The Board of Education plans to defend the school vaccine mandate and appeal the decision that let the kids return to the classroom for now. That appeal will be heard by the state Supreme Court, likely early next year.

Lawsuits against Covid vaccine mandates were abundant during the pandemic, but the legal battles playing out in West Virginia could presage broader attempts to roll back childhood vaccination requirements for dangerous illness such as measles, whooping cough, polio or diphtheria nationwide. A similar challenge in New York was recently appealed to the U.S. Supreme Court after it was struck down by a lower court in March. The plaintiffs, which include three private Amish schools, are pushing back on New York's 2019 decision to end religious exemptions to its school vaccine mandate.

Last month, the Department of Health and Human Services said West Virginia was obligated to follow its Equal Protection for Religion Act in order to receive funding from the Vaccines for Children Program, putting pressure on the health department to grant exemptions. The program makes some vaccines free to kids who are uninsured or underinsured. HHS subsequently sent out nationwide letters reminding states that they could only get funds from the program if they complied with religious exemption laws.

"We will enforce conscience protections and defend every family's right to make informed health decisions," Kennedy said in a post on X.

Should the governor's order stand, Jackson worries about breakthrough infections -- the small number of infections that may occur in vaccinated people, particularly if there's an outbreak -- at Maxwell's school as more families claim exemptions.

"I think that's the point where public school would no longer be safe for him," she said.

Even if Maxwell is immunized against the severe effects of a virus like measles, she said, a simple cough could lead to vomiting and pneumonia because he has difficulty clearing mucus on his own.

Doctors say it's easy to forget how devastating vaccine-preventable illnesses can be, since vaccines have rendered them far less common and life-threatening. In today's misinformation climate, they say, unfounded claims about adverse reactions may seem scarier than the known risks of viruses themselves.

"Vaccines are important for all populations. They're specifically important for us because of our challenges with access to health care," said Dr. Jeffrey Lancaster, an associate professor of pediatrics at West Virginia University.

West Virginia is one of the poorest states in the country and has some of the worst health outcomes. It's also mostly rural, so many families have to travel far to see a doctor, making it harder to treat illnesses early.

Aaron Siri, a lawyer representing the plaintiffs seeking religious exemptions, pushed back on the idea that relaxing mandates would lead to health risks by noting there are many pathogens that children aren't required to be vaccinated against.

"There's no such thing as a child whose immune state renders them only susceptible to serious harm from the few pathogens for which vaccination is required to attend school in West Virginia," he wrote via email. He deferred to court filings for questions regarding the case and said he would not allow his clients to speak to the media during active litigation.

According to the lawsuit, all three plaintiffs are Christian and say they object to "altering" their children's immune systems through vaccination.

One plaintiff, registered nurse Miranda Guzman, "sincerely believes that God designed her child's immune system with special care and with the well-designed ability to counteract disease," the lawsuit says.

In her view, the suit adds, "to preemptively alter that immune system would demonstrate a lack of faith in God."

In West Virginia, a legal battle over school vaccine mandates reflects national tension