AUGUSTA, Maine (AP) Maine Democratic Gov. Janet Mills has signed into law a bill that eliminates religious and philosophical exemptions for required vaccinations.

With her signature on Friday, Maine will end non-medical vaccine opt-outs by 2021 for students at public and private schools and universities, including nursery schools, and for health care facility employees.

Maine joins California, Mississippi and West Virginia to become the fourth state without religious exemptions for vaccine requirements.

Maine has one of the highest rates of non-medical vaccine exemptions in the nation, and health officials say the opt-out rates appear to be rising.

The sponsor, Democratic Rep. Ryan Tipping of Orono, said it has become clear amid reports of measles and other preventable diseases “that we must act to ensure the health of our communities.”