Can Vaccines Be Mandated by Law?
By Sam MacArthur

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With Covid-19 vaccines finally available for the larger public, there has been controversy over whether vaccines will become mandatory for certain groups (like healthcare workers or teachers) and certain activities (like international travel). Since vaccines are an essential part of public health, to help readers understand, MPHOnline is looking into whether vaccines can be mandated.

Can the Federal Government Make Vaccines Mandatory?

No, the federal government cannot make mandatory vaccine laws due to the 14th Amendment of the Constitution. The key language from the 14th Amendment that covers vaccines is as follows:

“No state shall make or enforce any law abridging the privileges or immunities of citizens of the United States or deprive any person of life, liberty, or property without due process of the law.”

This amendment is widely viewed as the one that enforces personal rights that can’t be arbitrarily violated by the federal government. The U.S. government can use indirect avenues to enforce vaccination, such as mandating vaccines for individuals crossing state borders through its ability to regulate interstate commerce or tie state funding to vaccinating the population of a given state. However, it’s assumed that attempts to make a mandatory vaccine requirement by the federal government will be quickly overridden by federal courts. There are other avenues that allow for mandatory vaccination and ensure that enough of the population obtains herd immunity to protect the population that chooses to not vaccinate for whatever reason. 

However, even though the federal government cannot directly make mandatory vaccine laws, the states are free to make vaccines mandatory.

What are the States Where Vaccines are Mandatory?

All 50 states are states where vaccines are mandatory. In 1905, a Supreme Court case set the legal precedent for states to write their own vaccination laws and make vaccines mandatory. The case, known as Jacobson v. Massachusetts, was brought before the U.S. Supreme Court over smallpox vaccinations in Cambridge, MA. The town of Cambridge created an ordinance that required all adults receive a smallpox vaccination or be revaccinated in order to stop a small outbreak. Non-compliant residents were fined $5 ($150 in 2021). A resident by the last name of Jacobson took the town to court under the argument that the state was violating his constitutionally protected liberties with the mandatory vaccine requirement. 

The Supreme Court disagreed with Jacobson by stating that each state has police powers, also a Constitutional right for states, to make vaccines that are mandatory for the public health, safety and the common good. In sum, the interests of many overpower the interests of few.

In order to vaccinate as many people as possible, while tracking those who were not vaccinated, the states used the public school systems and enacted legislation that vaccines are mandatory in places where children are in close quarters such as private schools and day cares. All states have a standing requirement that children entering the school system have a vaccination record unless they have a religious exemption or a documented allergic reaction to vaccination. Some school systems offer vaccinations with permission from parents, but most prefer that parents have their children vaccinated in a clinical setting. 

States also require adults who work in certain fields, such as healthcare, to get vaccinated in order to work in healthcare settings. Employers are required by state law to ensure employees are vaccinated prior to allowing them to work in a facility. 

The majority of adults in a given U.S. state aren’t typically required to get vaccines unless they’re traveling to a country that has a mandatory vaccine rule. There is potential for states to enact legislation to require adults get vaccinated for COVID-19, but it’s usually more difficult to track adults than it is children. However, it is unlikely that states will make a COVID-19 vaccination mandatory as the virus is predicted to become as common as the flu over time. There is no mandatory vaccine requirement for the flu and states leave it up to the individual to decide if they want to get vaccinated. The same will probably be likely for COVID-19. 

What Are the Vaccines That Are Mandatory?

Every state has different mandatory vaccine requirements. The requirements are usually based on the risk of an individual contracting a particular disease. Some viruses thrive in warm weather, so warmer states will make a vaccine for those diseases mandatory. The most common vaccines that are mandatory are:

  • Chickenpox
  • Diphtheria
  • Hepatitis B
  • Human Papillomavirus
  • Influenza or Flu
  • Measles
  • Meningitis
  • Pertussis or Whooping Cough
  • Polio
  • Pneumococcal Disease
  • Rotavirus
  • Rubella or German Measles
  • Tetanus or Lockjaw

Should vaccines be mandatory? The Supreme Court created a precedent over 100 years ago that has shown that mandatory vaccines help save lives and improve the overall health of the population. Polio was once a dreaded disease due to its ease of transmission along with its disfiguring properties that affected children for their entire lives until a vaccine was created to prevent its transmission. Everyone is entitled to their opinion about whether vaccines should be mandatory or not, but the value of vaccination cannot be overstated, especially in light of their life-saving properties. 

Related:

Covid-19 Vaccines: Where We Stand

Vaccine Process

Fast-Tracking Coronavirus Vaccines

Vaccines and Public Health