Are mask mandates a form of Christian persecution? That’s the argument a California man is making after his two teens were sent home for violating their high school’s mask policy.

“The Bible says we’re made in the image of God and Satan tries to cover that up. A mask is a sign of oppression,” Gary Nelson told NBC News. And then it gets worse. He claimed that Muslims and Jews would have been accommodated but that the school administrators “feel safe” persecuting Christians.

These claims are laughable. Nothing in the Bible says you can’t wear masks. And you don’t see anti-masker Christians arguing against wearing clothing or hats or sunglasses. When these conservative Christians start mandating nudity, then they might have a claim about not covering up what God has created.

The first part of his argument is a dangerous but common form of Christian nationalism; the second is a core tenet of both the Jewish and Christian religions. Where he goes into cringe-worthy territory is when he argues that “that image is seen the most by our face.” That’s simply not part of the biblical story in Genesis, and it has been manufactured out of whole cloth to serve an anti-masker agenda.

So why, then, are we seeing new news stories about (mostly conservative) religious communities pushing back against public health initiatives? Liberty University, an evangelical Christian school in Virginia, for example, is under a temporary campus-wide Covid-19 quarantine because of a spike in cases. The school lifted building capacity restrictions and distancing and masking requirements for the fall, and it doesn’t require vaccination, unlike many other colleges trying to return to in-person teaching.

Liberty University’s reluctance to enact Covid-19 protocols has little to do with the Bible, however — and everything to do with politics. Evangelical Christians report some of the highest rates of vaccine hesitancy of any major religious group. And this is closely connected to their allegiance to former President Donald Trump and the GOP.

Besides political leanings, the other big factor driving conservative Christianity’s anti-mask and anti-vaccination movements is a shared persecution complex. Conservative Christians continue to claim persecution in the U.S., even when 7 out of every 10 Americans is Christian. The playbook looks familiar whether the specific issue is the design of Starbucks’ holiday cups, nondiscrimination protections for LGBTQ people or insurance plans that cover contraception. There’s a narrative of Christian persecution that has become so powerful that it’s now a central theme of the religious right’s political strategy (again, emphasis on political).

So no, obviously, the Bible doesn’t say protecting your nose from a virus is a sin. But the cultural narrative that makes that argument appealing to a fringe few is no laughing matter. Instead of trying to use religion to avoid a commonsense scientific solution to a deadly pandemic, I hope religious Americans (and nonreligious Americans) can instead focus on how we can protect one another and save lives. Because the Bible does have a lot to say about that.

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Now that the Food and Drug Administration has fully approved a Covid-19 vaccine, the Pfizer-BioNTech shot dubbed Comirnaty, more employers and universities are mandating immunization. Some people may seek medical exemptions to not receive the shots, but what medical conditions would warrant exemptions?

Individual companies and other institutions can determine what medical exemptions they will allow for Covid vaccination and may leave the decision up to people’s doctors.

Typically, medical exemptions are based on “contraindications” — reasons not to administer a product — cited by the FDA, along with guidance from the Centers for Disease Control and Prevention and other leading medical groups.

That does not mean that anyone with a history of any kind of allergies or anaphylaxis is medically unable to get a Covid vaccine.

“So if you’re allergic to peanuts, it’s irrelevant, because there are no peanuts in the vaccines,” Grabenstein said. “If you’re allergic to pollen, it’s irrelevant, because there’s no ragweed. If you’re allergic to penicillin, there’s no penicillin in the vaccines. So you have to be allergic to a component of the vaccine.”

The number of people who have had anaphylactic reactions to Covid vaccines is very small, about 2 to 5 cases per million doses, said Dr. Niraj Patel of Atlanta, chair of the American College of Allergy, Asthma and Immunology’s Covid-19 Vaccine Task Force.

“Putting this into perspective, you’re as likely to get struck by lightning as you are to have an allergic reaction to a Covid vaccine,” he said.

