Immunization in crisis: The role of mandatory vaccines in safeguarding communities
Written by Jake Isakoff
In 2020, the world came to a halt when the COVID-19 pandemic unleashed a public health crisis unlike any seen in a century. Hospitals overflowed, economies suffered, and lives were drastically altered by a virus we barely understood. As time passed, the development of vaccines seemingly offered a much-needed light at the end of the tunnel, but with them came a wave of controversy over whether governments could or should mandate vaccination.
This question lies at the heart of a broader debate sparked by the pandemic: the balance between individual freedoms and collective safety. Governments have historically relied on mandatory vaccination policies (e.g. smallpox and measles) to control outbreaks and protect public health. As COVID-19 spread, these measures resurfaced as a potential pathway to herd immunity and easing the burden on healthcare systems. However, the concept of compulsory vaccination raises significant legal and ethical concerns, particularly regarding how far governments can go in diminishing personal autonomy for the greater public good.
Vaccine mandates have played a vital role in public health laws in various nations since the 19th century. The earliest instances can be traced back to European countries, where laws requiring smallpox vaccinations were initially passed. In 1806, Piombino and Lucca, former Napoleonic principalities in present-day Italy, were among the first to implement such responses. This trend soon spread to other nations, with France beginning to adopt smallpox vaccination requirements in 1810, followed by Sweden in 1816. Meanwhile, in the U.S., Massachusetts passed its first immunization laws in 1809, requiring smallpox vaccination for the general population. Nearly a century later, this mandate would be challenged in front of the Supreme Court, setting a precedent for future discussions on compulsory vaccination policies.
The constitutionality of the Massachusetts law was questioned when Henning Jacobson, a resident of Cambridge, Massachusetts, refused to be vaccinated against smallpox and was consequently fined $5 in accordance with the law. Jacobson’s case was then taken to the Supreme Court, where he claimed that “a compulsory vaccination law is unreasonable, arbitrary and oppressive, and therefore, hostile to the inherent right of every freeman to care for his own body and health in such way as to him seems best.” In the 1905 Jacobson v. Massachusetts decision, the Supreme Court ruled against Jacobson and upheld that state vaccine mandates were legal and enforceable to protect public health. In essence, the Court affirmed the right of the states to require vaccination as a valid exercise of their police powers, emphasizing that protecting public health takes precedence over certain individual rights, to a reasonable extent. In 1922, the Supreme Court further reinforced this principle in Zucht v. King, where it upheld the constitutionality of school vaccination laws by rejecting a challenge to a San Antonio ordinance that excluded unvaccinated children from public schools. The Court ruled that such laws did not violate individual rights, affirming the authority of governing bodies to enforce vaccination as a condition for protecting public health and safety even if there was currently no public health emergency. Both cases established a crucial foundation for public health law in the United States.
This legal precedent takes on a renewed importance today, as the COVID-19 pandemic has once again brought compulsory vaccinations into the forefront of the public safety discussion. During times of crisis, many advocate for the adoption of utilitarian principles, which assert that actions should aim to achieve the greatest good for the largest number of people. The debate surrounding mandatory vaccinations underscores this idea. Utilitarianism is particularly appealing because it offers a straightforward solution: prioritizing the well-being of the majority. This sentiment is supported by both of the aforementioned Supreme Court cases. However, the National Library of Medicine (NLM) highlights where this argument may falter, especially when considering diseases such as the seasonal Influenza virus (flu). Despite the widespread availability of the flu vaccine and its proven effectiveness in reducing illness and hospitalizations, it remains optional for most of the population. While many healthcare facilities require their staff to be vaccinated, the government has not extended such mandates to the general public. So if utilitarian principles were strictly applied, the flu, which is responsible for thousands of deaths annually, should warrant a similar approach to COVID-19, with compulsory vaccinations being implemented for the greater good.
The inconsistency between these approaches reveals the complexity of applying utilitarianism in public health policy. While both diseases pose serious health risks, the perceived severity of COVID-19, especially in the early stages of the pandemic, led to a stronger push for vaccine mandates. The flu, despite its impact, is often viewed as a manageable seasonal illness, leading to a more relaxed attitude toward vaccination. As our understanding of COVID-19 continues to evolve, it is increasingly likened to the flu in terms of its seasonal recurrence and the potential need for annual vaccinations. This comparison, drawn as both diseases became associated with long-term, manageable risks, further complicates the debate on appropriate public health measures. Such a discrepancy suggests that utilitarianism, while offering a clear-cut path in theory, becomes less straightforward in practice when public perception, individual rights, and the varying severity of diseases are taken into account.
Thus, this complexity goes even deeper when considering the rationale of people who choose not to get vaccinated. Vaccine hesitancy stems from a variety of factors, including mistrust of government or pharmaceutical companies, concerns about the safety and side effects of vaccines, and deeply held beliefs about personal autonomy, often related to religious practices. For some, the speed at which the COVID-19 vaccines were developed raised fears about inadequate testing, while others resisted what they thought of as government overreach into their personal health decisions. Additionally, misinformation and conspiracy theories circulating on social media have fueled skepticism and fear, making it harder for public health officials to gain widespread trust. These concerns highlight the tension between collective safety and individual choice, complicating efforts to apply utilitarian principles in public health decisions.
So what should the government do? These concerns about vaccine safety and personal autonomy are undoubtedly important, yet perhaps they do not negate the constitutionality of compulsory vaccination. The legal foundation for mandating vaccinations still rests on the government’s obligations to protect public health and prevent the spread of infectious diseases. The Supreme Court’s rulings in cases like Jacobson v. Massachusetts established that states can have the authority to impose such mandates, emphasizing that individual rights can be limited when public welfare is at stake. While personal beliefs and fears may influence individual’s decisions regarding vaccination, the general principle upheld by the courts is that protecting the health of the community can justifiably take precedence over individual preferences, especially when those preferences have the potential to put others at risk.
Moreover, the idea of the social contract supports the constitutionality of vaccine mandates. Citizens can benefit from the protections provided by public health measures in exchange for following reasonable regulations meant to ensure community well-being. This balance between individual freedoms and public safety is crucial, especially during outbreaks of infectious diseases. By reinforcing the legal framework for mandatory vaccinations, societies can reduce health risks and protect the most vulnerable members of the community, ultimately making a healthier environment for everyone.
