Jacobson v. Massachusetts: Vaccine Mandates and COVID-Era Limits

Jacobson v. Massachusetts, 197 U.S. 11 (1905), is the Supreme Court decision that established a state’s authority to require vaccination during a public health emergency. By a 7–2 vote, the Court held that individual liberty can be restricted by reasonable health regulations when an infectious disease threatens the community.¹ More than a century later, it is still the starting point courts use when the government tries to restrict individual behavior to protect public health, though recent rulings have made clear the case does not suspend other constitutional protections.

What the Case Was About

Smallpox was climbing across Massachusetts in early 1902. On February 27 of that year, the Cambridge Board of Health ordered all residents who had not been successfully vaccinated since March 1, 1897, to be vaccinated or revaccinated.² The Board acted under a state statute authorizing local health officials to require vaccination when they judged it necessary to protect the public.

Refusal by an adult over twenty-one carried a $5 fine, and anyone who did not pay could be held in custody until the fine was satisfied. The statute allowed one narrow exception: children could be excused if a doctor certified they were medically unfit. There was no comparable exemption for adults, and personal or religious objections did not qualify.¹

Henning Jacobson, a Lutheran pastor in Cambridge, refused the order on March 15, 1902. He testified that vaccination as a child in Sweden had caused him “great and extreme suffering,” and that his son had reacted similarly. He was charged, convicted, and fined $5, and he appealed through the Massachusetts courts to the U.S. Supreme Court, arguing that the compulsory vaccination law violated the Fourteenth Amendment’s guarantee that no state may deprive a person of liberty without due process.² One point turned out to be decisive at trial: he never offered to prove that his own medical condition at the time of the order actually made him unfit for the vaccine. He argued in generalities about vaccine dangers rather than establishing a personal medical reason to be excused.

What the Supreme Court Held

The Court decided the case on February 20, 1905. Justice John Marshall Harlan wrote the majority opinion for seven justices; Justices Brewer and Peckham dissented without a written opinion.¹

Harlan rejected each of Jacobson’s arguments. The Constitution, he wrote, does not give any individual “an absolute right in each person to be at all times, and in all circumstances wholly freed from restraint.”² Living in a community carries obligations to that community, and when an infectious disease threatens public safety, a state can require vaccination as a reasonable protective measure.

The Court also refused to reopen the underlying medical question. Letting a defendant relitigate the scientific judgment behind a health statute, Harlan reasoned, would “practically strip the legislative department of its function to care for the public health.” The legislature had already weighed mainstream medical opinion, and the Court would not second-guess that judgment based on minority views.¹

The Limits the Court Built In

The legal foundation for the ruling was state police power: the inherent authority of state governments to pass laws protecting public health, safety, and welfare. Harlan described this power as reaching “such reasonable regulations relating to matters completely within its territory” as will safeguard the public.² Because the federal government has no general police power, public health enforcement of this kind belongs to the states.

But the ruling was not unlimited. Harlan wrote in two guardrails that still matter:

A real or substantial relation to public health. A regulation must have a genuine connection to protecting the public; a law with no logical relationship to public safety, or aimed at a threat that is not real, can be struck down.¹
No arbitrary or oppressive application. Even a regulation with a legitimate purpose can go too far. The Court acknowledged that enforcing a vaccination order against someone for whom the procedure would be medically harmful would be “cruel and inhumane,” and a court could intervene.¹

The practical result was a burden-shifting framework. The government did not need to prove its regulation was perfect, but a challenger had to show it was unreasonable, unconnected to public health, or oppressive as applied to that specific person. Jacobson lost because he never established that he was personally unfit for the vaccine.

How the Ruling Has Been Applied Since

Jacobson quickly extended beyond one man’s refusal. In Zucht v. King (1922), the Court treated the constitutional question as already settled, writing that “Jacobson v. Massachusetts had settled that it is within the police power of a state to provide for compulsory vaccination,” and that a state could delegate that authority to local officials to enforce school entry requirements.³ School vaccination requirements across the country rest on that line of authority. The case has also been cited in disputes over motorcycle helmet laws, water fluoridation, tobacco restrictions, and quarantine authority.

The precedent has a darker chapter as well. In Buck v. Bell (1927), the Court upheld a Virginia law allowing the forced sterilization of people the state deemed “feebleminded.” Justice Oliver Wendell Holmes leaned directly on Jacobson, writing that “the principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes.”⁴ That sentence became the legal justification for tens of thousands of forced sterilizations under state eugenics programs. Buck v. Bell has never been formally overruled, though it is now universally condemned and has not been followed by any modern court.

How COVID-Era Rulings Narrowed the Case

The COVID-19 pandemic brought Jacobson back into open dispute. Some lower courts early on read it broadly, treating the 1905 decision as near-blanket authority for emergency health orders. The Supreme Court pushed back in two significant cases.

In Roman Catholic Diocese of Brooklyn v. Cuomo (2020), the Court struck down New York’s strict attendance limits on religious services. Justice Gorsuch addressed the overuse of the precedent head-on in concurrence: “Jacobson hardly supports cutting the Constitution loose during a pandemic.” The 1905 decision, he wrote, applied conventional legal analysis to the right at issue and never created a special, more permissive standard for emergencies. When a regulation burdens a fundamental right such as religious exercise, courts must apply the same scrutiny they would in normal times.⁵

Two years later, in National Federation of Independent Business v. OSHA (2022), the Court stayed a federal rule requiring COVID-19 vaccination or testing at businesses with 100 or more employees. The problem was jurisdictional: OSHA, a federal agency, was exercising what amounted to a general public health power that the Constitution reserves to the states. The Court found the mandate was a “blunt instrument” that drew no distinctions based on industry or workplace exposure risk, applying the same rule to “lifeguards and linemen” as to “medics and meatpackers.” Without clear congressional authorization, the agency had overstepped.⁶ Jacobson’s logic supported state and local vaccination mandates. It did not give the federal government equivalent authority.

The Open Question on Religious Exemptions

One issue the Court has not definitively resolved is whether the First Amendment’s Free Exercise Clause requires states to offer religious exemptions to vaccine mandates. When COVID-era rules for healthcare workers allowed medical exemptions but not religious ones, some Justices argued that offering any secular exemption while denying a religious one triggers heightened scrutiny. The full Court has not ruled. Most states already offer religious or philosophical exemptions to school vaccination requirements, so the practical conflict has been limited, but a state mandate with no religious exemption in a future outbreak would almost certainly force the issue.

Why the Case Still Matters

Jacobson v. Massachusetts set a framework that has held for more than a century: states can require reasonable health measures during a genuine public emergency, but that power has edges. The regulation must bear a real connection to public safety. It cannot be arbitrary or oppressive as applied. And it cannot override other constitutional protections simply because a health crisis exists. Every new public health challenge sends courts back to those same lines to decide where exactly the balance falls.

1
Justia U.S. Supreme Court Center. Jacobson v. Massachusetts, 197 U.S. 11 (1905)
2
Supreme Court of the United States. Jacobson v. Massachusetts, 197 U.S. 11
3
Justia U.S. Supreme Court Center. Zucht v. King, 260 U.S. 174 (1922)
4
Justia U.S. Supreme Court Center. Buck v. Bell, 274 U.S. 200 (1927)
5
Supreme Court of the United States. Roman Catholic Diocese of Brooklyn v. Cuomo
6
Supreme Court of the United States. National Federation of Independent Business v. Department of Labor, Occupational Safety and Health Administration