The 1905 landmark case, Jacobson v. Massachusetts, has served as the foundation for public health laws and the U.S. Supreme Court endorsement of the rights of states to pass and enforce compulsory vaccination laws.  In 1922, deciding a case filed by a girl excluded from a public school (and later a private school) in San Antonio, Texas, the Supreme Court found school immunization requirements to be constitutional.  Since then, courts have been generally supportive of the states’ power to enact and implement immunization requirements.

Because laws concerning immunization are state-based, there are differences in requirements across the USA. Multiple studies report an increase in the local risk of vaccine-preventable diseases when there is geographic aggregation of unvaccinated persons.

For example, measles vaccination has been very successful in controlling this infection.  In the United States, the reported number of measles infections dropped from an average of 500,000 annually in the era before vaccination (with reported cases considered to be a fraction of the estimated total, which was more than 2 million) to a mean of 62 cases per year from 2000 through 2007.


Injuries that appear in association with vaccination have been reported and witnessed. The percentage who are injured is certainly very small but in some cases has been severe and long-lasting.

Vaccine refusal not only increases the individual risk of disease but also increases the risk for the whole community. Concerns about the consequences of vaccination must be considered against the potential for the benefit not only for the person being vaccinated but the community at large.