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November 5, 2003

Uses of Jacobson v Massachusetts in the Age of Bioterror

Author Affiliations
  • 1Yale University, New Haven, Conn
JAMA. 2003;290(17):2331. doi:10.1001/jama.290.17.2331

Contemporary dilemmas about vaccination and public health law have deeply rooted historical precedents. The story of Henning Jacobson is the story of a central challenge in public health: how to protect community health and safety while preserving individual civil liberties. In June 1894, the Commonwealth of Massachusetts enacted a law that allowed municipalities to order the compulsory vaccination of its residents during disease outbreaks.1 When the Boston smallpox epidemic that began in May 1901 spread to surrounding towns, the Cambridge Board of Health in February 1902 ordered its residents who had not received the smallpox vaccine since March 1897 to be vaccinated.2 Jacobson, the minister of the Swedish Evangelical Lutheran Church in Cambridge, had been vaccinated against smallpox as a child and had experienced a serious reaction to the vaccine. Jacobson refused to comply with the Board of Health's vaccination order. Charged with violating the law, Jacobson plead not guilty in the municipal court, but was eventually convicted and fined $5. After the Massachusetts Supreme Court upheld the lower court's decision, Jacobson appealed his case to the US Supreme Court.3 The Court's decision in Jacobson v Massachusetts, which upheld the state's right to order that its citizens be compulsorily vaccinated, became a foundational case in American law and, for the past century, the decision has defined the scope of public health law.4