Jacquelynn Vance-Pauls, a real estate lawyer in upstate New York, has a 14-year-old son with autism who was recently kicked out of his private special needs school.

Her 9-year-old twins and her high-school senior are also on the verge of being expelled from their public schools. The children did not do anything wrong, nor are they sick.

The Bible, she said, barred her as a Christian from “desecrating the body” – which is what she says vaccines do.

The famous faces of the anti-vaccine movement Show all 7 1 /7 The famous faces of the anti-vaccine movement The famous faces of the anti-vaccine movement Charlie Sheen Sheen fought a legal battle against ex-wife Denise Richards to try and block her from vaccinating their children. Richards of course won and Sheen was reportedly so bitter that he paid the paediatrician bill entirely in nickels Getty The famous faces of the anti-vaccine movement Gwyneth Paltrow Paltrow's "health and wellness" company Goop hosted a notorious anti-vaccine speaker at their 2018 Goop Summit Getty The famous faces of the anti-vaccine movement Rob Schneider Schneider demanded the freedom to decline vaccination Getty The famous faces of the anti-vaccine movement Jenny McCarthy McCarthy has claimed that "people are dying from vaccinations", believes that her son caught autism from a vaccine and has pushed her opinions on the topic publicly for many years AFP/Getty The famous faces of the anti-vaccine movement Bill Maher Maher has long spoken against vaccines sating on Larry King live that "a flu shot is the worst thing you can do." His stance appears to stem from a distrust of government AFP/Getty The famous faces of the anti-vaccine movement Alicia Silverstone In Silverstone's book The Kind Mama, she wrote that "there is increasing anecdotal evidence from doctors who have gotten distressed phone calls from parents claiming their child was ‘never the same’ after receiving a vaccine." Getty The famous faces of the anti-vaccine movement Andrew Wakefield Godfather of the anti-vax movement, disgraced doctor Andrew Wakefield famously published a report in the medical journal Lancet claiming a link between the MMR vaccine and autism in 1998. The Lancet retracted the report in 2010 and Wakefield was struck off the medical register PA

“If you have a child who you gave peanut butter to and he almost died, why would you give it to your next child?” she said during an interview in August, trying to explain her fears.

“How do we turn our backs against what we have believed all these years because we have a gun to our heads?”

With the start of school this week, Ms Vance-Pauls, along with the parents of about 26,000 other New York children who previously obtained religious exemptions to vaccinations, are facing a moment of reckoning.

Under the new law, all children must begin getting their vaccines within the first two weeks of classes and complete them by the end of the school year. Otherwise, their parents must home-school them or move out of the state.

Since the start of the outbreak in October 2018, there have been 654 measles cases in the city and 414 in other parts of the state, where transmission has also slowed.

The large majority of cases have involved unvaccinated children in Hasidic Jewish communities, where immunisation rates were sometimes far lower than the state average of 96 per cent.

Wide-scale vaccination campaigns have helped lift those rates.

But health officials warned on Tuesday that as school begins, the highly contagious disease could easily return, particularly if vaccination rates drop again.

The World Health Organization warns of global rise in measles cases

“The threat remains, given other outbreaks in the U.S. and around the world,” said Dr Oxiris Barbot, the city’s health commissioner. “Our best defence against renewed transmission is having a well-immunised city.”

With the passage of the new law 13 June, New York became only the fifth state to bar all nonmedical exemptions to vaccination and now has among the strictest policies in the nation.

Maine, where a new law barring all but medical exemptions does not go into effect until 2021, makes exceptions for special education students. California, where nonmedical exemptions were ended in 2015, gave parents with nonmedical exemptions extra time to comply and allowed districts to exempt disabled children.

The New York law allows no such exceptions.

The anti-vaccination community in New York has filed several lawsuits seeking to block the legislation, but none have succeeded so far.

The law is already encouraging parents on the fence about vaccination to immunise their children and is sending a message to public and private schools that the days of selective vaccination are over. But for parents who remain deeply sceptical, more steps will be needed, say doctors who study vaccine refusal.

Dr Daniel Salmon, director of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health, pointed out that unease about vaccines is not just a fringe issue.

A 2011 study, for example, found that roughly a quarter of all American parents had serious concerns about vaccines, and 30 per cent worried that vaccines may cause learning disabilities, such as autism.

Eliminating nonmedical exemptions is a partial solution, Dr Salmon said, adding that more research funding was needed to study the safety of vaccines and to counteract the anti-vaccine lobby.

“It’s a big hammer that isn’t getting at the big problem,” he said. “Parents have concerns that aren’t being addressed.”

In the state’s Mennonite and Amish communities, where some schools had high religious exemption rates, health officials reported progress after meetings about the vaccination requirements.

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In Yates County in the Finger Lakes region, “well over 50 children” were scheduled for shots in late August, said Deborah Minor, director of public health for Yates and Schuyler counties.

“My sense is that the schools are taking this very seriously,” she said.

Rabbi Yakov Horowitz, founding dean of Yeshiva Darchei Noam in Rockland County, said public sentiment in his Orthodox Jewish community had “shifted significantly” towards vaccination over the past year because of the measles outbreak, public health outreach and supportive statements by influential rabbis.

“Hopefully, most people will abide,” said Dr Patricia Schnabel Ruppert, health commissioner of Rockland County. But she also said that because her efforts had been focused only on preventing measles, there was much more education to do about vaccines to protect against other diseases.

Some parents who do not want to vaccinate their children are turning to home schooling. Under state law, home-schooled children may meet in cooperative learning groups for up to three hours a day.

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Kristina Staykova said she was shutting down her fashion business as she tries to figure out how to home-school her children, including a 4-year-old with autism. Her 5-year-old daughter has already been told not to return to Public School 6 on Manhattan’s Upper East Side.

She recently went to a home-schooling conference in Melville, New York, where there were about 300 parents, most of whom, like her, believed that their children had been injured by vaccines, she said.

Part of the challenge facing health officials across the country, said Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine in Texas, is that steps should have been taken years ago to reduce nonmedical exemptions before they became more common and opposition spread.

Still, only a tiny fraction of New York children had religious exemptions: about 0.8 per cent of all schoolchildren statewide in 2017-18, the last school year for which data was available.

For Ms Vance-Pauls, Tuesday was the end of the line. With school starting on Wednesday, she made an appointment with a doctor on Tuesday for each of her children to get one shot apiece and appointments over the coming weeks for the rest of the required shots.

Her family did not have the option to home-school or move, so she felt she had no other choice.

“I’m praying to God that my twins are now 9 and can handle what Jack couldn’t handle when he was a baby,” Ms Vance-Pauls said, referring to her autistic son. “I feel like there is nowhere for us to run.”