Vaccination Policies
Compelling Policy Question: Should the Government make vaccinations compulsory?
Important terms:
1 : required by a law or rule
compulsory [=mandatory] education
2 : having the power of forcing someone to do something
a compulsory law
Vaccine: a substance that is usually injected into a person or animal to protect against a particular disease
Policy Case Study:
Revised Law of Massachusetts Chapter 75, section 137
“the board of health of a city or town, if, in its opinion, it is necessary for the public health or safety, shall require and enforce the vaccination and revaccination of all the inhabitants thereof, and shall provide them with the means of free vaccination. Whoever, being over twenty-one years of age and not under guardianship, refuses or neglects to comply with such requirement shall forfeit $5.”
Section 139 allowed, 'children who present a certificate, signed by a registered physician, that they are unfit subjects for vaccination.' not to have to be vaccinated.
Historical Context:
Smallpox Globally
Smallpox is an infectious disease caused by two different viruses. Scientists believe it began in Egypt. As different civilizations came into contact through exploration and trade, smallpox spread all over the globe.
Doctors in China and the Middle East developed the technique of Variolation, as a way to make a person immune to smallpox. Material from a person sick with smallpox would be put into scratches on a patient’s skin, or be inhaled through the patient’s nose. The patient’s immune system could fight the resulting weaker type of smallpox, and then develop immunity to the disease.
The technique made its way to Europe in the 1700’s, thanks to the wife of the British Ambassador to Turkey, who observed the Turkish inoculating healthy children. She had her son inoculated in Turkey, and her daughter inoculated in front of the royal court of George I to demonstrate the technique.
Another advancement in fighting smallpox called vaccination began in 1796. English countryside doctors observed that farmers who had previously had cowpox didn’t show any smallpox symptoms after variolation. An English Doctor named Edward Jenner took material from a cowpox sore from a milkmaid’s hand, and inoculated it into the arm of his gardener's 9-year old son. The boy was exposed to the smallpox virus, but never developed smallpox. In 1801, Jenner published a book about his experiments. He wrote that he hoped it would lead to “the annihilation of the smallpox, the most dreadful scourge of the human species...”
Smallpox in America
European explorers brought smallpox to the Americas. The Native peoples in America had no immunity to the disease and it became a pandemic. It killed millions of Native Americans. Some historians believe smallpox along with other “Old World” diseases killed 90%-95% of the Indigenous populations of America.
During the 17th and 18th centuries smallpox also had occasional breakouts in American cities.
The actions of an enslaved man named Onesimus, led to the introduction of the inoculation practice in America. In 1721 smallpox was killing many people in Boston and Onesimus told his owner, Cotton Mather, about the practice of inoculation used in Africa. Thanks to Onesimus, of the 242 people who were inoculated, only six of them died. Among the rest of the population of Boston that was not inoculated, one out of seven people died because of smallpox.
In 1799 a doctor in New York got the vaccine created by Edward Jenner in 1796, and successfully vaccinated his children. In 1799, New York sponsored a free vaccination program for New York’s poor. During the 19th century use of vaccines spreads in America and both the Federal and State governments become involved in supporting and regulating the use of vaccinations.
In 1802 Massachusetts became the first state to encourage, but not require the smallpox vaccine. In 1813 Congress created "An Act to Encourage Vaccination," establishing a National Vaccine Agency which protected the quality of the vaccine. In 1822 the Act was repealed and supervision of vaccines was turned over to the state governments. In 1832 the Federal Government distributed smallpox vaccinations for free to Native Americans to prevent the spread of the disease within Tribal populations.
The response to Smallpox in Massachusetts: Massachusetts Commonwealth Revised Law Ch. 75 Section 137.
During another smallpox epidemic in Boston, Massachusetts from 1901-1903, 1596 people became sick with smallpox. Almost 300 of those people died. Massachusetts had passed a law which said that “the board of health of a city or town, if, in its opinion, it is necessary for the public health or safety, shall require and enforce the vaccination and revaccination of all the inhabitants thereof, and shall provide them with the means of free vaccination. Whoever, being over twenty-one years of age and not under guardianship, refuses or neglects to comply with such requirement shall forfeit $5.” An exception in the law (§ 139) allowed, 'children who present a certificate, signed by a registered physician, that they are unfit subjects for vaccination.' not to have to be vaccinated.
In response, on February 27, 1902 the city of Cambridge, Massachusetts, created a vaccine regulation which said: 'Whereas, smallpox has been prevalent to some extent in the city of Cambridge, and still continues to increase; and whereas, it is necessary for the speedy extermination of the disease that all persons not protected by vaccination should be vaccinated; and whereas, in the opinion of the board, the public health and safety require the vaccination or revaccination of all the inhabitants of Cambridge; be it ordered, that all the inhabitants habitants of the city who have not been successfully vaccinated since March 1st, 1897, be vaccinated or re-vaccinated.'
The Legal Challenge to the Massachusetts law
An immigrant from Sweden named Pastor Henning Jacobson refused the vaccination. Jacobson said as a child in Sweden he had to get vaccinated for smallpox because Sweden had a mandatory vaccination policy. He claimed that vaccination led to "great and extreme suffering" during the rest of his life. He also said one of his sons who had to be vaccinated as a child “suffered adverse effects”. Because of these two reasons Jacobson and his wife were against the mandatory vaccinations required by Massachusetts. When Jacobson refused to get vaccinated, as a penalty for breaking the law he was fined $5 (equal to $146 in 2019). Jacobson appealed his case first to the Supreme Court of Massachusetts, and after losing there appealed to the Supreme Court of the United States claiming the vaccine law was an "invasion of his liberty".