Patel noted that doctors still are not sure which component or components of the vaccines might trigger anaphylaxis. In the case of the mRNA vaccines made by Pfizer and Moderna, a suspected culprit is polyethylene glycol, or PEG. With the Johnson & Johnson vaccine, it could be polysorbate 80. Both compounds are used in other common products that people may encounter regularly. PEG, for example, is a common ingredient in over-the-counter laxatives. And polysorbate 80 is used as an emulsifier to make foods like ice cream and pudding creamier.

Because the ingredients differ between the mRNA vaccines and the Johnson & Johnson vaccine, it is possible that a person who could be allergic to an mRNA vaccine could safely receive the Johnson & Johnson vaccine, and vice versa, Patel said, though he advised consulting with an allergist first.

What about other medical conditions?

As for any concerns about Covid vaccines in immunocompromised people, Patel said the vaccines are just as safe as they are in the general population, and in fact the FDA recently authorized a booster shot of either the Pfizer or the Moderna vaccines for some patients with very weakened immune systems, such as organ transplant recipients, because they need extra protection.

Cancer patients who are undergoing chemotherapy or other treatments that can weaken their immune systems also can safely get the Covid vaccines but should talk with their physicians about the timing of the shots, said Dr. Julie Gralow, chief medical officer for the American Society of Clinical Oncology.

The CDC says Covid vaccines can be given to pregnant women and most people with underlying medical conditions as long as they do not have severe allergies to the vaccine.

Patients can discuss their concerns with their personal physicians, who may make suggestions about the timing or the type of vaccine.

In the rare cases when someone develops heart inflammation known as myocarditis or pericarditis after an mRNA vaccination, for instance, the CDC advises that patients seeking second doses wait until their symptoms have resolved. And patients with Guillain-Barré syndrome may decide, in consultation with physicians, to receive an mRNA vaccine rather than the Johnson & Johnson vaccine, which has been linked to a potentially increased risk of the syndrome.

The bottom line, Grabenstein said, is that the vast majority of people can safely receive a Covid vaccine, so not very many should be able to claim true medical exemptions.

“We’ve gone past the 200 millionth person to have gotten Covid vaccination just in the United States alone,” he said. “So we now have extensive safety experience with these vaccines.”

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Religious exemptions could prove to be the latest legal battlefield of the pandemic, as Americans opposed to the coronavirus vaccines try to find ways around employer and government vaccination mandates.

Some evangelical pastors are reportedly providing religious exemption documents to members of their churches, and right-wing forums are sharing strategies to skirt vaccination requirements. Religious freedom groups are sending threatening letters to states, schools and employers and preparing legal challenges to fight vaccination mandates.

“There are some First Amendment implications here and there’s a patchwork of laws that could potentially be implicated by these mandates,” said James Sonne, a law professor at Stanford Law School and founding director of its Religious Liberty Clinic. “It's certainly something we’ll see getting worked out in the courts.”

The challenge for governments and institutions is balancing American civil liberties with a worsening public health crisis.

Those challenging employer-created mandates cite Title VII of the Civil Rights Act, which requires employers to make reasonable efforts to accommodate employees, while government-created mandates are being challenged under the First Amendment. Both, however, bring up the question of whether a person’s religious beliefs are sincere.

Thomas Berg, a self-described “strong supporter of religious exemptions” and a religious liberty advocate who teaches law at the University of St. Thomas, a Catholic institution in St. Paul, Minnesota, said he believes that there is a strong case to deny many of the religious claims and to test religious sincerity.

“In cases where you’ve got a lot of potential insincere claims — and I think there’s evidence that is what’s happening here in which people are raising religious objections when they’re motivated by fear of the vaccine or political opposition to it — testing sincerity makes sense,” he said. “We have to test sincerity or else we have to accept them all or deny them all, so I think the courts will provide room for testing that.”

One driver for testing sincerity is the fact that no major organized religion objects to the vaccines, and Roman Catholic and other Christian, Jewish and Muslim leaders have advised followers to get the shots. Pope Francis went so far as to say that getting vaccinated was “the moral choice because it is about your life but also the lives of others.”

