Yes. Jacobson v. Massachusetts is still good law. The 1905 Supreme Court decision remains the foundational precedent for state authority to enact public health measures, and no case has overruled it. What has changed is the space around it: recent Supreme Court rulings have made clear that Jacobson’s deferential framework does not displace stricter review when other constitutional rights are at stake, and it does not authorize federal agencies to reach beyond their statutory lanes.
What Jacobson Still Stands For
At its core, Jacobson held that a state, acting through its police power, can require vaccination during a genuine public health threat and can penalize refusal. Justice John Marshall Harlan grounded the 7-2 ruling in the idea of a social compact: people in an organized society accept certain constraints on personal liberty for the safety of everyone. A community facing an epidemic, the Court wrote, “has the right to protect itself against an epidemic of disease which threatens the safety of its members.”1Justia. Jacobson v. Massachusetts, 197 U.S. 11 (1905)
The opinion also told courts to stay out of second-guessing legislatures on the choice of health measures. So long as a legislature’s approach was reasonable and had a real connection to protecting public health, judges were to defer. Legal scholars now describe that posture as the ancestor of rational basis review for public health regulations, though the opinion itself never used the phrase.1Justia. Jacobson v. Massachusetts, 197 U.S. 11 (1905)
That core proposition has never been overturned. Every time a court evaluates a state or local health mandate, Jacobson is the starting point.
The Limits Built Into the Ruling
Jacobson was never a blank check, and the limits Harlan wrote into the opinion are part of what keeps it viable today. The Court identified several boundaries on the police power, even if it never numbered them as a formal test.
The government has to show a genuine threat. Smallpox was actively spreading through Cambridge when Massachusetts acted, and the vaccination order was a direct response to an ongoing danger. The chosen measure must have a “real or substantial relation” to protecting public health. And the measure cannot go “so far beyond what was reasonably required for the safety of the public” that it becomes arbitrary.1Justia. Jacobson v. Massachusetts, 197 U.S. 11 (1905)
Harlan also recognized that a law valid in general could be unconstitutional as applied to a particular person. Forcing vaccination on someone whose medical condition made the procedure dangerous would be, in his words, “cruel and inhuman in the last degree.”1Justia. Jacobson v. Massachusetts, 197 U.S. 11 (1905) Above all, a health regulation that amounted to “a plain, palpable invasion of rights secured by the fundamental law” had to fall regardless of its stated public health purpose.
Those internal limits are why the decision still functions. Courts applying Jacobson are not just asking whether the state invoked public health; they are asking whether the threat is real, the response is reasonable, and the burden is proportionate.
How Courts Used Jacobson During COVID-19
The COVID-19 pandemic put Jacobson back in the middle of American constitutional law. Early in the crisis, federal courts relied on it to uphold emergency public health orders, applying its deferential framework to restrictions on gatherings, business closures, and limits on certain medical procedures. In 2021, a federal district court in Indiana used Jacobson to uphold Indiana University’s campus vaccination requirement, finding a rational basis connected to a legitimate public health interest.
Those rulings confirmed that Jacobson still does work in cases where a state or state actor imposes a general health measure to address a real disease threat. That is the heart of what the 1905 opinion was about, and courts have kept applying it there.
Where Jacobson No Longer Controls
The Supreme Court used the pandemic to draw sharper lines around Jacobson’s reach. Two decisions in particular signaled that the precedent is not a universal answer to public health litigation.
In Roman Catholic Diocese of Brooklyn v. Cuomo (2020), the Court struck down New York’s fixed occupancy caps on religious services. Because the rules were not neutral and generally applicable, they had to survive strict scrutiny, not Jacobson-style deference. Justice Gorsuch’s concurrence went directly at the question, arguing that Jacobson had applied ordinary rational basis review and was never intended to create a special, lower standard of constitutional protection during pandemics. He wrote that “nothing in Jacobson purported to address, let alone approve, such serious and long-lasting intrusions into settled constitutional rights.”2Supreme Court of the United States. Roman Catholic Diocese of Brooklyn v. Cuomo, 592 U.S. ___ (2020)
The message: when a health order burdens a fundamental right like the free exercise of religion, Jacobson’s deferential standard is not the governing test.
Then in early 2022, the Court blocked the federal Occupational Safety and Health Administration’s emergency rule requiring large employers to mandate vaccination or weekly testing. National Federation of Independent Business v. OSHA rested on statutory grounds and the major questions doctrine rather than on Jacobson. OSHA’s authority, the Court held, extended to workplace safety hazards, not to broad public health regulation of risks people face regardless of employment.3Supreme Court of the United States. National Federation of Independent Business v. Department of Labor, OSHA, 595 U.S. ___ (2022) The decision left state police power over public health untouched but drew a sharp line around federal agencies trying to achieve similar goals through workplace rules.
Together, these rulings mean Jacobson still governs state public health measures reviewed under rational basis, but it does not override strict scrutiny when a fundamental right is burdened, and it does not fill in missing federal statutory authority.
A Cautionary Note: Buck v. Bell
Any honest account of Jacobson’s status has to reckon with how the precedent was once misused. In Buck v. Bell (1927), Justice Oliver Wendell Holmes Jr. upheld Virginia’s forced sterilization law with a single sentence tying it to vaccination: “The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes.”4Justia. Buck v. Bell, 274 U.S. 200 (1927)
Legal scholars have widely criticized that leap as a distortion of Jacobson, which had upheld a modest fine for refusing a common procedure during an active epidemic, not a permanent, irreversible bodily invasion for eugenic purposes. The Supreme Court has never formally overruled Buck v. Bell, though its reasoning is broadly regarded as discredited and incompatible with modern constitutional protections for bodily autonomy and reproductive rights. The episode is a reminder that Jacobson’s meaning depends on the limits Harlan wrote into it, not the sweeping uses later courts have occasionally tried to make of it.
The Bottom Line
Jacobson v. Massachusetts is still binding precedent, and it still supplies the framework courts use to evaluate state public health mandates. What it does not do is override other constitutional protections or extend federal agency authority beyond what Congress has granted. The decision forces both sides of any modern challenge to show their work. The government has to prove the threat is real and the response is reasonable. The individual has to show that the regulation crosses a constitutional line rather than merely being inconvenient. That is the same balance Harlan struck in 1905, and it is the reason the case has lasted.