There is no doubt that vaccination has been one of the greatest successes of public health programs in the 20th century. Vaccinations have eradicated naturally occurring smallpox, and have substantially reduced morbidity and mortality from infectious diseases that previously ravaged the population, such as polio and measles. Despite the successes, there has been a history of “anti-vaccinationists” in the U.S., who among other challenges, argued compulsory vaccination was an infringement upon personal liberty and their right to choice (1, 2). In fact, it took a Supreme Court decision to ultimately assert whether a state mandating vaccination infringed upon the U.S. Constitution.
Compulsory vaccination in the U.S. was established in the federal Supreme Court case Jacobson v. Massachusetts, which ruled that the common good allowed a state to require vaccination (3). This 1905 landmark decision held that the common good – defined as safety and health – could override personal liberty in the matter of vaccination laws (3).
Henning Jacobson, a resident of Cambridge, Massachusetts, refused smallpox vaccination required by a recently enacted regulation of the city, and was assessed a $5 fine (roughly $125 in today’s currency). Mr. Jacobson refused on the grounds the vaccination caused harm and violated his personal liberties granted by the U.S. Constitution, citing the Preamble and the 14th amendment; namely, Section 1 of the 14th amendment, which states “No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law” (4).
The case progressed from the local court to the state supreme court, each time being upheld as constitutional, and consequently, Mr. Jacobson was in violation of the law and required to pay the original $5 fine. Ultimately the U.S. Supreme Court agreed to hear the case and address the question, “[is the state’s] statute, so construed, therefore, inconsistent with the liberty which the Constitution of the United States secures to every person against deprivation by the state” (3). In other words, the Court examined the notion of a state’s police powers, the extent, and enforceability of such. In a 7 to 2 court decision, the Justices ruled that the safety and health of the citizens of Massachusetts were superior to the individual right, and by extension, compulsory vaccination is constitutional both within the Massachusetts and U.S. constitutions.
Over one hundred years removed from this decision, this case is still discussed and analyzed in scholarly works, indicating the sustained relevance of the tensions and conflicts. The U.S. Supreme Court cited this case 69 times through 2004 (5). In addition to granting compulsory vaccination at the state level, Jacobson v. Massachusetts has been used to justify public health initiatives ranging from quarantine of diseased individuals...