and State Epidemiologist Dr. Sydney Stein added their voices to the chorus encouraging childhood vaccination. 

“This one is a no-brainer. This vaccine works, and it protects our kids,” Pillen said during a press conference. 

But vaccination efforts could grow even more challenging thanks to funding cuts at the federal and state levels. 

Health districts are in line to lose millions in state support over the next two years under a budget bill signed by Pillen earlier this month.

Meanwhile, measles cases continue to rise nationally. As of May 23, the Centers for Disease Control and Prevention reported 1,046 cases in the U.S. Of those, 96% were unvaccinated. Three people have died. 

Rauner said it’s incumbent on officials at every level to encourage vaccination efforts, and ensure that one case doesn’t become many.

“When rubber hits the road,” he said, “you don’t want babies dying.” 

The Flatwater Free Press is Nebraska’s first independent, nonprofit newsroom focused on investigations and feature stories that matter.