Jacobson v. Massachusetts
|Jacobson v. Massachusetts|
|Argued December 6, 1904
Decided February 20, 1905
|Full case name||Henning Jacobson, plaintiff in error v. Commonwealth of Massachusetts|
|Citations||197 U.S. 11 (more)|
|[T]he police power of a state must be held to embrace, at least, such reasonable regulations established directly by legislative enactment as will protect the public health and the public safety.|
|Majority||Harlan for seven members|
|Dissent||Brewer and Peckham|
Jacobson v. Massachusetts, 197 U.S. 11 (1905), was a United States Supreme Court case in which the Court upheld the authority of states to enforce compulsory vaccination laws. The Court's decision articulated the view that the freedom of the individual must sometimes be subordinated to the common welfare and is subject to the police power of the state.
Henning Jacobson, a Swedish immigrant to the United States and a minister, lived in Cambridge, Massachusetts. During an outbreak of smallpox in 1902, he refused to comply with the town's order for all adults to be vaccinated. He claimed a vaccine had made him seriously ill as a child and had made his son and others sick as well. He was ordered to pay a $5 fine. He refused to pay and the Massachusetts courts, including the Supreme Judicial Court, rejected his arguments that the compulsory inoculation violated the state and U.S. constitutions. Jacobson was supported by the Massachusetts Anti-Compulsory Vaccination Association. Massachusetts was one of only eleven states that had compulsory vaccination laws.
Opinion of the Court
Ruling on Henning Jacobson
Justice John Marshall Harlan delivered the decision for a 7-2 majority. He rejected Henning Jacobson’s claim that the Fourteenth Amendment gave him the right to refuse vaccination. Harlan deemed that the Massachusetts state punishment of fine or imprisonment on those who refused vaccines was acceptable but that those individuals could not be forcibly vaccinated.  At the end of his decision, Judge Harlan acknowledged that for certain individuals, the requirement of vaccination would be cruel and inhuman and therefore an overreach of government power. This created a medical exemption for adults under the Massachusetts health law but Harlan denied that Henning Jacobson deserved exemption. 
Harlan ruled that personal liberties could be suspended given external circumstances. During an outbreak, for example, the state can encroach on those liberties when "the safety of the general public may demand." He compared the smallpox outbreak to the Civil War (in which three out of nine Justices at the term served) by saying that a community has the right to protect itself both from disease and from military invasion. 
More broadly, Harlan ruled that the State of Massachusetts was justified in mandating vaccination, as “there are manifold restraints to which each person is necessarily subject for the common good”  While Harlan supported such restraints, he also warned that if the state targeted specific individuals or populations to unnecessary restrictions the court may have to step in to protect them. This specification falls just a few years after Wong Wai v. Williamson in which a federal circuit court injunction in San Francisco was overturned. This injunction required all Chinese residents of San Francisco to get a dangerous bubonic plague inoculation if they wished to leave the city, which Judge William Morrow ruled was "boldly directed against the Asiatic or Mongolian race as a class."
Harlan's decision both supported both police power and limits on said power, and his decision would be invoked to support both in later cases. He stated his nuanced opinion on the limits of government power by saying that “general terms should be so limited in their application as not to lead to injustice, oppression or absurd consequence.” 
The anti-vaccine movement mobilized following the decision and the Anti-Vaccination League of America was founded three years later in Philadelphia to promote the principle that "health is nature’s greatest safeguard against disease and that therefore no State has the right to demand of anyone the impairment of his or her health." The League warned about what they believed were the dangers of vaccination and the dangers of allowing the intrusion of government and science into private life, part of the broader process identified with the Progressive Movement. The League asked: "We have repudiated religious tyranny; we have rejected political tyranny; shall we now submit to medical tyranny?"
The Supreme Court reaffirmed its decision in Jacobson in Zucht v. King (1922), which held that a school system could refuse admission to a student who failed to receive a required vaccination.
One analysis of the decision in Jacobson called it "a foundational public health law case" but also said that "It addressed issues about medicine, disease, and society that are no longer relevant today", because protection against airborne diseases like smallpox requires a different response from public health authorities than the diseases communicated by intimate contact for which vaccines are being developed in the late 20th and 21st centuries such as the HPV vaccine.
- ""Toward a Twenty-First-Century Jacobson v. Massachusetts"". Harvard Law Review (The Harvard Law Review Association) 121 (7): 1822. May 2008. Retrieved 13 March 2014.
- Curry, Lynn (2002). The Human Body On Trial: A Sourcebook With Cases, Laws, And Documents. ABC-CLIO. p. 105. ISBN 1-57607-349-1.
- Willrich, Michael (2011). Pox: An American History. Penguin Books. pp. 319–329. ISBN 978-0-14-312078-0.
- "Toward a 21st-century", 1823-4
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- "Toward a 21st-century", 1821
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- George J. Annas, "Blinded by Bioterrorism: Public Health and Liberty in the 21st Century," Health Matrix (2003)
- James Colgrove and Ronald Bayer, "Manifold Restraints: Liberty, Public Health, and the Legacy of Jacobson v. Massachusetts", American Journal of Public Health, vol. 95, no. 4 (2005), 571–576
- Lawrence O. Gostin, "Jacobson v. Massachusetts at 100 Years: Police Power and Civil Liberties in Tension," American Journal of Public Health, vol. 95, no. 4 (2005), 576–581
- Wendy K. Mariner et al., "Jacobson v. Massachusetts: It's Not Your Great-Great-Grandfather's Public Health Law," American Journal of Public Health, vol. 95, no. 4 (2005)
- Michael Willrich, Pox: An American History (Penguin, 2011)