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)|
|The police power of a state must be held to embrace at least such reasonable regulations established directly by legislative enactment to protect public health and 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 he was a child, he was vaccinated for smallpox. Although the efforts to eradicate smallpox were successful in Sweden, he 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. Like his experience, one of his sons was vaccinated as a child as well and "suffered adverse effects" from it. Jacobson and his wife were thus resistant when  it came to mandatory vaccinations in Massachusetts.
A leader in his community, Jacobson was one of the few who resisted mandatory vaccinations for smallpox in 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 injected inside of them. Jacobson was distraught by this and took his case to the Supreme Court in 1905 against mandatory vaccinations. He refused the vaccine stating it was an "invasion of his liberty." Efforts to end the smallpox epidemic included mandatory vaccination. According to the Supreme Court documents, the argument against Jacobson was that the " mandatory smallpox and mumps vaccination [was] constitutional." Those who refuse vaccination would be prosecuted. The fine for refusal of the vaccination was a $5 monetary fine, equivalent to about $130 today. Pastor Jacobson refused vaccination by claiming that "he and his son had had bad reactions to earlier vaccinations." Because of his refusal of the vaccination, Jacobson was fined $5 and appealed to the Supreme Court.
The Fourteenth Amendment was brought up during the case on 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. One was that "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 by indicating that mandatory immunization in the face of epdemic was neither but insisted that vaccination was a measure for "getting to their goal of eradicating smallpox." Massachusetts was one of only 11 states that had compulsory vaccination laws.
Justice John Marshall Harlan delivered the decision for a 7-2 majority. He rejected Jacobson's claim that the Fourteenth Amendment gave him the right to refuse vaccination. Harlan deemed that the Massachusetts state punishment of a fine or imprisonment on those who refused vaccines was acceptable, but those individuals could not be forcibly vaccinated. At the end of his decision, he acknowledged that for certain individuals, the requirement of vaccination would be cruel and inhumane and so an overreach of government power. That 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 American Civil War (in which three out of nine Justices at the term served) by saying that a community has the right to protect itself from both disease and military invasion.
More broadly, Harlan ruled that Massachusetts was justified in mandating vaccination: "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 might have to step in to protect them.
That was a few years after Wong Wai v. Williamson in which a federal circuit court injunction in San Francisco was overturned. It 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 the 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 it believed to be 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 from the diseases that are communicated by intimate contact for which vaccines are being developed in the late 20th and 21st centuries, such as the HPV vaccine.
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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)