Families with religious objections to immunizing their children soon will have an additional hurdle to clear if they want to enroll students in public or private schools.

Last week, Gov. Bruce Rauner approved a measure aimed at reducing the number of unvaccinated children in the classroom. But because Rauner did not sign the bill until after many students had received their routine checkups or started school, the new requirements will not go into effect until Oct. 16 — the day after students must receive their vaccines or file objections.

That delays the law’s full impact by a year.

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“This is a bit of a difficult situation since it was just signed into law last Monday,” said Melaney Arnold, a spokeswoman for the state’s Department of Public Health. “A lot of kids have already gone to get their physical and so forth. Some schools have already started. To send them back to the doctor would be costing the parents.”

Families seeking a religious exemption next year, or transferring after Oct. 16, will have to complete a certificate explaining their objection on religious grounds before kindergarten, sixth and ninth grades.

That certificate also must include the signature of a doctor, attesting that he or she counseled the parents about the risks of skipping vaccines.

How effective the new law will be in reducing the number of unvaccinated children is not clear, since how schools define a religious objection is not clear either.

The Illinois State Board of Education tracked more than 13,000 such exemptions in 2013, said spokeswoman Megan Griffin. While the objection doesn’t have to be based on religious doctrine, it can’t be based simply on personal preference either, she said.

“General, philosophical or moral reluctance to allow physical examinations … will not provide a sufficient basis for an exception,” Griffin said. “When local schools are looking at it they’re advised to look for words like ‘deity’ or ‘faith’ or ‘prayer’ or ‘higher power,’ things like that. Red flags go up when they see words that refer to a moral basis or fear of vaccines as opposed to a personal religious belief. It does have to be based on religious belief, but it doesn’t necessarily have to be tenets of a religious organization.”

With Rauner’s signature, Illinois remains one of the 47 states that allow children to be exempt from vaccines due to religious concerns. Only three states — California, Mississippi and West Virginia — prohibit nonmedical exemptions.

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California became the largest state in June to end exemptions for personal or religious reasons after a measles outbreak at Disneyland was attributed to unvaccinated children. Now California families who refuse to vaccinate their children for nonmedical reasons must home-school.

The new Illinois law mostly applies to people of faith who can’t point to institutional tenets. For example, some Roman Catholics reject about a third of the childhood immunizations, including vaccines against polio, rubella, chicken pox and hepatitis A because they have been derived from the cell lines of aborted fetuses.

The Vatican has said alternatives should be sought, but if there is none, vaccines are morally acceptable and serve the common good.

“The church isn’t going to say to you ‘You have to get your kids vaccinated even if you’re morally uncomfortable about this,'” said Eric Scheidler, executive director of the Pro-Life Action League. “You can have a more scrupulous moral position than the official teaching of the church.”

Finding any religion that discourages vaccines can be difficult. Even the founder of Christian Science, which champions the healing power of prayer, didn’t oppose legally mandated immunization.

“Rather than quarrel over vaccination, I recommend, if the law demand, that an individual submit to this process, that he obey the law, and then appeal to the gospel to save him from bad physical results,” founder Mary Baker Eddy wrote in The First Church of Christ, Scientist, and Miscellany published in 1913, three years after her death.

When state Sen. John Mulroe, of Park Ridge, initially proposed a bill mandating that a religious official and notary public sign off on objections, more than 500 people from across the state voiced concerns.

An amended version of the bill replaced that requirement with the signature of a doctor.

“I can’t say anyone pinpointed any scripture or religious document that said it would be harmful or against some religion to have their kids vaccinated,” Mulroe said, explaining why he shifted his approach. “How about we make sure the people who are exercising this right are informed?”

Laura Cellini, a mother of two and a children’s health advocate who negotiated on behalf of families, said she encountered a wide range of religious objections she had never considered. In addition to evangelical Christians and Catholics who objected to how vaccines are derived, she met parents who believed injecting children with vaccines derived from animal DNA would violate the trust God placed in them by giving them children.

“When we look at religion and spirituality, it’s such a personal privately held right in this country,” she said. “Whenever we try to infringe on it we need to be very, very careful. It’s a tremendous freedom that we should never take for granted. … Your relationship with God might lead to a different conclusion.”

Cellini said the bill makes clear that doctors who sign religious exemption certificates are not endorsing the waiver. Dr. Ruben Rucoba, a Wheaton pediatrician, said that is especially important in his practice where he said he plans to sign certificates for families who object, then advise them to find another doctor. To curb the number of patients in his practice who oppose vaccines he and his colleagues adopted a policy barring unvaccinated children without a medical reason.

“I don’t want to play judge and jury,” Rucoba said. “Religious liberty is one thing. Public health and public safety is another. We need to have a balance and I need to make sure in my practice I protect all the kids.”

That said, he has encountered a number of parents opposed to vaccinating their children, but rarely, if ever, for religious reasons.

John Grabenstein, executive director of global health and medical affairs for Merck Vaccines, respects the rights of families to object on moral grounds. But avoiding vaccines altogether is not the way to express those objections, he said. He cited several scriptures that spell out an obligation to protect the community.

“I am my brother’s keeper,” said Grabenstein, quoting the Old Testament’s Book of Genesis. “That certainly relates to contagious diseases. … They should object to the vaccine and tell the manufacturers to do something different. But fundamentally the parents have a responsibility to vaccinate.”

Carla Dobrovits, 47, of south suburban Frankfort, said it’s up to individual parents to determine what will keep their children safe.

A practicing lawyer and mother of nine, she said her devotion to Catholic teachings has kept her from vaccinating her children since she discovered the polio, rubella and chicken pox vaccines were derived from aborted fetuses.

She appreciates the concern about public health and knows that if measles pops up in her children’s school, she will have to keep them home for 21 days. But she feels too strongly about the issue to back down. She would selectively vaccinate against measles and mumps if she could, but the only option available in the U.S. is the MMR, which bundles all three doses together. She would like to see more people lobbying for individual doses and ethically sourced vaccines.

“No one wants to see their children get sick and suffer,” she said. “We’re all trying to weigh this as best as we can. Why is the onus on those of us who have religious objections?” she said. “Why is the onus on us to advocate and go against our beliefs?”

Manya Brachear Pashman can be reached at [email protected]