Timeline of Vaccination Mandates

One of our readers asked about the history of vaccine mandates, given the current sentiment in a segment of the United States population about vaccine mandates. Some people on social media are comparing vaccination mandates to the oppressive steps taken by authoritarian governments to punish groups and individuals. Knowing the history of vaccine mandates can help ease some of the apprehensions about them, showing that vaccine mandates have not caused the collapse of societies or the restriction of freedoms. On the contrary, requiring vaccinations have led to the thriving of populations, and, as you’ll see below, there is good evidence that the United States won the War of Independence because of vaccine’s precursor: inoculation.

This post will be updated as we collect more information on vaccination mandates from around the world.

  • George Washington Crossing the frozen Delaware River

    1777: Washington Forcefully Inoculates the Continental Army

    At the Battle of Quebec, the Continental Army had to retreat because too many of the soldiers were struck down by smallpox. This was 1775, and the smallpox vaccine was about 20 years away. Nevertheless, there was a medical procedure akin to vaccination: inoculation. With inoculation, a person would receive smallpox material from an infected person, but it would be done by a physician in a controlled manner. Unlike catching smallpox in “the natural way,” inoculation didn’t cause as much illness, and the risk of dying was lower. People who underwent the procedure successfully would then be immune to the scourge that was smallpox.

    George Washington saw the value of inoculation and wrote to the Continental Congress in 1777 that new recruits would have to be inoculated as part of their intake into the Continental Army: “The small pox has made such Head in every Quarter that I find it impossible to keep it from spreading thro’ the whole Army in the natural way. I have therefore determined, not only to innoculate all the Troops now here, that have not had it, but shall order Docr. Shippen to innoculate the Recruits as fast as they come in to Philadelphia.”

  • Different expeditions to the New World

    1803: The Balmis Expedition

    In 1803, after reading Jenner’s account of vaccination (translated into French and then into Spanish), King Charles IV ordered his royal surgeon, Dr. Francisco Xavier de Balmis, to lead the Royal Philanthropic Vaccine Expedition to what is now Latin America and the Philippines. Dr. Balmis and his crew took several orphans who were given — one by one — the smallpox vaccine from La Coruña to the Caribbean. From there, the expedition split into two, with one group heading south along the Andes and the other into Mexico and then on to the Philippines. Along the way, the vaccinators gave the smallpox vaccine to tens of thousands of people with the help of the local Catholic dioceses, leaving instructions on vaccination so that the practice could be continued locally. Upon hearing of the expedition, other governments — the British in Hong Kong and the Portuguese in Macao — asked for the vaccine to be delivered to their overseas territories as well.

  • Benjamin Waterhouse

    1809: Massachusetts Mandates the Smallpox Vaccine

    After the smallpox vaccine’s safety and efficacy was agreed upon by scientists of the time, the Massachusetts Legislature passed a law in 1809 requiring smallpox vaccination. The legislature came approved the law after Jenner’s cowpox vaccine was proven to work via an experiment at Noddle’s Island (now part of the peninsula where Logan Airport is located near Boston). At the island, Benjamin Waterhouse vaccinated nineteen children against smallpox and then allowed them to be exposed to the disease at a smallpox hospital. They were also inoculated with smallpox and, like James Phipps back in England, none of the children contracted smallpox.

    The experiment proved that Jenner’s vaccine with the relatively harmless cowpox protected people from smallpox without the risks of inoculation. As a result, the legislature ordered compulsory vaccination against smallpox as well as the mandated reporting of cases to the health board. Between 1811 and 1837, only thirty-nine deaths from smallpox were reported. In 1838, thinking that vaccination was no longer required and that it infringed on individual liberties, the legislature repealed the law. By 1855, there were 1,032 reported smallpox deaths, and the legislature again passed compulsory vaccination laws.

  • UK Parliament Building

    1840: The United Kingdom Makes Vaccination Free of Charge and Compulsory Thirteen Years Later

    Realizing that vaccination was safer than inoculation (variolation), the UK Parliament passed the first of several vaccination acts in 1840. It would be another thirteen years (1853) before childhood vaccination would be compulsory. All children under the age of three months were to be vaccinated, and a record of their vaccination be kept by the civil registry. Any parents not vaccinating their children faced a fine of £1 (about £130 in today’s currency).

  • 1855: Massachusetts Requires Smallpox Vaccination for School, Other States Follow Suit

    After smallpox came roaring back when vaccination was no longer mandated, the Massachusetts Legislature decided that at least the children had to be vaccinated to protect them from smallpox. Parents who did not vaccinate their children by age 2 faced a fine of $5 yearly (about $156 in today’s dollars). Furthermore, no school would allow unvaccinated children to be enrolled. This was the first such law in the United States. By 1900, thirteen other states required vaccination for children to attend school.

    From then on, other states adopted the vaccination requirements, amending them as necessary as new vaccines were discovered and proven to be safe and effective.

  • 1887: Montreal Requires Vaccination Against Smallpox After a Deadly Epidemic Swept Through

    A deadly epidemic of smallpox compelled the local government in Montreal to require smallpox vaccination. In 1894, citing the success of Montreal, Toronto followed suit.

  • Mississippi State Supreme Court

    1900: Mississippi Requires Vaccination

    Like other states in the United States, Mississippi required vaccination of children for them to attend public schools. Sixty years later, the legislature added a religious exemption. However, in 1979, a challenge to the religious exemption under the Equal Protection Clause of the US Constitution was successful in having the Mississippi religious exemption struck down; if only some religious groups were protected from the compulsory nature of the vaccine law, then not everyone enjoyed that protection.

  • United States Supreme Court Building

    1905: The Supreme Court of the United States Upholds Vaccination Requirements in Jacobson v Massachusetts

    Remember that $5 fine mentioned above? In the early 1900s, a man by the last name of Jacobson decided that he was not to get the vaccine, and he also did not want to pay the fine. He took his case all the way to the Supreme Court, where the Court decided that vaccination requirements (and subsequent fines) were well within the authority of local governments under the United States Constitution and the police powers delegated to the states therein.

  • During the colonial era, India produced many vaccines, like the cholera and plague vaccines from the Haffkine Institute.

    1978: Post-Colonial India Adopts Vaccination

    Over 30 years after gaining independence from Great Britain, India adopted a vaccination strategy aimed at several childhood diseases. Like other countries, the Indian government made vaccination a requirement for children. However, with the burdens of being a developing nation and having had its wealth stripped by the British colonial authorities, India was slow in adopting a strategy to have all children vaccinated at the same rates as developed nations.

  • The Pentagon

    2021: US Military Servicemembers to Receive the COVID-19 Vaccine

    President Joseph Biden has ordered the compulsory vaccination of all American troops with the COVID-19 vaccine. The Pentagon has told the different branches of the military that vaccination against the novel coronavirus will be mandatory as soon as the Food and Drug Administration (FDA) fully approves a COVID-19 vaccine. (As of August 2021, FDA had only approved the vaccines under an Emergency Use Authorization [EUA].) If the vaccines do not receive full authorization by FDA by mid-September, then the Secretary of Defense will request a waiver from President Biden to make the vaccines mandatory even if the EUA is still in place.

Author: René F. Najera, DrPH

I am the editor of the History of Vaccines site, an online project by the College of Physicians of Philadelphia. All opinions expressed on these blog posts are not necessarily those of the College or any of my employers. Check out my professional profile on LinkedIn: https://www.linkedin.com/in/renenajera Feel free to follow me on Twitter: @EpiRen