Should vaccination be mandatory in a public health emergency?

Image credits: https://www.healthylifefamilymedicine.com/blog/what-vaccines-do-i-really-need

By: Jasmin Sangha 

This essay argues that vaccination mandates are necessary when refusing vaccinations puts others at risk. Using the harm principle, legal cases, and the example of Maggie, a child with leukemia, the essay explains why protecting vulnerable populations must take priority over personal choice. Mandates should not force people to get vaccinated, but should instead have clear rules and fair consequences to protect public health. 

After being exposed to measles by an unvaccinated child during a hospital visit undergoing chemotherapy, five-year old Maggie and her ten-month old brother had to receive emergency antibody treatment and stay in isolation for multiple weeks (“Maggie”). A real risk emerged showing how a person that is unvaccinated is not only harmful to themselves, but other vulnerable populations. This story raises an important question: how did Maggie, a child battling acute lymphoblastic leukemia, end up at risk with a disease that had been eliminated in the United States? What happens to children who cannot protect themselves when others choose not to vaccinate and undermine the very prevention systems that protect them? Once scientific awareness is established, refusal to vaccinate is an act of harm, not an omission. The question we should be asking is not whether to enforce mandates, but how. 

Herd immunity is when a large portion of a population becomes immune to an infectious disease and significantly reduces the spread of the disease from person-to-person (Cleveland Clinic). During a disease outbreak, herd immunity must be achieved in order to prevent the rapid spread of the virus. Once individuals in society become aware of a disease, vaccination, and the herd immunity dynamic, their passive non-vaccination status is no longer a neutral omission. It is a choice with a measurable causal chain of harm. Maggie, who was already fighting cancer, and her ten-month old brother’s lives were jeopardized because of a parent’s failure to comply with the measles vaccination mandate for their child. Luckily, in Maggie’s case, both her and her brother received antibodies immediately which temporarily prevented the contraction of measles. But what if another immunocompromised child was not fortunate enough to receive antibodies so quickly? How would that child’s life be impacted because of a parent’s failure to comply? 

If an individual is detached from society and lives independently in a rural area, denying a vaccination is a self-regarding act. However, when a member of society makes the choice to refuse a vaccination, they are no longer committing a self-regarding act but an other-regarding act. When they are actively maintaining a disease-transmissable state in a shared social environment, their actions are directly affecting the individuals around them. There is no longer a personal choice being made as their body becomes a vector of risk in shared spaces, where proximity to Maggie is proximity to harm. Their non-vaccinated status is enabling the spread of the disease between people and stunting the progression towards achieving herd immunity. In the Harm Principle written by John Stuart Mill, he argues that the only purpose for when “power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others” (Mill 13). The Harm Principle doesn’t merely permit vaccine mandates in a public health emergency, it demands them. Once a person is made aware of the potential harm their non-vaxxer status can have on other individuals, their act can no longer be considered a neutral position and states hold power to mandate vaccinations in order to protect society from harm. 

In 1902, Massachusetts had a smallpox outbreak and the Massachusetts board of health mandated that all residents over the age of twenty-one be vaccinated unless excused by a physician due to health. Henning Jacobson refused to get the vaccination due to prior adverse reactions in his family and was fined (Mosvick; Jacobson v. Massachusetts 13).

While Jacobson had the legal right to be skeptical of the vaccination considering his past familial experiences, in order to remain a productive member of society, as Justice Harlan declared, “the 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” (Jacobson v. Massachusetts 26). While the U.S. Constitution ensures the liberty and freedom of all citizens, public health authority isn’t absolute. A mandate exercises an individual’s right to choice and is different from an authoritarian rule because there are proportional consequences. In this case, Jacobson and other individuals that refused the vaccination were fined, but in a more modern case that took place during the COVID-19 vaccination mandate, a nurse named Jennifer Bridges and over 100 other employees were forced to resign or terminated from their position at the Methodist Hospital due to their lack of compliance with the enforced vaccination policy (Bridges, et al., Applicants, v. The Methodist Hospital 2). These were both proportional consequences because of the potential risk these un-vaccinated individuals posed on society. They both carried the risk of contracting and transmitting the disease, limiting the ability to achieve the necessary herd immunity threshold. Membership in a shared community is consent to follow these rules. Justice Harlan continues his logic by adding that the “social compact” requires that all individuals oblige to temporary limitation on personal liberty for the common good (Jacobson v. Massachusetts 27). The common good cannot be held hostage by private skepticism. To remain a productive member of society and contribute to the well-being and safety of all individuals, it is necessary to follow the mandate rules or accept the consequences that follow. 

