Anti-vaccine advocates in New York are encouraging parents to homeschool their children rather than protect them from serious diseases, according to a recent report in The Wall Street Journal.

The move by New York anti-vaccine groups comes just weeks after state lawmakers eliminated exemptions that allowed parents to opt their children out of standard school vaccination requirements on the basis of religious beliefs. Very few religions actually have objections to vaccinations, and the ones that do tend to have relatively few followers. But many parents who reject vaccines based on falsehoods and misinformation about their safety have claimed religious objections as a way to dodge immunization requirements.

As cases of measles in the United States have exploded in recent years—largely due to a small but loud band of anti-vaccine advocates misinforming parents—states are now cracking down on non-medical exemptions. New York, which has faced a massive and prolonged outbreak since last September, is the fifth state to eliminate religious exemptions. It joins California, Maine, Mississippi, and West Virginia. Overall, lawmakers in 26 states have recently introduced bills aimed at tightening rules on who can receive exemptions, according to The Hill.

As of July 3, the Centers for Disease Control and Prevention has confirmed 1,109 cases of vaccine-preventable measles in 28 states. That’s the highest number of cases in the country since 1992. In 2000, public health officials declared the disease eliminated from the country (meaning an absence of continuous spread for 12 months, though travelers continued to bring in cases). The country’s measles elimination status is now in question.

Still, with the stricter exemption rules, anti-vaccine advocates are working to skirt regulations. In California, lawmakers had to work up additional legislation when they realized that anti-vaccine parents were paying unscrupulous doctors for questionable medical exemptions after the state banned exemptions based on personal beliefs, including religion, in 2005. New legislation aims to add state oversight on medical exemptions.

“Educators” and consent

In New York last week, hundreds of parents attended a four-hour workshop called Homeschooling 101 in the ballroom of a hotel on Long Island, according to the WSJ. The event was hosted by the anti-vaccine group New York Alliance for Vaccine Rights and covered course requirements, instruction plans, extracurricular activity options, and potential financial resources for parents.

(Throughout the measles outbreak in New York, anti-vaccine groups have targeted vulnerable communities where the disease is concentrated, namely insular Orthodox Jewish communities.)

While some parents in attendance said they were hopeful that the state would reinstate religious exemptions, others said that homeschooling their children is the “only option we have at this point.” One mother said she would quit her part-time job as a fashion designer to homeschool her three unvaccinated children. “I need to quit everything I’m doing to become an educator,” she said.

Meanwhile, the American Medical Association, the country’s largest physician’s group, has set out to actively fight for stricter exemption rules. And in order to protect the children of anti-vaccine parents—who may be headed for homeschool in some states with stricter exemption rules—the association recently voted to encourage states to pass policies that allow minors to “override their parent’s refusal for vaccinations.”

“The prevalence of unvaccinated pediatric patients is troubling to physicians,” AMA board member Dr. Bobby Mukkamala said in a statement. “Many children go unvaccinated as anti-vaccine related messages and advertisements target parents with misinformation. Allowing mature minors to provide informed consent to vaccinations will ensure these patients can access this type of preventive care.”

The AMA in its statement went on to note that “the overwhelming scientific evidence shows that vaccines are among the most effective and safest interventions to both prevent individual illness and protect public health.”

Currently, only a handful of states allows minors to independently consent to vaccination, according to a recent article in the New England Journal of Medicine.