Vaccination Laws: A Historical Overview

The question of when it became law to vaccinate is a complex one and differs across countries and states. In the US, all 50 states have required that parents vaccinate their children against various diseases, including polio and measles, as a prerequisite for enrolling them in public schools. The US Supreme Court has held that mandatory vaccinations are within the State's police power. The first US law regarding vaccination was passed in 1905, with several more being passed in the following decades. However, it is important to note that these laws typically respect religious and philosophical exemptions, and the actual enforcement of vaccination laws can vary.

US mandatory school vaccinations

The history of mandatory school vaccinations in the US dates back to the 19th century, specifically the 1850s in Massachusetts, where the first school vaccination requirement was enacted to prevent the spread of smallpox. This came about after the compulsory school attendance law led to a rapid increase in the number of children in public schools, raising the risk of smallpox outbreaks. Boston was the first city to mandate that all children entering public schools show proof of vaccination, and by 1855, Massachusetts had established its own statewide vaccination requirements for all students. This influenced other states to implement similar laws, including New York in 1862, Connecticut in 1872, and Pennsylvania in 1895.

The early movement towards school vaccination laws began at the local level, including counties, cities, and boards of education. However, these vaccination laws also resulted in political debates across the US, with those opposed to vaccination seeking to repeal local policies and state laws. Despite this resistance, the Supreme Court ruled in 1905 that state police powers include the right to protect the public against infectious disease by enacting universal vaccination requirements. This paved the way for all states to adopt immunization legislation.

In 1922, the constitutionality of childhood vaccination was further examined in the Supreme Court case Zucht v. King, where the court ruled that a school could deny admission to children who failed to provide certification of vaccination to protect public health. This ruling set a precedent for states' rights to require vaccinations for school entry, and by 1963, twenty states had implemented school vaccination laws.

Today, all fifty states in the US mandate immunizations for children to enroll in public school, but the specific vaccines required vary from state to state, and various exemptions are available depending on state law. All states have medical exemptions for children at significant risk from vaccination, 48 states have religious exemptions, and 19 states have philosophical exemptions. While these exemptions allow for parental autonomy, history and research show that state mandates play a crucial role in maximizing immunization rates and protecting both individuals and the general population from vaccine-preventable diseases.

The Reagan administration's opposition to the vaccine protection law

The Reagan administration was opposed to the 1986 childhood vaccine protection law, which was designed to ensure the continued manufacture of childhood vaccines by providing "no-fault" compensation to children injured by vaccines. The law was passed over White House opposition after several years of negotiations between the vaccine industry and members of Congress.

The Reagan administration's objections to the law included the following:

• They believed that the law would be undermined if injured claimants with potentially large awards rejected their no-fault awards and chose to sue instead.
• They opposed funding the benefits through either an excise tax or general revenues. The original idea was to fund the no-fault benefits by imposing a special excise tax on each dose of vaccine sold and putting the proceeds into a government fund. However, due to disagreements, the enactment of a financing mechanism was postponed.
• They argued that the law should be revised to resemble the workers' compensation system, with responsibility for paying damages left to manufacturers and their insurance companies.
• They objected to the law's reliance on the federal-court system, which they believed would be expensive for parents seeking compensation.
• They argued that the law was unlikely to ease the liability-insurance crisis because there was still access to the tort system and the costs were not predictable.

Despite the Reagan administration's opposition, the 1986 childhood vaccine protection law was passed. However, it is important to note that the law had not gone into effect as of March 1987 because no financing mechanism was included.

US policies and laws that maintain high vaccination coverage

All US states have laws that require students to be vaccinated against specific contagious diseases to attend school. These laws often apply not only to children attending public schools but also to those attending private schools and daycare facilities. All states provide medical exemptions, and some state laws also offer exemptions for religious and/or philosophical reasons. State laws also establish mechanisms for enforcing school vaccination requirements and exemptions.

State vaccination requirements are important tools for maintaining high vaccination coverage rates and, in turn, lower rates of vaccine-preventable diseases (VPDs). Studies have shown that vaccine exemptions tend to cluster geographically, making some communities more at risk for outbreaks.

To improve vaccination coverage rates, states can consider strengthening the rigor of the application process, submission frequency, and enforcement. In addition, stronger healthcare practices, such as more in-depth discussions with hesitant parents and establishing vaccination as the default, are strategies that can help improve vaccination coverage rates.

State Immunization Information Systems (IIS) keep digital records of all vaccine shots given by healthcare providers in a specific area. These systems are also known as vaccine registries. When a healthcare provider administers a vaccine, they typically record details about the patient and the vaccine in the medical record and report it to an IIS database managed by a health department.

The Centers for Disease Control and Prevention (CDC) partners with other organizations to support vaccine safety. Vaccination laws improve vaccine safety by providing vaccination rules for certain age groups and populations. The CDC's Public Health Law Program (PHLP) offers resources about state vaccination laws for health workers and their legal advisors.

The PHLP has compiled state statutes and regulations regarding school vaccinations, and its website provides access to state school and childcare vaccination laws. The PHLP also reviews state rules, regulations, and health department policies about school vaccinations.

