Vaccination Mandates—An Old Public Health Tool Faces New Challenges

The authority of states and localities to require vaccination is a bedrock principle of public health law. Since 1905, when the US Supreme Court upheld compulsory smallpox inoculations, there has been sustained judicial consensus that the Constitution “does not import an absolute right to be…wholly freed from restraint.”1 Otherwise, “organized society could not exist with safety to its members.”1 Until recently, objections to mandatory vaccinations were confined to a small minority of US residents. However, civic values eroded during the COVID-19 pandemic, creating a groundswell of resistance. With state legislatures now sharply limiting public health authority and a bevy of legal challenges mounted (eTables 1 and 2 in the Supplement), vaccination mandates—an old and highly effective public health tool—face legal uncertainty that only a few years ago seemed inconceivable.

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