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More than half the children who attend Munchkin Land Daycare near Billings, Montana, have special needs or compromised immune systems.

Providers and health care advocates warn a proposed rule change in Montana would jeopardize immunity levels in child care centers and communities. Efforts to change vaccination exemption rules are underway in other states, too.

Montana, like 44 other states, allows religious exemptions from immunization requirements for school-age children.

The trend toward removing religious exemptions for childhood vaccinations is reversing, fueled by conservative backlash to COVID-19 vaccinations and partisan politics.

Until recently, the trend had been going the other way, with four states — California, New York, Connecticut, and Maine — removing religious exemption policies over the past decade.