To promote higher rates of vaccination coverage, vaccination requirements should reach more children through a broad range of facilities, have more requirements for receiving an exemption, require parental documentation of exemption requests, and be implemented with strong enforcement and monitoring. Ongoing provider outreach and public education about vaccines and the diseases they prevent may also lead to an increase in vaccination coverage.

The legality of forcing people to take a cure for the mutant gene

However, there are also strong arguments against forcing people to undergo genetic modification. Firstly, there are safety concerns as gene therapy can be technically dangerous and may have unforeseen consequences. Forcing people to undergo such procedures without their consent would be a violation of their bodily autonomy and could cause physical and psychological harm. Secondly, there is the potential for discrimination and the perpetuation of eugenics ideals. Forcing a cure for the mutant gene on people could be seen as a way of "treating" and "normalizing" those who are different, which goes against the values of diversity and inclusion. Additionally, it could lead to a slippery slope where certain genetic traits are deemed undesirable and targeted for eradication.

Furthermore, the effectiveness of forcing a cure on people is questionable. As seen in the example of some mutants in the X-Men universe, not all mutations are detrimental, and some people may choose to embrace their unique abilities rather than conform to a standard of "normalcy." Forcing a cure on people who do not want it could lead to resistance and non-compliance, potentially undermining the intended benefits of the cure.

Overall, the legality of forcing people to take a cure for the mutant gene is a complex issue that involves considerations of ethics, safety, discrimination, and individual rights. While gene therapy and genetic engineering offer potential benefits, the implications of forcing people to undergo such procedures must be carefully weighed against the potential harms and impact on society.

The role of tort law in mandatory school vaccinations

The United States is facing a public health crisis, with all 50 states requiring parents to vaccinate their children against diseases such as polio and measles before enrolling them in public schools. While states have allowed religious and philosophical exemptions, the widespread use of these exemptions threatens the benefits of mandatory vaccinations, such as "herd immunity". As state governments are unlikely to eliminate these exemptions, other methods to incentivise vaccination and compensate victims of disease outbreaks must be considered.

Overview of Mandatory School Vaccinations

States enforce mandatory immunisation requirements for public school enrolment as it is the most efficient way to maintain herd immunity. Herd immunity is achieved when a high percentage of a community is immunised against a particular disease, protecting those who are vaccinated as well as those with weak immune systems. It is also a cost-effective solution, as treating victims after a disease has appeared is more expensive.

Religious and Philosophical Exemptions

Although many organised religions do not prohibit vaccinations, smaller sects such as Christian Scientists and the Amish do. Other individuals have non-religious objections, such as the belief that vaccines interfere with "nature's genetic blueprint". These exemptions are not required by the US Constitution, and since 100% immunisation rates are not needed for herd immunity, most states exempt certain individuals. 48 out of 50 states exempt those with religious objections, and 18 states also exempt those with non-religious cultural or philosophical objections.

The Dangers of Religious and Philosophical Exemptions

The premise that communities can still achieve herd immunity despite these exemptions has come under doubt. Religious communities, particularly Christian Science, Amish, and Mennonite communities, have been the source of many preventable disease outbreaks in recent years. This has resulted in high costs to society, with vaccine-preventable diseases imposing $10 billion in healthcare costs and 30,000 avoidable deaths annually in America.

Furthermore, many individuals take these exemptions out of convenience rather than genuine belief. Thousands of parents have joined mail-order or sham religions to qualify for religious exemptions and avoid vaccinating their children. States that allow philosophical exemptions have the highest vaccination opt-out rates.

The Role of Tort Law

Tort law may allow state governments to retain religious, philosophical, and other exemptions while providing a deterrent against religious exemptions of convenience and a mechanism for victim compensation. A "tort" is a civil wrong that causes injury, for which the victim can receive a judicial remedy, typically in the form of monetary damages.

Class Action Lawsuits

One obstacle to applying tort law in the mandatory vaccination context is the difficulty in assigning blame to specific individuals for the loss of herd immunity. Class action lawsuits may provide a solution, allowing members of a class to sue or be sued as representative parties on behalf of the entire class. The prerequisites for a class action lawsuit, such as numerosity, commonality, typicality, and adequacy of representation, are likely to be met in this context.

The HPV Vaccine and Lawsuits Against Specific Individuals

The unique nature of the HPV vaccine, which can prevent cervical cancer and genital warts caused by HPV, may allow for specific individuals to file suit against others for damages resulting from a refusal to vaccinate. This is because HPV is primarily spread through sexual contact, and infection can be traced back to specific individuals. However, one obstacle to such lawsuits is the consent defence to the tort of battery, as courts have held that plaintiffs consent to the possibility of receiving a sexually transmitted disease when consenting to sexual intercourse.

Allowing causes of action under tort law would be consistent with the primary purposes of tort law, which are to deter risky behaviour that may harm others and to assign responsibility for injuries that arise in social interaction. While states can justify respecting genuine religious objections, it is more difficult to justify not allowing those who have suffered tangible harm to receive compensation.

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