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Facing an expanding measles epidemic, New York Mayor Bill de Blasio on Tuesday declared a public health emergency and ordered a mandatory vaccination program in parts of Brooklyn.
Such an order of health is rare but not unheard of in American history, medical experts said. This happened several times.
The Supreme Court ruled over a century ago that compulsory vaccination was legal, although the court distinction between punishing the citizens for their refusal and actually vaccinating them by force.
Nevertheless, these two tactics have been imposed over the past 120 years – from the plague outbreak of 1900 in San Francisco and the measles outbreak in Philadelphia in 1991.
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The order of vaccination in New York is written in such a way as to leave both possibilities open, depending on the rigor with which the city chooses to apply it.
The mayor of Blasio said that New Yorkers in affected neighborhoods who refuse to be vaccinated or have their children vaccinated face a $ 1,000 fine.
Health Commissioner Dr Oxiris Barbot, however, clarified that anyone who has not been vaccinated and can not prove that she was safe from measles or if an exemption medical treatment, "will be vaccinated".
Below the Commissioner's signature – outside the very text of the decision – is an additional warning that non-compliance is a crime and may result in fines or imprisonment.
On Tuesday, Dr. Barbot said that persistent refusals would be dealt with "on a case-by-case basis, and that we should talk to our legal adviser".
the defining case in the field, according to Daniel A. Salmon, director of the Institute for Vaccine Safety of the Johns Hopkins Bloomberg School of Public Health, is the 1905 judgment of the Supreme Court in the case of Jacobson c. Massachusetts.
The court confirmed the power of states to impose compulsory vaccination on the grounds that, in the event of imminent danger, the liberty of an individual could be subordinated to the common good.
The complainant, Henning Jacobson, was a pastor in Cambridge, Massachusetts, who had been vaccinated against smallpox as a child in Sweden and claimed that it caused him suffering throughout his life.
He also stated that vaccination was an "infringement of his freedom" within the meaning of the 14th Amendment. During an outbreak of smallpox, he refused to be vaccinated, he or his son, and was fined $ 5.
Massachusetts was then one of 11 states with mandatory vaccination laws, but it did not allow for forced vaccination. By a vote of seven to two, the court allowed the subsequent fine and the imprisonment could also have been inflicted.
But Judge John Harlan wrote for the majority that individuals could not be forcibly vaccinated.
However, forced vaccination was used in Philadelphia in 1991, said Dr. Paul A. Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia.
A measles outbreak that year infected more than 1,400 people and killed several children. It started in two fundamentalist churches that rejected modern medicine and practiced faith healing.
A court ordered that the children of these churches be vaccinated. Their families did not resist.
"They were peaceful," Dr. Offit recalls. "Once that was the law of the city, they understood it and they were rather calm about it."
(The pastor of a church vaccinated his dog because the law required it, said his son, but his son died from an infection caused by the bacterium Hib, which is avoided thanks to a vaccine administered systematically to children every two months.)
City and state health commissioners often have broad powers. Most public health laws date back to the 19th century, when cities were regularly swept by waves of cholera, yellow fever and smallpox that killed thousands.
In the 1892 cholera outbreak, Dr. Cyrus Hudson, New York's health commissioner, was questioned by a congressional committee about the limits of his powers. He replied that he could even seize the city hall and turn it into a hospital.
In the 1990s, when some New Yorkers with multidrug-resistant TB – mostly homeless men – refused to take antibiotics, they were incarcerated in a locked room at Bellevue Hospital and forced to take medication until That they are no longer contagious.
Forced vaccination is, however, more politically sensitive than quarantine or forced treatment. Vaccines are given to healthy people – sometimes infants – rather than to those who are sick and clearly endanger other people.
Smallpox vaccination was made compulsory in some parts of Europe in 1806, but the first forced vaccination attempt in this country took place in San Francisco's Chinatown in 1900. The city almost exploded into riots, said Dr. Howard Markel, director of the University's Center for the History of Medicine of Michigan.
As he described in his book "When Germs Travel," the entire neighborhood was cordoned off by the police on March 7, 1900, less than 24 hours after local health authorities had concluded that a salvaged wood dealer had was found dead in a basement bed at a pension of one penny a night had perished from the plague.
The plague was then common in China and by 1899 it had reached Honolulu's Chinatown. A "controlled fire" of a few plague-infested houses, ordered by the city's health council, had gone out of control and set fire to 4,000 houses, leaving thousands homeless.
Anti-Chinese prejudices were rife in California, and the Chinese were terrified that what had happened in Hawaii was repeating itself.
San Francisco Quarantine was lifted on March 9, in part because employers needed their workers. Health inspectors and the police began searching the community for the sick and beat everyone who resisted.
In May, the surgeon general in Washington telegraphed federal health officials to take control of the epidemic, cordon off Chinatown again, prevent the Chinese and Japanese from leaving the city, disinfect all their homes – and vaccinate them all with an experimental test. vaccine against plague.
(The national panic was such that the Treasury Secretary briefly gave orders that all Asians could be denied public carrier transportation anywhere in the country.)
The vaccine had been invented three years earlier by Waldemar Haffkine, an Orthodox Jew driven out of Russia by anti-Semitism and had moved his lab to India.
The second quarantine lasted weeks and Chinatown faced famine until local merchants gave food. The Chinese press reported that the Haffkine vaccine had killed some Indians and that some Chinatown residents who accepted it had fallen ill.
The Chinese Consolidated Benevolent Association, a group of citizens, sued, and a federal district judge ended vaccinations, saying the order was targeting Asians for no medical reason.
In the end, vaccination efforts were dropped because the governor asked President William McKinley to intervene. The federal health official had started giving orders so radical that they effectively prevented all Californians from leaving the state without his permission.
Imposing fines on people who refuse to be vaccinated has a complex story, said Dr. Salmon. In Britain, he noted, fines were sometimes imposed repeatedly for repeated refusals.
"People lost their homes and became martyrs," he said.
In addition, fines create inequalities because some people can afford them and others can not. "You end up punishing people based on their ability to pay," said Dr. Salmon.
There is almost always a backlash.
In Great Britain, the Vaccination Act of 1853 galvanized the creation of an anti-vaccination movement, and in the United States, the Anti-Vaccination League of America was created three years after the Jacobson v. Massachusetts.
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