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Justice John Marshall Harlan delivered the decision for a 7-2 majority.He rejected Jacobson's claim that the Fourteenth Amendment gave him the right to refuse vaccination.Jacobson was distraught by this and took his case against mandatory vaccinations to the Supreme Court in 1905.He refused the vaccine stating it was an "invasion of his liberty", Pastor Jacobson refused vaccination saying that "he and his son had had bad reactions to earlier vaccinations".

He stated his nuanced opinion on the limits of government power by saying that "general terms should be so limited in their application as not to lead to injustice, oppression or absurd consequence".

The anti-vaccine movement mobilized following the decision and the Anti-Vaccination League of America was founded three years later in Philadelphia to promote the principle that "health is nature's greatest safeguard against disease and that therefore no State has the right to demand of anyone the impairment of his or her health." The League warned about what it believed to be the dangers of vaccination and the dangers of allowing the intrusion of government and science into private life, part of the broader process identified with the Progressive Movement.

The League asked, "We have repudiated religious tyranny; we have rejected political tyranny; shall we now submit to medical tyranny?

Harlan deemed that the Massachusetts state punishment of a fine or imprisonment on those who refused vaccines was acceptable, but those individuals could not be forcibly vaccinated.

At the end of his decision, he acknowledged that for certain individuals, the requirement of vaccination would be cruel and inhumane and therefore an overreach of government power.

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