Both Jacobson and Bridges’ cases allowed consequences for the lack of compulsion, but injections were never forced onto individuals. Each individual had the choice to get vaccinated and contribute to herd immunity or reject the mandate and accept the consequences. A mandate should allow justifiable repercussions but never permit forced medical intervention. A forced medical intervention authorizes citizens to question their own authority in society and oppose the state’s authoritarian approach and overall control during an emergency. Instead, citizens must be given full transparency on the components of the mandate and clearly understand consequences that result from choices that jeopardize the safety of individuals that make up the public. Citizens who understand that their choice degrades herd immunity in measurable ways are more likely to comply, and mandates built on transparency rather than compulsion are more constitutionally durable. 

If a vaccination is limiting the transmission of a disease, a strict state government issued mandate is justifiable under the harm principle and feels like a necessary action to take in order to prevent the spread of a harmful disease that others could contract. Members of society that do not follow the mandate should be met with proportional consequences, such as termination of employment. If a vaccination has been proven to only protect oneself from the given illness, a mandate under this circumstance feels like an overreach on one’s personal liberty and does not fit Mill or Harlan’s framework. Therefore, even during a public health emergency, a vaccination

against a disease that has not been proven to limit transmission should not be mandated but instead encouraged as a voluntary measure. Under this policy, citizens’ personal autonomy is only restricted when essential.

If vaccinations become widely accessible and individuals are able to receive injections in schools or work, the same herd immunity threshold can be achieved through voluntary measures. Additionally, if disease prevention and the necessity of receiving a vaccination is added to the education system’s curriculum, mandates mary start to seem unreasonable and disproportionate. However, promoting voluntary measures has a limit. Measles is highly contagious and requires a 93% to 95% immunity threshold to prevent the transmission of the disease. The Measles, Mumps, and Rubella (MMR) vaccination rate for kindergarteners in the US fell to 92.5% which is below the herd immunity threshold (McPhillips). As a result of relying on voluntary measures, clusters of unvaccinated individuals compromise the threshold. In the recent school year, approximately 5.2 million children nationwide were taught in classrooms where the vaccination rate fell below the necessary herd immunity threshold (Weber et al.). Additionally, while the advantages of vaccinations are not directly taught in school, the majority of Americans are well informed on the importance of vaccinations and a study shows that eight in ten US parents are confident in the safety of MMR vaccines (Audrey Kearney et al.). While voluntary measures would be ideal, a vaccination mandate ensures that the herd immunity threshold for diseases such as measles and smallpox is maintained. 

Inaction by governments is itself a policy choice as individuals such as Maggie could be harmed by the government’s refusals to enforce a vaccination mandate. Ultimately, governments have an obligation to enforce policies that protect the health and safety of citizens under all circumstances.

Works Cited

Audrey Kearney, et al. “KFF Tracking Poll on Health Information and Trust: Trust in the CDC  

         and Views of Federal Childhood Vaccine Schedule Changes | KFF.” KFF, 6 Feb. 2026, 

 www.kff.org/health-information-trust/trust-in-cdc-and-views-of-federal-childhood-vac cine-schedule-changes/.

Bridges, et al., Applicants, v. The Methodist Hospital. United States Court of Appeals for the

Fifth Circuit, no. 24-20483, 17 June 2025. Supreme Court of the United States, www.supremecourt.gov/DocketPDF/25/25A257/373278/20250830133409535_Appendix%20Final-A.pdf.

Cleveland Clinic. “Herd Immunity: History, Vaccines, Threshold & What It Means.” Cleveland Clinic, 20 Oct. 2025, my.clevelandclinic.org/health/articles/22599-herd-immunity.

Jacobson v. Massachusetts. vol. 197, U.S. Supreme Court, 1905, pp. 11-39. Library of Congress, tile.loc.gov/storage-services/service/ll/usrep/usrep197/usrep197011/usrep197011.pdf

“Maggie.” Vaccinate Your Family, vaccinateyourfamily.org/testimonials/maggie/.

McPhillips, Deidre. “Record Share of US Kindergartners Missed Required Vaccinations Last Year, ahead of Surge in Measles Cases.” CNN, 31 July 2025, www.cnn.com/2025/07/31/health/vaccination-school-requirements-cdc.

Mill, John Stuart. On Liberty. Batoche Books, 2001, eet.pixel-online.org/files/etranslation /original/Mill,%20On%20Liberty.pdf.

Mosvick, Nicholas. “On This Day, the Supreme Court Rules on Vaccines and Public Health – National Constitution Center.” National Constitution Center – Constitutioncenter.org, 20 Feb. 2024, constitutioncenter.org/blog/on-this-day-the-supreme-court-rules-on-vaccines -and-public-health.

Weber, Lauren, et al. “As U.S. Vaccination Rates Fall, See How Your School Compares.” The Washington Post, 31 Dec. 2025, www.washingtonpost.com/health/interactive/2025/meas les-vaccine-schools-outbreaks-public-health/.