Municipality or State? A Call to Localize Mandatory Vaccination Codification

Since October 2018, the state of New York has witnessed over 700 cases of measles.[1] Although the illness is a highly contagious respiratory infection, it is entirely preventable through vaccination. While such modern-day measures are in place, the state of New York has found itself in the grips of a burgeoning social phenomenon: the anti-vaccination movement. Fueled by orthodox religious groups and modern-medicine critics, the movement’s growth gave rise to a measles epidemic in the state. In fact, on April 9, 2019, Mayor Bill de Blasio of New York declared the measles outbreak affecting the Orthodox Jewish community in Williamsburg a public health emergency. [2]

In light of such threats to public health, New York State Assemblyman Jeffrey Dinowitz (D-Bronx) introduced Bill A02371 into the New York Legislature, a measure that stands to “repeal subdivision 9 of section 2164 of the public health law, relating to exemption from vaccination due to religious beliefs.” [3] In short, Dinowitz’s measure will repeal all non-medical exemptions, including religious exemptions, from vaccination requirements for children, mandating that New Yorkers vaccinate their children whenever the state government directs parents to do so. [4] While the measure was proposed with the public’s health in mind, the question is raised: does NY A02371 erode personal rights? More specifically, does NY A02371 run the risk of homogenizing populations of the state of New York and subsequently mandating vaccinations for groups that may have legitimate grounds for exemption? In order to avoid such potential effects of uniform, state-led legislation, mandatory vaccinations should instead fall under the jurisdiction of municipalities as opposed to state legislatures.

Historically, the U.S. Supreme Court’s stance on the issue at hand has largely favored state government control over that of the federal government, designating mandatory vaccinations as a local issue. For example, in Jacobson v. Massachusetts (1905), Pastor Henning Jacobson, an immigrant from Sweden who had been vaccinated for smallpox as a child, argued against the principle of mandatory smallpox vaccinations to “protect” his sons from any adverse effect from the vaccine, as he had endured “great and extreme suffering” caused by the vaccination in his youth. [5] While the mandatory vaccination in question was administered in Sweden during a smallpox epidemic and was successful in eradicating the disease, Jacobson argued that the mandatory nature of the vaccinations violated personal rights, specifically citing Section 1 of the Fourteenth Amendment which asserts that “no state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States.” [6]

Justice John Marshall Harlan delivered the decision for a 7-2 majority, rejecting Jacobson’s Fourteenth Amendment claim and ruling that “[t]he liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good.” [7] While the Supreme Court of the United States ruled that the common welfare, specifically the health of the public, supersedes the freedoms granted to an individual under the Fourteenth Amendment, it also determined that mandatory vaccinations, regardless of circumstance, were far too inhumane and an overreach of government power. Thus, while Jacobson was denied an exemption, the U.S. Supreme Court established medical exemptions under Massachusetts health law. In the end, Jacobson upheld the state of Massachusetts’ power in granting municipal boards of health the authority to mandate vaccinations.

While Jacobson was a step in the right direction, as it localized the scope of mandatory vaccination laws and allowed states to transfer power to municipal health boards, it still left mandatory vaccinations under the sole jurisdiction of the state. What can be seen from Jacobson is that while states are able to transfer power to municipalities, they are not required to. Thus, a state can pass a bill like NY A02371 without consulting municipalities or metropolitan hubs like New York City, enacting sweeping legislation that may disregard individual requests for exemption that municipalities would be much more equipped to handle.

While Jacobson was a seminal case on the institution of mandatory vaccinations, Phillips v. City of New York (2015) establishes a precedent in the realm of religious liberties and mandatory vaccinations, further stabilizing the legal validity of NY A02371. In Phillips, the plaintiffs argued against the exclusion of their children, who had been previously exempt from mandatory vaccinations, from New York public schools following an outbreak of chickenpox. However, due to the exemptions granted to their children, the parents had also agreed to New York’s School Immunization Requirements Code which asserts that “in the event of an outbreak of a vaccine-preventable disease in a school, the commissioner, or his or her designee may order the appropriate school officials to exclude from attendance” those students who have received exemptions from mandatory vaccination. [8] Despite their previous agreement to such measures, the parents argued that their rights of religious liberty, as granted by the First Amendment, had been transgressed.

In response to the plaintiffs’ claims, the United States Court of Appeals for the Second Circuit cited Jacobson, arguing that mandatory vaccinations were within the authority of state legislatures. Moreover, the Court of Appeals cited Prince v. Massachusetts (1944) in response to the plaintiff’s free exercise of religion claim, which asserts that “the right to practice religion freely does not include [the] liberty to expose the community or the child to communicable disease or the latter to ill health or death.” [10] Ultimately, just as the U.S. Supreme Court held in Jacobson, the Court of Appeals asserted that the common welfare of the people trumps individual liberties in the face of an epidemic.

Moreover, it is important to further discuss the implications of sweeping legislation like NY A02371. Dinowitz’s bill would repeal any and all non-medical exemptions from vaccination for the entire state of New York. However, such legislation runs the risk of homogenizing municipalities within the state. For example, while New York City on the municipality level is home to the largest population of Orthodox Jews in the United States, the state of New York has a small population of the religious minority overall. Because this religious community is fueled by sectarian animosity towards vaccinations, it would be far more appropriate to settle this issue at the municipal level than at the state level, or in this case for the city of New York to address mandatory vaccinations than for the state to do so. More specifically, the city engages with its people at town halls and city council meetings and develops more intimate relationships in order to better understand the needs of its people that should be reflected in legislation. Of course, this does not mean that religious exemptions must be unrestricted and unfailingly approved, but rather the scope of the decision making entity should be narrowed in order to allow for a more well informed, case-by-case approach when handling religious exemptions.

With a more focused and thorough understanding of its own population, a municipality is better equipped to assess its populations and deem exemptions as legitimate or over-reaching. At the same time, sweeping legislation such as NY A02371 has its merits. Diseases and illnesses cannot merely be divided by municipality. With populations that travel and interact with other individuals more than ever, the jurisdiction of one municipality has as much of an effect on its people as it does on the civilians with whom their citizens interact with outside of that area. Either way, there is a definite need for legislative reform in order to protect the people of New York in the face of a burgeoning epidemic.

Sources:

[1] Mcneil, Donald G. “Measles Cases Surpass 700 as Outbreak Continues Unabated.” The New York Times, The New York Times, 29 Apr. 2019, www.nytimes.com/2019/04/29/health/measles-outbreak-cdc.html.

[2] Hogan, Gwynne. “NYC Mayor Bill De Blasio Declares Public Health Emergency To Combat Measles Outbreak.” NPR, NPR, 9 Apr. 2019, www.npr.org/2019/04/09/711536573/nyc-mayor-bill-de-blasio-declares-public-health-emergency-to-combat-measles-outb.

[3] Dinowitz, Jeffrey. “Bill No. A02371.” New York State Assembly | Bill Search and Legislative Information, assembly.state.ny.us/leg/?default_fld=&bn=A02371&term=2019&Summary=Y&Actions=Y&Text=Y&Committee%26nbspVotes=Y&Floor%26nbspVotes=Y.

[4] Ibid.

[5] United States Supreme Court. Jacobson v. Massachusetts. 20 Feb. 1905.

[6] Ibid.

[7] Ibid.

[8] 10 N.Y.C.R.R. § 661.10.

[9] United States Court of Appeals for the Second Circuit. Phillips v. City of New York. 7 Jan. 2015.

[10] Ibid.