Soon after the British physician Edward Jenner demonstrated vaccination's immunizing power against smallpox in 1798, the practice spread rapidly through Europe and overseas to the Americas. Yet from its inception vaccination was neither simple, foolproof, nor benign. Although most physicians believed that its benefits far outweighed its risks, vaccination could, and did, go awry. Over the course of the nineteenth century, issues of efficacy and stories of infection, disease, and even death after vaccination undermined public confidence to the point that people did not vaccinate sufficiently to prevent the periodic resurgence of smallpox epidemics.

By the middle of the century, widespread avoidance of vaccination drove some states to exact compliance through legal compulsion. The authoritarian nature of compulsory vaccination troubled people who believed it subverted democratic ideals of personal liberty. In their view, vaccination represented a departure from time-honored police power methods to protect public health. Nuisance abatement, quarantine, and isolation of the sick infringed private rights to body and property, but they dealt with obvious threats to public health. Even during the eighteenth century, when inoculation with mild smallpox (variolation) became a standard method of immunizing against further attacks, colonies did not make it compulsory. In fact, they had to make rules to restrict the procedure for fear that inoculation could spark epidemics. Vaccination infected healthy individuals with vaccinia, a disease that did not spread smallpox, and that feature convinced legislators that compulsion was warranted despite the personal risk and discomfort it posed to the populace. Official proclamations to the contrary, health departments around the country at times pushed compulsion too far, routinely resorting to coercion or even force to vaccinate working poor, destitute, or nonwhite populations. By the 1890s, antivaccination societies had organized to fight compulsory laws in legislatures and courts all over the United States. General anxiety about vaccination also rendered many people sympathetic to antivaccinationists’ claims and their campaign against legal compulsion.

The antivaccination legal challenge culminated in a 1905 United States Supreme Court decision, Jacobson v. Massachusetts. In 1902, the ordinarily lawabiding Swedish Lutheran pastor Henning Jacobson refused to get vaccinated, despite a local health department order supported by state statute.