History and Precedent
Historically, the preservation of the public health has been the responsibility of state
and local governments, and the authority to enact laws relevant to the protection of the
public health derives from the state’s general police powers.1 With respect to the
preservation of the public health in cases of communicable disease outbreaks, these
powers may include the institution of quarantine or the enactment of mandatory
vaccination laws.2 Mandatory vaccination laws were first enacted in the early nineteenth
century, with Massachusetts enacting the first such law in 1809.3
Jacobson v. Massachusetts is viewed as the seminal case regarding a state’s or
municipality’s authority to institute a mandatory vaccination program as an exercise of
its police powers.4 In Jacobson, the Supreme Court upheld a Massachusetts law that gave
municipal boards of health the authority to require the vaccination of persons over the age
of 21 against smallpox, and determined that the vaccination program instituted in the city
of Cambridge had “a real and substantial relation to the protection of the public health and
safety.”5 In upholding the law, the Court noted that “the police power of a State must be
held to embrace, at least, such reasonable regulations established directly by legislative
enactment as will protect the public health and the public safety.”6 The Court added that
such laws were within the full discretion of the State, and that Federal powers with respect
to such laws extended only to ensure that the state laws did not “contravene the
Constitution of the United States or infringe any right granted or secured by that
instrument.”7
Role of the Federal GovernmentUnder the Public Health Service Act, the Secretary of Health and Human Services
has the authority to make and enforce regulations necessary “to prevent the introduction,
transmission, or spread of communicable diseases from foreign countries into the States
or possessions, or from one State or possession into any other State or possession.”30
While this language appears to confer broad authority to promulgate regulations necessary
to prevent the spread of disease, the only regulations specifically authorized by the Act
relate to the apprehension, detention, examination, or conditional release of individuals.31
The Act does not specifically authorize regulations related to mandatory vaccination
programs, nor do there appear to be any regulations regarding the implementation of a
mandatory vaccination program at the federal level during a public health emergency.32
As noted above, state and local governments have the primary responsibility for
protecting the public health, and this has been reflected in the enactment of state laws
pertaining to public health and establishing procedures during a public health emergency.
Any federal mandatory vaccination program applicable to the general public would likely
be limited to areas of existing federal jurisdiction, similar to the federal quarantine
authority.33 Generally, federal regulations authorizing the apprehension, detention,
examination, or conditional release of individuals are applicable only to individuals
coming into a State or possession from a foreign country or a possession.34 This
limitation on federal jurisdiction acknowledges that states have the primary responsibility
for protecting the public health, but under certain circumstances, federal intervention may
be necessary. Any federal mandatory vaccination program applicable to the general
public would likely incorporate similar jurisdictional limitations.
http://www.fas.org/sgp/crs/RS21414.pdfMuch more at link (PDF file)