Section #1 Guiding Question: Why do some people believe vaccinations should be compulsory?
In his 1905 Opinion in the Jacobson v. Massachusetts Supreme Court Case, Justice John Marshall Harlan said... (Excerpts/link to original)
The Supreme Court ruled 7-2 against Jacobson.
The authority of the state to enact this statute is to be referred to what is commonly called the police power... [T]he police power of a state must ... protect the public health and the public safety.
The defendant insists that... a compulsory vaccination law is… hostile to the inherent right of every freeman to care for his own body and health...
[T]he rights of the individual... may... be subjected to such restraint... as the safety of the general public may demand...
The state legislature... recognized vaccination as... an effective, if not the best-known, way in which to meet and suppress the evils of a smallpox epidemic that imperiled an entire population.
Could [the defendant] reasonably claim... exemption because 'quite often,' or 'occasionally,' injury had resulted from vaccination...?
[This] would... mean that compulsory vaccination could not... be legally enforced... [no matter] however widespread the epidemic of smallpox, and however deep and universal was the belief of the community and of its medical advisers that… vaccination was vital to the safety of all.
We are unwilling to [rule] the liberty secured by the Constitution of the United States that one person, or a minority of persons, residing in any community... should have the power thus to dominate the majority...
In 1907 the Illinois State Board of Health made a broadside titled "Smallpox Is Prevented by Vaccination".
Section #2 Guiding Question: Why do some people oppose compulsory vaccinations?
In 1902, a doctor named J.W. Hodge, gave a speech to the Western New York Homoepathic Medical Society in Buffalo New York. In his speech Hodge said...
(excerpts/link to original) This speech was published in his book, "VACCINATION SUPERSTITION"
Hodge was a doctor in Niagara Falls, N.Y.
[A] bold attempt has recently been made... to place upon our statute books a compulsory vaccination measure… mark[ing] a height of... medical despotism...
After a careful consideration of the history of vaccination and smallpox, and... from having vaccinated more than 3,000 subjects, I am firmly convinced that Edward Jenner saddled a legacy of disease and death upon the human race, and incidentally made $150,000....
[That] vaccination has been the means of disseminating… diseases, such as leprosy, cancer, syphilis, tetanus and tuberculosis;
That vaccination is not only useless, but positively injurious...
That there is no evidence... to prove that vaccination either prevents or mitigates smallpox;
That many thousands of healthy children have died from the effects of vaccination;
That millions of vaccinated people have died of confluent smallpox while having the plainest vaccine scars on their bodies;
That when these facts are fully realized... it will not take long to put an end to the crime of compulsory vaccination;
[L]aws sanctioning this crime still disgrace the statute books of "free" America;
That compulsory vaccination ranks with human slavery and religious persecution as one of the most flagrant outrages upon the rights of the human race...
In 1902, the Anti-Vaccination Society of America created an advertisement for their organization to recruit new members.
“The Anti-Compulsory Vaccination Hymn,”
In the late 1800's, the London Society for the Abolition of Compulsory Vaccination published an image titled "Death the Vaccinator".
"Do Not Vaccinate!!", 1892
Vaccination to Order, 1890s
In 1900, a handbill was created advertising a book by J.M. Peebles, titled "Vaccination a Curse and a Menace to Personal Liberty"
Description:
"Vaccination a Curse and a Menace to Personal Liberty" handbill advertising a book by J.M. Peebles entitled Eczema from Vaccination. An Innocent Victim of the Vaccinator's Lance. Compulsory Vaccination and the Result. Peebles wrote and published several similarly titled books beginning around 1900. This handbill was likely distributed by the Anti-Vaccination Society of America
Link to the 1920 book "Horrors of Vaccination Exposed and Illustrated", by Chas. M. Higgins
Compulsory Vaccination debates since 1905:
The Anti-Vaccination movement grew in 1908, three years after the Jacobson Supreme Court Case, when the Anti-Vaccination League of America is formed in Philadelphia. The League claimed 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 argued that vaccinations were dangerous, and that they were an example of the government and science intruding on people’s private lives. The League wrote; "We have repudiated religious tyranny; we have rejected political tyranny; shall we now submit to medical tyranny?
History of Compulsory Vaccinations related to Schools.
While Massachusetts first passed a law requiring children be vaccinated before they could attend schools in the 1850’s, by the start of the 1900’s almost half of all states required children to be vaccinated in order to enroll in school.
In Texas, local school districts were able to make decisions about requiring students be vaccinated, and that is what happened in San Antonio. The San Antonio school district required students present a certificate showing they had been vaccinated in order for them to be able to enroll in school. Rosalyn Zucht’s parents did not have her vaccinated, so she was not allowed to enroll in San Antonio’s schools. She was also denied admission to a private school in San Antonio. Rosalyn Zucht sued the school district arguing that the compulsory vaccination policy violated her liberty. Zucht’s case made it all the way to the Supreme Court in 1922 (Zucht v. King). The Court unanimously ruled against her. The Court’s opinion was delivered by Justice Louis Brandeis, who explained that the “Police Power” of the State made it Constitutional for a State to pass a law banning an unvaccinated child from being able to attend school.
Today many states have multiple different types of exemptions that allow unvaccinated children to attend school. These exemptions are frequently debated.