CHARLESTON, W.Va. (AP) — West Virginia would join 45 other states that allow religious exemptions from childhood vaccines required for school attendance under a bill that passed the House of Delegates on Monday.

The religious exemption is included in a bill that would let private schools decide whether to implement vaccine mandates. It was added to the bill as an amendment that passed on Friday. The overall bill was approved Monday on a 57-41 vote and now goes to the state Senate, where its chances of passage are uncertain. But the Senate will have to act quickly: the 60-day regular session ends on March 9.

Some medical experts in West Virginia, one of the unhealthiest states in the nation among adults, called the bill archaic.

“Legislators want to turn the clock back nearly 100 years and remove some of the safeguards in our vaccination policies,” said Dr. Steven Eshenaur, the health officer for the Kanawha-Charleston health department. “It escapes sound reasoning why anyone would want to weaken childhood immunization laws. Our children are more important than any agenda that would bring these horrific diseases back to the Mountain State.”

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The bill’s original intent was to eliminate vaccine requirements for students in public virtual schools. It was expanded in committee to allow private schools to set their own vaccination standards. Then came the religious exemption added in last week’s amendment.

Amendment sponsor Todd Kirby, a Raleigh County Republican, said the exemption sends a message about existing guarantees of religious freedom. Kirby, who said his children are fully vaccinated, added that it would allow unvaccinated children to be welcomed into schools and day-care facilities and “to have the camaraderie and social interactions that we all know are so important.”

Last year, Kirby co-sponsored a bill later signed by Republican Gov. Jim Justice that would create a test for courts to apply when people challenge government regulations they believe interfere with their constitutional right to religious freedom. About two dozen other states have similar laws.

A federal appeals court last August upheld a 2021 Connecticut law that eliminated the state’s longstanding religious exemption from childhood immunization requirements for schools, colleges and day care facilities. And in Mississippi, a federal judge ruled in April 2023 that the state must allow such exemptions.

Other states that currently don’t have religious exemptions for school immunization requirements are California, Maine and New York, according to the National Conference of State Legislatures.

Unless they have a valid medical excuse, children entering school for the first time in West Virginia currently must be immunized against nine diseases or infections, including chickenpox, measles, whooping cough and tetanus.

Kanawha County Republican JB Akers said he supports the religious exemption but doesn’t like how the bill would let private schools decide on student vaccine requirements while public school students currently must be immunized.

“I think we are potentially creating an equal protection problem,” he said in voting against the bill.

Students who compete in state-sponsored athletic competitions must be immunized and cannot receive a religious exemption under the bill.

Kanawha County Democrat Mike Pushkin chided the House for meddling with the current school vaccine law.

“We do not have the right to harm others,” Pushkin said. “This bill does harm.”

According to the Centers for Disease Control and Prevention, West Virginia’s life expectancy in 2020 was 72.8 years. Only Mississippi’s was lower at 71.9. West Virginia has the nation’s highest death rate from diabetes and heart disease, and has long had the nation’s highest drug-related death rate. It was among three states with an obesity prevalence of 40% or greater in adults in 2022, the CDC said.