Henning Jacobson, a Lutheran pastor in Cambridge, Massachusetts, had been vaccinated against smallpox as a boy. As historian Michael Willrich writes in his terrific book, Pox: An American History, Jacobson said later that the jab brought him “great and extreme suffering.” One of his children, he said, had also suffered adverse health effects from a smallpox vaccination. He was anti-vaccine, and he thought he was right on the religious and medical aspects.
Vaccination as practiced at the end of the 19th century sometimes caused adverse reactions, or even deaths. But smallpox, a deadly and extremely contagious disease, had been scourging humanity for a millennium. Cambridge was in the grip of a smallpox outbreak in 1902. State law permitted local health boards in such a situation to require everyone to be vaccinated—with an exception for children if a doctor certified that it was too risky for them. A Board of Health doctor came to Jacobson’s door and asked him to accept a free vaccination. (Smallpox vaccinations did not confer lifelong immunity; thus Jacobson needed another dose.) He refused; a judge fined him $5—close to $150 today.
Jacobson took his case to the United States Supreme Court. He did not argue that he had special health reasons for refusing the vaccination; he argued that vaccination in general was harmful and ineffective. Some medical authorities agreed with him; most others did not. In an opinion by Justice John Marshall Harlan, the Court held, 7-2, that local governments could decide which medical authority to believe. “We are not prepared to hold that a minority … may thus defy the will of its constituted authorities, acting in good faith for all, under the legislative sanction of the state,” Harlan wrote. The government could draft some people and make them bear arms; there was no reason it could not require others to be vaccinated.