There has been growing controversy in recent years over vaccinations, with those opposed to vaccinations claiming that mandating them violates their constitutional rights. This article seeks to look past the debate on mandatory vaccines and instead focus on examining the legal precedent surrounding the issue, which will help us determine what the future of mandatory vaccines in the United States looks like. 

Currently, all 50 states require some form of mandatory vaccinations. When broken down further, each state differs on the specific vaccinations required and what constitutes an acceptable excuse to be exempt from a vaccine. Forty-seven states and the District of Columbia currently allow parents to exempt their children from immunizations on religious grounds while 18 states allow for said exemptions on philosophical grounds. 

Before we look ahead towards the future of vaccinations, let’s take a look at the legal history of vaccination in the United States. In 1809, Massachusetts was the first state to instate mandatory vaccinations for smallpox. This started a growing trend between medical advancements and government mandates for vaccinations. By 1855, Massachusetts became the first state to require vaccinations to attend public schools. They were followed by a slew of states in the years thereafter. However, this did not happen without citizen backlash and legal challenges. In the latter half of the nineteenth century, organizations such as The Anti-Vaccination Society of America and the New England Anti-Compulsory Vaccination League were created. These groups were inspired in part by British anti-vaccination groups who grew in number and influence after the passage of the U.K. Vaccination Acts of 1840, 1853, and 1867. The group urged that “no man can be compelled to submit to any surgical operation against his own will” and ordered their followers “to protest against any legislation calculated to make vaccination compulsory.”

Anti-vaccination groups proved to be effective in their efforts. Through state-by-state lobbying via battles through the courts and on the floors of state legislatures, compulsory vaccination laws were repealed in several states. While the momentum swung between pro-vaccine advocates and anti-vaxxers in the late nineteenth century, the first defining court ruling on vaccines came shortly after the turn of the new century. 

The case ​Jacobson v. Massachusetts (1905) ​was a prominent challenge to this law, which set a legal precedent for mandatory vaccinations. In this case, Henning Jacobson argued that a Massachusetts law that allowed cities to institute mandatory vaccinations violated his Fourteenth Amendment right to privacy. Jacobson lost his case on appeal before the Supreme Court in a 7-2 majority opinion that ruled it is within the state’s power to protect the public health and safety of its citizens. The Court deemed that mandating vaccinations against smallpox was within that power. However, the decision allowed for further challenges as it allowed for a legal medical exemption and stipulated that while people could be fined for refusing vaccinations, they could not be forced to get vaccines. The Court reaffirmed this precedent 17 years later in ​Zucht v. King (1922)​. ​​This unanimous decision by the Court ruled that it is “within the police power of a state to provide for compulsory vaccination” thus granting authority to public schools to deny students entry if they refused to get appropriate vaccinations. 

Several vaccination-related laws went through Congress in the 1980s and 1990s, which have shaped the current political climate around vaccines. In 1986, Congress passed the ​National Childhood Vaccine Injury Act, which prohibited vaccine manufacturers and doctors from being held liable if an individual had a severe reaction to vaccines. Two years later, Congress passed the ​National Vaccine Injury Compensation Program, which sought “to ensure an adequate supply of vaccines, stabilize vaccine costs, and establish and maintain an accessible and efficient forum for individuals found to be injured by certain vaccines.” Congress continued advocating for vaccines via the ​Comprehensive Childhood Immunization Act of 1993, ​which established a program that gave low-income kids access to free vaccinations. After more than 200 years of vaccine-related legislation passed in the state and federal government, it is important to note that the federal government has ​never ​passed any legislation demanding vaccinations. Throughout time, this has always been an issue decided upon by a state-by-state basis. 

In America today, there is a resurgent “anti-vaxxer” movement that is seeking to strike government mandates on vaccines. This movement is propagated on the belief that there is a direct link between vaccines and autism, as well as a belief that the government is infringing on personal liberties. This claim generated a substantial amount of attention when a doctor named Andrew Wakefield in 1998 released an article in which he concluded that there is a direct link between certain vaccines and autism. After an investigation into his findings, they were found to be unsubstantiated, and Wakefield was stripped of his license to practice medicine in the United Kingdom in 2011. Even though Wakefield’s findings were disproven, people still share his sentiments on the issue. In an interview with VICE News, Texas State Rep. Briscoe Cain, R-Texas, effectively summarized the constitutional lens through which anti-vaxxers advocates see this issue. “I believe that in the hierarchy of rights, liberty is higher than safety and security,” Cain said. 

As recent laws have been proposed in statehouses across the country to close loopholes which allow parents to exempt their students from receiving vaccines on religious and philosophical grounds, the anti-vaxxer movement has swarmed these statehouses to protest. For example, in the wake of a measles outbreak which infected dozens of people in Washington State, the House last month voted in favor of a bill which banned religious and philosophical objections to vaccines. This drew hundreds of anti-vaccine protesters to Olympia, saying that the bill violated their freedom to choose whether to vaccinate their children. A similar instance occurred in 2015 where an outbreak of measles at Disneyland in Anaheim, California prompted lawmakers to take swift action by passing Senate Bill 277. Similar to the bill passed in Washington, this bill too removed religious and philosophical exemptions from vaccines. 

In the interim, it appears there is a general consensus held by lawmakers that vaccines are effective at preventing diseases and do not directly result in autism. However, we are experiencing a shift towards anti-vaccine sentiments within the conservative movement, which reflects the beliefs of Mr. Cain. Three GOP gubernatorial candidates who ran in 2018 echoed sentiments shared widely by anti-vaxxers. Connecticut gubernatorial hopeful Bob Stefanowski said it “depends on the vaccination” whether the government should mandate vaccinations to enroll in a public school. Policy discussions on vaccinations are apt to change if conservatives continue to trend in this direction. 

In future legal battles over vaccinations, if judges are of the belief that personal liberties prevail over any other right, we could see a departure from long-standing legal precedent which allows for states to mandate vaccinations. However, the anti-vaccination movement has not experienced any tangible legislative victories in recent years. The belief that mandatory vaccines do not violate constitutional rights still remains the consensus opinion and is likely not to change in the foreseeable future.