Individually held beliefs, however, could provide some protections.

The challenge with religious exemptions

The Christian argument for religious exemptions follows two tracks typically: first, that the vaccine shots at some point in their production used aborted fetal cell lines. The second argument cites a Bible verse that claims that the human body is God’s temple of the Holy Spirit and argues that for that reason receiving a vaccine would be a sin.

Johnson & Johnson did use a replicated fetal cell line in the production of its vaccine, but Pfizer and Moderna did not. They did, however, use replicated fetal cell lines to test the effectiveness of their vaccines. Those cell lines, however, were isolated from two fetuses in 1973 and 1985 and then replicated numerous times over the ensuing decades. They are commonly used in the pharmaceutical and biotech industries to test and create medications.

Arthur Caplan, a bioethics professor at New York University Langone Medical Center, said that people who oppose the coronavirus on religious grounds should also oppose numerous medications and vaccines developed over the past 30 to 40 years.

“There’s a lot more drugs, vaccines and medicines you should not be taking and protesting if you’re really worried about these fetal cells being used,” Caplan said. “I don’t think most of this is sincere. I think it’s just a way to get out of having to take a vaccine.”

But there are many groups that are taking it seriously and giving individuals support and advice on ways to obtain a religious exemption or even challenge a vaccination mandate.

On its website, Liberty Counsel — an evangelical ministry that provides legal assistance in religious liberty cases — provides a 23-minute video guide that has been viewed more than 150,000 times on how to file a religious exemption. It, like other groups, also provides a handful of sample documents to file for an exemption.

Over the past few months, Liberty Counsel has become one of the groups leading the charge on claiming religious exemptions to the growing number of vaccination mandates.

“Just in a few weeks, we’ve received over 10,000 people contacting us for help,” Mathew Staver, the group’s founder and director said. “It’s more than anything we’ve ever encountered before. We’re getting people calling. Some are very concerned and upset, some break down, because they are being forced on a very quick time frame to make a decision between getting one of the Covid shots and their jobs.”

How past cases held up

Last week, Liberty Counsel filed a lawsuit against Maine’s vaccination mandate, arguing it violates a worker’s right to object to the vaccines on religious grounds. The suit was filed on behalf of 2,000 unnamed Maine health care workers who objected to Maine's vaccination mandate for health care workers on the grounds that the state did not allow for a religious exemption.

"We will vigorously defend the requirement against this lawsuit and we are confident that it will be upheld," Maine Attorney General Aaron M. Frey said in a statement to NBC News. "For many years the state has required health care workers to be vaccinated against various communicable diseases and, to our knowledge, that requirement has never been challenged. The state has now simply added an additional disease — COVID-19 — to the list of ones for which health care workers must be vaccinated."

The statement added that federal courts have consistently upheld mandatory vaccination requirements.

Experts said some of their challenges have already been tested and pointed to past legal battles over vaccination mandates, such as those states created for children, nursing homes and hospitals.

Caplan, who was involved in developing some of the flu vaccination mandates that have become commonplace in hospitals, noted that states such as California, New York, Maine and Connecticut have entirely dropped religious exemptions for children.

Backlash to the latest push for religious exemptions could backfire, however.

Doug Opel, a bioethics and pediatrics professor at the University of Washington who has written about the challenges of religious exemptions and vaccination mandates, pointed out that arguing against and not allowing religious exemptions might do more harm than good.

Though there are certainly people who will attempt to falsely secure an exemption, he said he believed that only a small minority of the American population would likely try to obtain one. It might be better to allow religious exemptions to reduce the perception of coercion and allow the vaccination mandates to stand with fewer challenges, he said.

“A policy reason to have exemptions is to allow the very few people who want to opt out to opt out and then allow the mandate itself to stand and be acceptable and sustainable over time,” he said. “Even if a minority opt out, the vast majority will get vaccinated, and the mandate will have served its purpose of reducing transmission and disease.”

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