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  • Alexis Bauer

Vaccination: State or Federal Jurisdiction?

The Supreme Court of the United States made its judgments in both Biden v. Missouri and National Federation of Independent Business v. Dept. of Labor on January 13, ultimately overturning the Biden Administration’s proposed COVID-19 vaccination mandate for large companies. This mandate would have required any business with over 100 employees to require vaccinations against COVID-19 or for employees to submit weekly negative COVID-19 tests. The Court overturned the mandate, however, with the majority stating it was not within the power of the President to dictate. However, while the Supreme Court denied this portion of the mandate, a smaller, important mandate was allowed through the Court: the CMS Vaccine Mandate. The CMS mandate requires healthcare workers in Medicaid and Medicare-funded facilities to be vaccinated unless exempted.

Photo Courtesy: Demetrius Freeman/Washington Post

Many officials have reacted to this decision on both sides of the political spectrum. Some, such as dissenting liberal justices Stephen Breyer, Sonia Sotomayor and Elena Kagan, believe that this decision halted a life-saving tool against the COVID-19 pandemic . Others, including Republican Senators Marsha Blackburn (R-TN) and Bill Hagerty (R-TN), counter that the ruling stopped unconstitutional actions by the Biden Administration.

This recent decision by the highest Court is not the first decision with the nation’s public health in mind; it is also not the first decision involving vaccination mandates. However, this decision does create a new precedent on the federal government’s role in public health decisions.

Of tens of thousands of rulings, the Supreme Court has had over 100 cases dealing directly with public health. One of the most critical public health and vaccination cases came in the early twentieth century. In Jacobson v. Massachusetts (1905), the Supreme Court ruled that the city of Cambridge could fine residents who failed to comply with their mandatory smallpox vaccination.

The case occurred following a smallpox outbreak in Western Massachusetts when Pastor Henning Jacobs refused to receive the vaccination after citing harm from previous vaccines. Upon reaching the Supreme Court, the justices ultimately turned over the case, ruling that the state of Massachusetts was within its jurisdiction to require vaccination as it was determined to be the best way to protect the public health of the community. Essentially, Jacobson v. Massachusetts established police power in the hands of the state, meaning that states have a legal basis in making decisions based on public health. This case was one of the landmark cases in mandatory vaccinations in the history of the United States, and courts continue to cite this ruling. However, since the Biden mandate was at a federal-level mandate, the precedent of this case was unable to be used.

Due to the state-based nature of Jacobson v. Massachusetts, it is not surprising that the Supreme Court did not use it in favor of the Biden mandate. However, this does not mean that the federal government is without public health power. Thirty years after the decision of Jacobson v. Massachusetts, Congress passed the Social Security Act. Not only were the elderly and people with disabilities able to receive federal benefits under this Act, but the Social Security Act allotted state and local governments funds dedicated towards public health and public health facilities. Through this Act, direct federal intervention in the public health of the United States remains to the present day. However, similar to Jacobson v. Massachusetts, the ultimate power of public health authority was designated to the state, although funding was federal.

Through Jacobson v. Massachusetts and the Social Security Act, the Supreme Court established precedents for public health at state levels with some federal aid in the latter's case. These two historical precedents showcase that public health matters, such as vaccines, have long been in the hands of the states rather than the federal government. Thus, Biden’s mandate for vaccinations is new from a historical perspective. The ruling against the mandate from the Court establishes a new precedent in the relationship between public health and the federal government. It showcases that the states ultimately are within their right to oppose vaccination mandates unless directly funded by the federal government.

This is the case with the CMS mandate, which applies to health care facilities that receive funding from Medicare and Medicaid. In terms of non-federal-funded entities, the government is limited to enforcing public health mandates. With this denial of vaccination mandates, individual states and businesses must take responsibility for the public health of the United States. However, it is unlikely that any advancement in widespread mandates will reach a statewide level. Individual businesses may take up the tasks, but this is also unlikely due to the political debates around vaccinations and the hesitancy of certain employers.

Despite the COVID-19 pandemic only beginning in 2020, the debate between public health and government intervention has roots over a century old. Biden’s mandate and the Supreme Court’s ruling created a new precedent for future debates, but it is nowhere close to a final decision. The Supreme Court can change precedents when considering new cases, and the future presents a new set of public health problems. The ramifications of the denial of a federal vaccination mandate for business have yet to play out over the long term, but its precedents will join the ranks of those who came before.


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