The Antivaccine Heresy: Jacobson v. Massachusetts and the Troubled History of Compulsory Vaccination in the United States by Karen L. Walloch (review)

Candidate Donald Trump met with antivaccine activists during his campaign for the presidency in summer 2016. Those present found the candidate to be interested and open-minded on the matter of vaccination, while provaccine advocates criticized Trump’s refusal to enthusiastically support compulsory vaccination as another example of his willingness to ignore scientific studies for the sake of political expedience. Though mandatory vaccination has been part of American public health policy since the early nineteenth century, the controversy over the pros and cons is alive and well.

Karen L. Walloch masterfully tells the history of this debate in The Antivaccine Heresy: Jacobson v. Massachusetts and the Troubled History of Compulsory Vaccination in the United States. A professor of history at the University of Wisconsin–Madison, Walloch’s volume is the perfect scholarly commemoration of Pastor Henning Jacobson’s 1905 unsuccessful legal challenge to the Massachusetts law that required all residents of the state to have a smallpox vaccination.

Meticulously, Walloch leads readers through the history of smallpox vaccination in nineteenth-century Massachusetts, first made mandatory in 1809, chronicling the state of medical knowledge of smallpox and vaccination techniques. Some physicians made one puncture, while others preferred several scratch lines and still others abraded the skin. Discovering that bovine lymph sometimes resulted in infection, physicians added glycerin as a germicide. They soon learned that glycinerated virus had only a limited shelf life when it could be administered without risk of infection. As Congress deliberated federal regulation of vaccine production, Massachusetts established its own vaccine farm as a way to ensure vaccine purity.

The smallpox epidemic of 1901–2 tested the power of government to marshal the social resources necessary to battle the disease. Boston’s chief health officer, Dr. Samuel Durgin, tirelessly advocated for compulsory vaccination, but he could not completely calm public alarm as antivaccinationists aroused fears of complications such as tetanus.

Walloch is especially effective in describing Massachusetts antivaccinationists’ varied motivations. Rather than dismissing all as “antigovernment libertarians,” she offers a nuanced picture of “thoughtful people who posed legitimate questions about state interference in individual health matters, matters they believed should remain between a patient and her doctor” (p. 102). The author sees antivaccinationism as a kind of “populism.” Most wanted government to “ensure fairness in the medical marketplace as well as for their personal health concerns” (p. 103). Their battle was not only against intrusions by the state in the “personal realm of health,” but against the “predations of an elite group of physicians who sought to hijack American government to serve selfish commercial interests” (p. 113).

The battle against Massachusetts’s compulsory vaccination law was fought in the political arena and even in the streets when health officials sent squads of health department physicians with police escorts into lodging house districts to forcibly vaccinate. Was the police power of the state being exercised in excess? The matter ended up in the courtroom where antivaccinationists were prosecuted in criminal proceedings.

In 1902, in the midst of a smallpox epidemic, Cambridge Board of Health chairman E. Edwin Spencer swore out criminal complaints against six resisters, including the Reverend Henning Jacobson, a forty-six-year-old Swedish Lutheran minister who had arrived as an immigrant in 1869. Jacobson appealed his conviction, taking his case all the way to the Supreme Court, where he lost. Walloch skillfully navigates her readers through the majority opinion written by Justice John Marshall Harlan. Jacobson had contended that compulsory vaccination was an abuse of the police power of the state, an “assault upon his person.” Harlan asserted that the Constitution “does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint” (p. 209). Though Jacobson lost the appeal, it is likely that he...