Vaccines

Vaccination is the practice of inducing immunity to a disease by exposing the body to a weakened, killed, or partial form of the pathogen. It is among the most successful interventions in the history of medicine: smallpox, which killed an estimated three hundred million people in the twentieth century alone, was declared eradicated by the World Health Organization in 1980. Conservative argument about vaccines is not, in its serious form, an argument about whether they work.

The conservative dispute concerns compulsion. Who decides — the physician and the parent, the province or state, or a national administrative agency? What standard of evidence justifies overriding consent? And what happens to public trust when health authorities blur the line between the science they possess and the policy preferences they hold? These questions belong to constitutional government, and they were being fought over in English and American law more than a century before COVID-19.

Key Takeaways

• Vaccination as a documented medical technique dates to Edward Jenner’s cowpox inoculation of James Phipps on 14 May 1796, though variolation against smallpox was practised in Asia and the Ottoman Empire long before.
• Compulsory vaccination and organised resistance to it are both Victorian inventions: Britain’s Vaccination Act of 1853 made infant smallpox vaccination mandatory, and the amending Act of 1898 introduced the conscientious-objection clause that gave English the phrase.
• The governing American precedent, Jacobson v. Massachusetts (1905), upheld state compulsory vaccination under the police power — a state power, not a federal one.
• Conservatives distinguish sharply between vaccination as a medical good, which they accept, and mandate authority exercised by agencies with no democratic mandate, which they contest.
• The strongest conservative objection to the 2021-22 mandates was jurisdictional rather than medical, and the American courts split along precisely that line in January 2022.

History And Context

Inoculation with material from smallpox lesions — variolation — was practised in China and India for centuries and reached Constantinople by the seventeenth century. Lady Mary Wortley Montagu, wife of the British ambassador to the Porte, had her son inoculated in Turkey and brought the technique to England in 1721. The same year in Boston, the Puritan minister Cotton Mather, instructed by an enslaved West African man named Onesimus, urged inoculation during an epidemic and had a firebomb thrown through his window for it. Resistance to medical compulsion is as old as the compulsion.

Jenner, a Gloucestershire physician, observed that milkmaids who contracted cowpox did not take smallpox. On 14 May 1796 he inoculated eight-year-old James Phipps with matter from a cowpox lesion on the hand of the dairymaid Sarah Nelmes, then challenged him with smallpox; the boy did not sicken. Jenner published his findings privately in 1798.¹ The Latin for cow, vacca, gave the procedure its name.

Britain made infant smallpox vaccination compulsory in 1853 and added penalties in 1867. The Anti-Vaccination League and the Leicester demonstrations of 1885 forced a royal commission, and the Vaccination Act 1898 permitted parents to obtain exemption on grounds of conscience. In the United States the question reached the Supreme Court in 1905 when Henning Jacobson, a Lutheran pastor in Cambridge, Massachusetts, refused a smallpox vaccination and the five-dollar fine attached to refusal. The Court upheld the state law, grounding it in the police power reserved to the states.² That distinction — state authority yes, federal authority unaddressed — did the decisive work when the question returned.

The twentieth century delivered the successes: Salk’s inactivated polio vaccine licensed in 1955, Sabin’s oral vaccine after it, measles in 1963, smallpox eradication confirmed in 1980. It also delivered the cautionary cases. The Cutter Incident of 1955, in which improperly inactivated polio vaccine paralysed children, produced the modern American regulatory apparatus, and the National Childhood Vaccine Injury Act of 1986 created a no-fault compensation programme funded by an excise tax on doses.

The Conservative Position

Conservatives begin from the family and the physician, not from the ministry. The decision to administer a medical intervention to a healthy child belongs to the parent advised by a doctor, and the burden of displacing that decision falls on the state. This is not a claim that the burden can never be met. Smallpox met it. The argument is that the burden exists and must be discharged in public, by an accountable legislature, with a stated standard.

The second conservative principle is jurisdictional. American constitutional structure locates the police power in the states, and Jacobson affirmed it there. When the Occupational Safety and Health Administration issued an emergency standard in November 2021 requiring vaccination or weekly testing for employers with a hundred or more workers, the Supreme Court stayed it on 13 January 2022, holding that Congress had not authorised a workplace-safety agency to regulate public health at large.⁵ The same day, in Biden v. Missouri, the Court allowed a narrower vaccination rule for facilities receiving Medicare and Medicaid funds. The pairing illustrates the conservative position rather than contradicting it: authority delegated by statute is legitimate, authority assumed by an agency is not.

The third principle concerns expertise and its limits. Hayek’s argument that centrally held knowledge is always thinner than the dispersed knowledge of the people acting on the ground applies to epidemiology as much as to price-setting.⁴ Oakeshott’s critique of rationalism in politics describes the characteristic error precisely: the technician who mistakes a body of technical knowledge for a warrant to redesign social life, and who treats accumulated practice and local judgment as obstacles.³ A public-health authority that issues categorical guidance, reverses it without explanation, and treats dissent as a moral failing will exhaust the deference it depends on. Conservatives argued during 2021 and 2022 that this exhaustion, not any particular scientific claim, was the durable cost.

Canada supplied the sharpest example. Ottawa announced vaccination requirements for federally regulated transport workers and for domestic air and rail travel in October 2021, enforced them from 30 November, and suspended them on 20 June 2022. The trucker convoy that occupied central Ottawa in February 2022 was met with the first invocation of the Emergencies Act since its enactment in 1988. In January 2024 the Federal Court held that the invocation was unreasonable and infringed Charter rights, and the Federal Court of Appeal dismissed the government’s appeal in January 2026.

Differing Positions

The public-health case rests on externality. An unvaccinated person is not making a self-regarding choice: measles transmits at a basic reproduction number between twelve and eighteen, and herd immunity for it requires roughly ninety-five per cent coverage. Below that threshold, outbreaks reach infants too young to be vaccinated and immunocompromised patients who cannot be. On this reading, refusal imposes risk on identifiable third parties, and the classical liberal principle that restraint is justified to prevent harm to others licenses the mandate directly. Conservatives who invoke Mill against public-health measures are cutting against Mill.

The second argument is institutional. Exemption regimes with low friction produce clustered under-vaccination, and clusters, not national averages, cause outbreaks — the 2019 New York measles outbreak and the resurgence in Wales in 2013 both followed local collapses in coverage. Defenders of mandates argue that a right of conscience exercised at scale destroys the good it depends on.

The conservative answer is not to deny the externality but to insist that its existence settles nothing about who may act. A demonstrated harm to third parties is a reason for a legislature to act, not a warrant for an agency to act without one.

References

1. Edward Jenner, An Inquiry into the Causes and Effects of the Variolae Vaccinae (privately printed, London, 1798).
2. Jacobson v. Massachusetts, 197 U.S. 11 (1905).
3. Michael Oakeshott, “Rationalism in Politics”, in Rationalism in Politics and Other Essays (Methuen, 1962).
4. F. A. Hayek, “The Use of Knowledge in Society”, American Economic Review 35, no. 4 (1945).
5. National Federation of Independent Business v. Department of Labor, 595 U.S. 109 (2022).