In the early 1900s, regulation over individual behavior was on the rise. Restrictions over contraceptives, abortion, alcohol, and drug use were supported by the federal government. In addition, politicians and the courts prioritized economic rights over individual liberties. Along with these changing sentiments, smallpox and other infectious diseases were spreading. Boston had an outbreak of smallpox that led to 1,596 cases and 270 deaths. States began to require vaccination mandates to stop the spread of the disease. These new police power actions led to claims from those arguing for individual rights.
In Massachusetts, state law allowed for cities to require smallpox vaccinations. The city of Cambridge adopted a smallpox vaccination mandate, with some exceptions. However, Henning Jacobson, a Cambridge minister, refused to be vaccinated. Jacobson claimed he had adverse reactions to previous vaccinations. Jacobson was fined the equivalent of nearly one hundred and fifty dollars today. Jacobson and his lawyer argued that the vaccination mandate violated his Fourteenth Amendment rights to liberty. The Fourteenth Amendment’s text states that no state “shall… deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of laws.” The Supreme Court was asked to decide if Cambridge’s vaccination mandate violated Jacobson’s Fourteenth Amendment rights.
In a 7-2 decision, the Court held that Jacobson’s Fourteenth Amendment rights were not violated because states had the police power to handle health emergencies. While the Court acknowledged individual freedoms, Justice Marshall Harlan wrote in his decision that people do not have the right to refuse the smallpox vaccination. Harlan used social-compact theory, noting that citizens have a duty “to one another and to society as a whole.” Harlan compared Cambridge’s measures to quarantines of ships arriving in America when yellow fever was ablaze globally.
Justice Harlan set four standards for mandatory vaccinations imposed by the state: necessity, reasonable means, proportionality, and harm avoidance. Vaccines needed to be given with purpose, not arbitrarily. The methods of vaccination must prevent or get rid of an actual threat to human health. If the vaccine disproportionately harmed rather than helped an individual it was unconstitutional. The vaccine must also not pose a health risk to the person receiving the vaccine. Harlan and the majority decided that these standards were met since the local boards of health decided to mandate vaccines in order to stop the spread of smallpox.
Justices David Josiah Brewer and Rufus W. Peckham dissented. However, their dissents have been omitted from current copies of the case text.
The justices treated regulations on individual rights similarly to how they treated regulations on the economy at the time, with broad acceptance. Jacobson v. Massachusetts (1905) was a landmark case for police powers during public health emergencies and is often seen as the most important Supreme Court case about public health. The case has not often been subject to controversy or discussion.
However, public health experts have recently struggled with the tensions Jacobson outlined. Supreme Court cases since 1905 have given more protection to individual liberties. In April of 2020, a United States appeals court used Jacobson as the only precedent to uphold a Texas law that banned abortions during the coronavirus pandemic. The court agreed with Texas Governor Greg Abbott that it was a non-essential medical service and took up personal protective equipment that was under short supply. This case never reached the Supreme Court since Governor Abbott decided to loosen the state’s abortion restrictions. In 2019, after Brooklyn, New York had an outbreak of measles, the New York City government mandated measles vaccinations. Courts have upheld the Brooklyn mandate by citing Jacobson. The Court has viewed vaccination mandates and other public health actions as constitutional as long as they address specific public health dangers.