Steven Michaud, president of the Maine Hospital Assn., speaks at a news conference with doctors opposed to Question 1 (Left).  State Rep. Justin Fecteau, R-Augusta, speaks at a news conference in favor of Question 1 (right). Credit: Robert F. Bukaty | AP

A people’s veto referendum that will determine the fate of a new Maine vaccination law is generating less campaign cash and fanfare than other recent ballot initiatives, but the sources behind the money and the messaging highlight a deep rift between the state’s leading health organizations and individuals who distrust vaccines.

The tension has played out in multiple states as health officials attempt to curb outbreaks of once eradicated diseases by tightening or eliminating opt-out exemptions for schoolchildren. But those efforts have run headlong into parents who want greater control over decisions affecting their children’s health as well as individuals and groups accused of promoting debunked theories about the health risks associated with vaccines.

One of those groups, the Organic Consumers Association, is now attempting to influence the Maine referendum. The Minnesota nonprofit came under fire in 2017 for promoting false claims linking vaccines with autism and was blamed for fueling an outbreak of measles within that state’s Somali-American population.

So far, more than $1 million has been spent to influence the referendum, which will take place March 3 alongside Maine’s presidential primary. At issue is a new law passed last year that repealed philosophical and religious exemptions for school children.

A “yes” vote on Question 1 will repeal the new law. A “no” vote will keep the law, which preserves exemptions for medical reasons and was designed to improve the state’s vaccination rate. Maine’s nonmedical opt-out rate is one of the highest in the country.

Repeal advocates, angered by what they view as an assault on parental rights, initially held a significant fundraising advantage. They were buoyed by small-dollar donations from individuals and higher amounts from chiropractors and purveyors of alternative medicine.

But that advantage has evaporated in recent weeks. One of the political action committees seeking to eliminate all but nonmedical exemptions, Maine Street Solutions – Protect Schools, has received $500,000 in support from pharmaceutical companies that manufacture vaccines and another $98,000 from the Biotechnology Innovation, the world’s largest trade organization representing the biotech industry.

The donations from pharmaceutical companies have been highlighted by repeal advocates and Yes on 1 Maine Reject Big Pharma.

“Big Pharma is clearly determined to add Maine to its mandate list, coercing compliance in their ever-expanding vaccine schedule to increase their already outrageous profits. Rather than letting Mainers decide for ourselves, Big Pharma is spending hundreds of thousands of dollars in a desperate attempt to influence this vote,” Yes on 1 campaign manager Cara Sacks said in a press statement released earlier this month. “We are confident that Mainers will see through this abuse of influence.”

The pharmaceutical company donations could play into the Yes on 1 messaging efforts, which attempt to convince Mainers that the elimination of nonmedical exemptions is in service of a massive industry that routinely contributes to political candidates and causes.

However, vaccines were once largely an unprofitable enterprise. Sales represented between 2 and 3 percent of pharmaceutical company profits in the mid-2000s, according to data compiled by the World Health Organization.

An industry analysis last year projected that vaccine sales could grow to $60 billion this year, up from $32 billion in 2014. The analysis pins the growth to a worldwide spike in infectious diseases.

Advocates of the new vaccine law say its sole purpose is to bolster public health and reverse a dangerous decline in vaccination rates. Maine has the highest rates of whooping cough in the country, according to the Maine Center for Disease Control and Prevention.

In addition to contributions from the pharmaceutical industry, advocates for the law have been fortified by donations from physicians and health providers. Maine Families for Vaccines, the group working with Maine Street Solutions – Protect Schools, has received more than $141,000 in donations, including $50,000 from the Maine Hospital Association and $25,000 from the novelist Stephen King. It has also received more than $11,000 in donations from roughly 70 people identifying as physicians or nurses.

Maine Families for Vaccines has transferred most of its contributions to the Maine Street Solutions – Protect Schools political committee, which used that money and its own donations to buy nearly $430,000 in television advertising.

Repeal advocates have spent nearly $120,000 on television and another $40,000 on digital and direct mail ads. The Organic Consumers Association is the single, biggest donor to Yes on 1 Maine Reject Big Pharma, the group spearheading the effort to repeal the new vaccination law.

Tax filings show that the Minnesota nonprofit was formed as an advocate for the restriction of genetically modified organisms, or GMOs, in food. But in recent years it has partnered with anti-vaccination groups such as the National Health Freedom Action and drawn public condemnation from Minnesota health officials over the measles outbreak among Somali-Americans.

Chiropractors are also among the Yes on 1 campaign’s most prolific donors. In October, the Portland Press Herald found that nearly a third of donations to the pro-repeal group Mainers for Health and Parental Rights were people identifying as chiropractors.

Recent filings show that chiropractors continue to help fund the repeal effort, but quantifying their total donations has become more difficult because donors are leaving the employer field on their donations blank, or identifying as “self-employed,” while still claiming to be involved in health care or medical occupations.

Chiropractors have backed other efforts to retain personal and philosophical exemptions in other states. Andrew Wakefield, a former physician who was discredited for falsifying information linking vaccinations to autism in a now-retracted study in The Lancet, was the keynote speaker at a conference for the International Chiropractors Association’s Annual Conference on Chiropractic and Pediatrics in 2016.

Wakefield, considered the founder of the modern anti-vaccination movement, was cited along with the Organic Consumers Association by Minnesota health officials for creating the measles outbreak among Somali-Americans in 2017.

Groups will continue to report campaign contributions and spending up to and following the March 3 referendum.

This article appears through a media partnership with Maine Public.