Takeaway
In short, this case holds that States may impose reasonable vaccination requirements during a public-health emergency, subject to constitutional limits against measures that lack a real public-health connection or are arbitrarily oppressive in a particular case.
Massachusetts authorized local boards of health to require vaccination when, in their judgment, it was necessary to protect public health or public safety. During a smallpox outbreak that was prevalent and increasing in Cambridge, the city’s Board of Health ordered adult residents to be vaccinated or revaccinated.
Jacobson refused vaccination and was prosecuted. He offered evidence intended to show that vaccination could cause serious injury or death and that he had suffered from a disease following vaccination as a child. The trial court excluded the proposed evidence, and Jacobson was found guilty and fined $5. The Supreme Judicial Court of Massachusetts upheld the conviction, construing the statute to require vaccination generally of competent adults who remained in Cambridge. Jacobson sought review in the Supreme Court of the United States.
Issue #1
Whether Massachusetts could, consistent with the Fourteenth Amendment’s protection of liberty, enforce a local compulsory-vaccination regulation during a smallpox outbreak by imposing a penalty on an adult who refused vaccination.
Holding
Yes. As applied to Jacobson, the vaccination requirement was a valid exercise of the State’s police power and did not deprive him of liberty without due process of law.
Reasoning
The Court began with the State’s police power: the reserved authority to enact reasonable measures protecting public health and public safety. That authority includes quarantine and health laws, and a State may authorize local health boards to act when a local emergency requires it. Cambridge’s board therefore could determine, under the legislature’s authorization, that vaccination was needed to address an increasing smallpox outbreak.
Constitutional liberty is not an absolute right to act according to one’s own judgment regardless of the consequences for others. Organized society necessarily imposes restraints for the common good. The Court compared vaccination requirements to quarantine and military service: in circumstances of serious public danger, a person’s control over his own movements or body may be subject to reasonable legal regulation.
The Court deferred substantially to the legislature’s judgment about how to address smallpox. Vaccination had long been accepted by much of the medical profession, legislatures, and the public as a means of preventing or limiting the disease. Faced with competing medical views, the legislature was entitled to choose the view it regarded as protective of public health; courts and juries were not to decide which of two health measures was scientifically best.
Judicial intervention remained available if a purported health measure had no real or substantial relation to public health or safety, or if it plainly and palpably invaded a right secured by the Constitution. But the Cambridge regulation easily cleared that threshold because smallpox was prevalent and increasing and vaccination bore an evident relation to controlling its spread. The fact that the requirement was inconvenient or objectionable to some individuals did not make it unconstitutional.
Issue #2
Whether the statute denied adults equal protection by exempting children certified by a physician as unfit for vaccination while providing no express equivalent exemption for adults.
Holding
No. The statute did not deny equal protection because it applied equally to adults in like circumstances, and the legislature could reasonably regulate adults and children differently.
Reasoning
The Court held that the different treatment of children did not establish unconstitutional discrimination against adults. The law treated adults alike, and there were obvious reasons why a regulation suitable for adults might not safely be applied in the same manner to children of tender years. The Fourteenth Amendment did not require identical rules for groups whose conditions and needs could reasonably differ.
Issue #3
Whether Jacobson’s evidence about the general risks of vaccination and his earlier adverse experience entitled him to an exemption from the vaccination requirement.
Holding
No. Jacobson’s offers of proof did not show that he was then medically unfit for vaccination, and they did not justify a judicial reexamination of the legislature’s general public-health judgment.
Reasoning
Most of Jacobson’s proposed evidence presented the general anti-vaccination view that vaccination was ineffective or dangerous. The Court concluded that this evidence merely asked the court and jury to revisit the policy dispute already resolved by the legislature. The existence of professional disagreement, or the possibility that vaccination could sometimes produce injury, did not make the public-health measure unconstitutional.
The Court carefully limited its decision. It recognized that a vaccination mandate could be arbitrary or oppressive in a particular case—for example, if vaccination of an adult in that person’s present physical condition would be cruel and inhuman, seriously impair health, or probably cause death. General statutory language should ordinarily be read to avoid such unjust or absurd consequences.
Jacobson, however, had not offered to prove that he was medically unfit when the Cambridge regulation was enforced or that the vaccine proposed for him was unsuitable. His childhood experience and fear of another injury did not establish a present medical inability to be vaccinated. On the record before it, the Court treated him as a healthy adult who refused a lawful measure adopted to protect the community during an epidemic.