In the early-to-mid 19th century, most Americans welcomed vaccines against smallpox. Cowpox-based smallpox vaccines, which drastically improved upon riskier live smallpox inoculations, were first trialed in the United States in 1800 and quickly embraced by prominent figures such as Thomas Jefferson and James Madison. Under Madison, "An Act to Encourage Vaccination" was passed in 1813, which provided for distribution of vaccines by mail. In newspaper coverage, vaccination was frequently represented as a measure of progress and enlightenment.
The efficacy of vaccines prompted some states to take a heavier hand in trying to eradicate the disease. In 1855, Massachusetts became the first state to mandate smallpox vaccination for children enrolled in public schools. By the early 1900s, several states had adopted similar policies. Given the devastatingly high mortality rates associated with smallpox, these laws were justified as measures to protect the general welfare.
While smallpox vaccines had previously garnered pockets of local resistance as alternative medical practices became more popular, the implementation of mandates intensified the opposition by giving it a new focus. Inspired by British activism over the same issue, the Anti-Vaccination Society of America formed in 1879. The organization adopted a twofold strategy, including advocacy for alternative remedies, such as homeopathy and naturopathy, and legal challenges to mandates.
A particularly far-reaching law escalated the matter to the Supreme Court. In 1902, the city of Cambridge, Mass., made the smallpox vaccine obligatory for all municipal residents; if they refused, they would incur a $5 penalty. In response, Henning Jacobson, a minister who had previously immigrated from Sweden, legally challenged his fine by arguing it was unconstitutional. Jacobson claimed that “compulsion to introduce disease into a healthy system is a violation of liberty.”
Like the anti-vaccine movement in Great Britain, this strategy of resistance to the smallpox vaccine relied heavily on liberal fears over government intrusion into "private" matters such as personal health and childrearing. Alfred Milnes, a prominent British anti-vaccination advocate, maintained that even if he could not convince his audience that vaccinations were ineffective, he hoped to win them over on the merits of personal liberty. Similarly, Jacobson argued that Cambridge’s vaccine mandate threatened his rights as an individual.
The Supreme Court disagreed. In a 7-2 decision, the Court upheld the law as a matter of self-defense, reasoning that restrictions on individuals can be justified for the public health of the community. Smallpox, a disease with a 30% fatality rate, and which often left survivors with severe scarring, qualified as such an emergency.