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.
Pastor Henning Jacobson already lived through an era of mandatory vaccinations back in his original home in Sweden. The national law made vaccination mandatory and when Henning was a child he was vaccinated for smallpox. Although these efforts to eradicate smallpox were successful in Sweden, Henning Jacobson did not agree with the methods. He claimed it caused a “great and extreme suffering” that he would have to endure for the rest of his life. Similar to Henning’s experience, one of his sons was vaccinated as a child as well and “suffered adverse effects” from it. Thus leading Henning Jacobson and his wife to be hesistant and resistant whe n it came to the mandatory vaccinations in the early 20th century in Massachusetts.
A leader in his community, Swedish immigrant Pastor Henning Jacobson was one of the few who resisted mandatory vaccinations against smallpox during the early 20th century in Cambridge, Massachusetts. While many were pleased to hear about a vaccine for smallpox, others were alarmed by the idea of being stabbed by a needle and having cowpox being injected inside of them. Jacobson was distraught by this vaccine and took his case to the Supreme Court in 1905 against mandatory vaccinations. Pastor Henning Jacobson, refused the vaccine stating it was an “invasion of his liberty”. During this time in history efforts to end the smallpox epidemic included mandatory vaccination. According to the Supreme Court documents, the argument against Jacobson was that the “mandatory smallpox vaccination [was] constitutional”. Those who refuse vaccination would be prosecuted. The fine for refusal of the vaccination was a $5 monetary fine which equals to about $100 today. Pastor Jacobson refused vaccination claiming, “he and his son had had bad reactions to earlier vaccinations”. Because of his refusal of the vaccination, Jacobson was fined $5 and afterwards he appealed to the Supreme Court.
The 14th Amendment was brought up during the Jacobson vs. Massachusetts case regarding individual liberty. The case showed that the State was “restricting one aspect of liberty” by forcing people to get vaccinated. In its ruling in support of the Massachusetts law, the Supreme Court identified two primary rationales. The first was that the “the state may be justified in restricting individual liberty...under the pressure of great dangers” to the safety of the “general public.” By identifying the smallpox epidemic as a danger to the general public, individual rights and liberty were subordinate to the State’s obligation to eradicate the disease. Jacobson had also argued that the law requiring vaccination was "arbitrary or oppressive."  The Court rejected the argument, indicating that mandatory immunization in the face of epdemic was neither, instead insisting that vaccination was a measure for “getting to their goal of eradicating smallpox”. 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 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.
- Wilrich, Michael (2011). Pox: An American History. Penguin.
- "FindLaw's United States Supreme Court case and opinions.". Findlaw. Retrieved 2015-11-22.
- Mariner, Wendy K.; Annas, George J.; Glantz, Leonard H. (2005-04-01). "Jacobson v Massachusetts: It’s Not Your Great-Great-Grandfather’s Public Health Law". American Journal of Public Health 95 (4): 581–590. doi:10.2105/AJPH.2004.055160. ISSN 0090-0036. PMC 1449224. PMID 15798113.
- "Toward a Twenty-First-Century Jacobson v. Massachusetts" (PDF). Harvard Law Review (The Harvard Law Review Association) 121 (7): 1822. May 2008. Retrieved 13 March 2014. Cite error: Invalid
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- 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.
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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)