History of vaccinology
Childhood vaccination requirements: Lessons from history,
Mississippi, and a path forward
Philip B. Cawkwella, David Oshinskya

Mississippi consistently leads the United States in childhood vaccination with a greater than 99%
measles–mumps–rubella vaccination rate for children entering kindergarten. The story of how this came to pass in a state that lags behind on nearly every other public health measure is pertinent given the recent outbreaks of measles in the United States, especially in pockets of the country where there is strong resistance to vaccination. The fight against compulsory vaccination law is centuries old and the
enduring success of Mississippi at repelling challenges to their vaccination requirements is a testament
to the public health infrastructure and legal framework established in the state. Herein we trace the
anti-vaccination movement from its origins in England up until the present time in the United States and explore how Mississippi has established a model vaccination system. Seminal court cases and legislation are evaluated for their impact. Finally, contemporary battles over vaccination legislation are examined and the feasibility of national-level change is considered.

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The US Supreme Court and other court cases cases supporting the right of the state to mandate vaccination by school children all make the following assumptions:

that the vaccines are safe for everyone,

that the vaccines are effective,

that without vaccination, enormous numbers would be killed or seriously harmed,

that vaccination is the best way to prevent and deal with the diseases in question – instead of quarantine or supportive medical treatment and letting the disease run its course,

that the vaccines harm so few that this harm is far outweighed by the protection afforded,

that vaccinated children do not contract a vaccine version of the disease and do more to spread it just as well as the unvaccinated who contract the diseases,

that there is a herd effect if all or nearly all children are vaccinated that prevents ,

and that unvaccinated children are a danger to vaccinated children.

If all these assumptions were true, then it would be reasonable to mandate vaccination, which includes overriding the individual’s religious and privacy rights.

What if some or all of these assumptions are not true?

The problem with the cases mentioned in this article is that the courts presume all these assumptions to be true. When a vaccine court case makes scientific assumptions which are incorrect, can the holding be challenged in court by asserting that the previous holding was invalid? The general rule of law is that when the highest court rules, the decision is stare decisis, or settled law. But when we learn that the scientific assumptions are no longer correct, such decisions should no longer be considered settled law, and they should be subject to reconsideration.

The following US cases supporting vaccines all make these assumptions:

Jacobson v. Massachusetts, 197 U.S. 11 1905. See also Mariner WK, Annas GJ, Glantz LH. Jacobson v Massachusetts: it’s not your great-great-grandfather’s public health law. Am J Public Health 2005;95(4):581–90.

Zucht v. King. 260 U.S. 174 (1922).

Prince v. Massachusetts. 321 U.S. 158 (1944).

They should all be subject to reconsideration, given that the scientific assumptions underlying them are incorrect.

The moral of the story is this: In any future vaccine suits, those challenging vaccination should not rely solely on preservation of our right of informed consent and our right to refuse to consent but should also argue that the scientific assumptions are at least in part incorrect.

The same holds true for suits against fluoridation. Most err in basing their cases simply on our right not to be medicated without our informed consent without arguing that fluoridation harms health and is relatively or completely ineffective.

James Robert Deal, Attorney

James at James Deal dot com