Child Health, Disease, Health Policy, Health Promotion, In the News, Recommendations, Vaccines

To Vaccine or Not to Vaccine – A Legal Question


Between January and March of 2019, there were multiple measles outbreaks. As of March 22nd, seventy-two individuals were diagnosed with measles. Outbreaks like this one have shown that pockets of low vaccination rate can results in outbreaks that threaten life, limb, and pocketbook. However, it is unclear what the government can do to prevent them. In Kentucky, a teenager is suing to be allowed to attend school despite not having the chickenpox vaccine—and a current chicken-pox outbreak in the area. In New York, Rockland County declared a state of emergency, banning unvaccinated youth from public places. This leads us to ask the question:

What does the Supreme Court have to say about vaccine requirements?

The United States government has a well-established duty to prevent disease outbreaks. In Jacobson v. Massachusetts (1905), the Supreme Court ruled that states are constitutionally justified in requiring their citizens to be vaccinated against contagious diseases unless medically contraindicated. Specifically, the majority opinion determined that 1) states have a duty to protect the health of their constituents, 2) states and municipalities are justified in requiring individuals to get vaccinated to fulfill this duty, and 3) individual beliefs or opinions are not sufficient reason to disobey these requirements.

“We are not prepared to hold that a minority, residing or remaining in any city or town where smallpox is prevalent, and enjoying the general protection afforded by an organized local government, may thus defy the will of its constituted authorities, acting in good faith for all, under the legislative sanction of the state. If such be the privilege of a minority, then a like privilege would belong to each individual of the community, and the spectacle would be presented of the welfare and safety of an entire population being subordinated to the notions of a single individual who chooses to remain a part of that population.” — Majority opinion by Justice Harlan.

The right of the state to require vaccinations was upheld in Zucht v. King (1922), when a young woman in San Antonio was excluded from attending both public and private schools because she refused to be vaccinated. Since then, states have required vaccinations with varying degrees of strictness.

What do you think?

Should states be able to fine or otherwise enforce vaccination requirements? Should people be able to refuse vaccinations for moral or religious reasons? What do you think the future holds for vaccine laws?

More Resources

  1. Mariner WK, Annas GJ, Glantz LH. Jacobson v Massachusetts: It’s Not Your Great-Great-Grandfather’s Public Health Law. American Journal of Public Health. 2005;95(4):581-590. doi:10.2105/ajph.2004.055160.
  2. Measles Outbreak 2019. Washington State Department of Health. Accessed March 1, 2019.
  3. Associated Press. Cost of Washington’s measles outbreak tops $1M. KGW8. Published February 23, 2019. Accessed March 1, 2019.
  4. HENNING JACOBSON, v. COMMONWEALTH OF MASSACHUSETTS. (United States Supreme Court 1905). Accessed March 1, 2019.
  5. The Supreme Court On Vaccination Laws. American Journal of Public Health. 1923;13(2):120-121. doi:10.2105/ajph.13.2.120.
  6. States with Religious and Philosophical Exemptions from School Immunization Requirements. Published January 30, 2019. Accessed March 1, 2019.