How did the government first deal with the legal issue of requiring vaccines that promote immunity against diseases? The legal debate goes back more than a century and gives most of that power to the states.
The resurfacing of controversy over vaccines due to the recent measles outbreak has brought more attention to the constitutional authority of the government to require vaccinations.
In the 1905 case Jacobson v. Massachusetts, the Supreme Court upheld the authority of the states to enforce mandatory vaccination laws under the police power of the states. In the opinion, Justice John Marshall Harlan explained that personal liberties might be suspended in cases where the interest of the “common good” of the community are of paramount importance.
The Court in Jacobson did, however, recognize that for some individuals a vaccine requirement could be harmful, creating room for medical exemptions where vaccines would be unduly harmful to the individual.
In a 1922, the Court further clarified in Zucht v. King that a school system could refuse admission to a student who did not meet vaccination requirements, and that this would not be in violation of the 14th Amendment’s Equal Protection Clause for singling out a particular class of individuals.
Then in 1944, in Prince v. Massachusetts, the Court held that states may require vaccination regardless of a parent’s religious objection, stating that, “the right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.” This case made it clear that religious exemptions offered by states are elective, rather than mandated by the First Amendment’s right to free exercise of religion.
While the Supreme Court authorized the states to pass these laws mandating vaccinations, it was in no way required for the states to do so. Federal authority on vaccines only applies to situations of national concern, such as the quarantine of foreign disease and regulation between states.
As a result, states have varying rules to regulate vaccines. All 50 states require students to be vaccinated before starting school, and every state has an exemption for cases of medical conditions that would make vaccines risky, like an immune disorder or cancer. Most states have the option for parents to opt out for religious reasons, and about half of states broaden that exemption to personal or philosophical reasons.
Some states have stringent requirements attached to their exemptions, such as approval of a doctor. Others however, particularly with religious and personal exemptions, are as simple as a checkbox on a student enrollment form.
There has been one recent case at the federal level that confirmed a state’s right to implement vaccine policy as it sees fit.
In January 2015, the Second Circuit Court of Appeals, based in New York, upheld a New York statute in Phillips v. City of New York that allows students with “genuine and sincere” religious beliefs against vaccination to go to school, but reserves the right of school authorities to send them home if believe there is an outbreak of disease.
Laura Beltz is a pro bono intern at the National Constitution Center. She is also a student at the University of Pennsylvania Law School.
