The disease did not originate there, but a preventive measure began in China. The measure spread around the world. Knowledge of it came to North America, where the disease had helped Europeans dominate the land, on a slave ship. The preventive inoculations led to claims of violations of personal and religious liberty. A vaccine was developed, and states began to require its use. Courts were asked to find a law requiring vaccinations unconstitutional, but the Supreme Court upheld the statutes. The vaccine was so successful that widespread inoculations have led to the elimination of the disease. This particular virus is no longer the scourge that killed hundreds of millions.

We don’t know precisely how or when smallpox developed, but we have evidence of it five thousand years ago in Egypt. It endured through the millennia. By the fifteenth century, it had spread to all parts of the globe except the Americas. That changed when Europeans brought it to what they thought of as the new world. Native populations, who had no immunity to the disease, succumbed at perhaps a 90% rate, making it easier for the Spanish and English to colonize what had once been extensively populated lands. Smallpox persisted. Millions of cases still occurred in the second half of the last century.

          People tried to prevent the disease, and by the sixteenth century, China was using an immunization method against smallpox in which powdered smallpox scabs were inserted into scratches made in the skin of the healthy. When this went well, the recipient developed only a mild form of the disease, but one that gave the person lifetime immunity. This inoculation method called variolation (Variola is the virus that causes smallpox) spread to the Middle East and Africa.

          Puritan Minister Cotton Mather learned this technique from his West African slave Onesimus and used it in the 1720s when Boston suffered a smallpox outbreak. Objections to the inoculations were strong. Although Cotton Mather was hardly lax on the religiosity front, the method was said to be ungodly because it was not mentioned in the Bible. Furthermore, it affronted God’s right to determine who was to die and how and when they should meet God. Others raised the non-religious objection that using the product of a disease to prevent a disease did not make sense. But the empirical data overwhelmingly showed that variolation prevented deaths from smallpox. The practice spread in colonial America, and in 1775 George Washington required the variolation of the Continental Army. It soon gained general acceptance in the larger cities and towns of the United States.

          The practice, however, did have dangers. While the inoculation recipient usually got only a mild case of the disease, occasionally it was severe, and deaths occurred. Near the end of the eighteenth century many recognized that a cowpox infection (which is related to, but much less virulent than, smallpox) seemed to protect against the more serious infection. Dr. Edward Jenner vaccinated (the terms vaccine and vaccination are derived from the name of the cowpox virus, variolae vaccinae) people with the cowpox virus and then later showed that this made the recipient immune to smallpox. Jenner is credited with creating a smallpox vaccine–the first vaccine ever. In doing so he is thought to have saved more lives than anyone else in history.

          Even with the vaccine, however, smallpox continued not just in backwaters or “primitive” areas of the world, but also in the United States. In 1827, Boston was the first American city to require school children to be vaccinated against smallpox, and other states and cities adopted the policy and added similar requirements as other vaccines were developed. Over a century after Jenner’s discovery, Cambridge, Massachusetts, in response to an outbreak and pursuant to a state law, required adults to get smallpox vaccinations.

          Henning Jacobson said that forcing him to be vaccinated violated the liberty guaranteed by the Constitution and that no one should be subjected to the law if they objected to vaccination no matter what their reason. The issue made its way to the United States Supreme Court. In 1905 Jacobson v. Massachusetts held that individual liberty could be restrained by reasonable laws for the safety of the general public and that “real liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own liberty, whether in respect of his person or property, regardless of the injury that may be done to others.” Jacobson had offered proof that some medical authorities contended that vaccinations would not stop the spread of smallpox and would cause other diseases and adverse consequences. The Court noted, however, that many other medical authorities held contrary opinions. The Court concluded that legislatures—not the courts– had the authority to decide how to protect the public. The mandatory vaccination requirement for adults was upheld.

          In 1922 the Supreme Court extended its Jacobson ruling. Zucht v. King upheld the San Antonio, Texas, school district’s rule that excluded children from both public and private schools if they did not have a smallpox vaccination. Since then lower courts have found many different vaccination requirements to be constitutional.

          Smallpox vaccinations, of course, have been a huge success. Intensive containment and vaccination efforts in the second half of the last century led to the worldwide eradication of the disease. The last case of it was in 1978.

          Since the development of the smallpox vaccine, many other vaccines have prevented much human misery, but in spite of what the Supreme Court held more than a century ago, many claim they have a constitutional right to refuse a mandated vaccination. The law and the Constitution are not on their side. They will succeed only if the present Court will be activist enough to overturn the settled precedents and find that individuals have a right never before found, a right to place others in peril. If so, society will suffer. And American life expectancy, which took the largest nosedive since World War II under Trump, the Has Been Guy, will drop further. Such a finding will, in fact, MALG–Make America Less Great.