The Legal Basis for Vaccination Requirements

Under INA § 212(a)(1)(A)(ii), an applicant is inadmissible if they fail to present documentation of having received vaccines in accordance with the recommendations of the Advisory Committee on Immunization Practices (ACIP). This is a documentation requirement — the applicant must be able to show that they received the required vaccines, not just that they are immune.

Required Vaccines

The required vaccines are those recommended by ACIP that are age-appropriate and medically appropriate for the applicant. The current list includes: MMR (measles, mumps, rubella), varicella, hepatitis A, hepatitis B, influenza (seasonal), meningococcal, pneumococcal, Tdap/Td (tetanus, diphtheria, pertussis), HPV (age-appropriate), COVID-19, and others as updated by ACIP.

The specific vaccines required depend on the applicant's age and medical history. For example, HPV vaccine is required for applicants aged 9–26 (with some exceptions). Influenza vaccine is required annually. Applicants 75 and older are exempt from the influenza requirement.

How Vaccination Records Are Evaluated

The civil surgeon reviews the applicant's vaccination records to determine which required vaccines have been documented. Foreign vaccination records are accepted if they are in a format the civil surgeon can verify — typically a written record with vaccine names, dates, and the name of the administering provider.

If a required vaccine is not documented, the civil surgeon will administer it at the time of the exam (if available) or refer the applicant to a pharmacy or clinic. The civil surgeon cannot complete Form I-693 until all required vaccines are either documented or administered.

What Happens When Vaccines Are Missing

Missing vaccines are the most common cause of delays at the immigration medical exam. If a required vaccine is not documented, the civil surgeon will administer it at the exam if it is available in the office. Some vaccines (such as the hepatitis B series) require multiple doses over several months — this can significantly delay the completion of Form I-693.

Attorneys should advise clients to obtain and bring all available vaccination records before the exam. This includes foreign vaccination records, childhood immunization records, school vaccination records, and any records from prior medical providers. Even partial records are helpful — they may document some vaccines and reduce the number that need to be administered at the exam.

Foreign Vaccination Records

Foreign vaccination records are accepted by civil surgeons if they are legible and contain sufficient information to verify the vaccines received. Records in languages other than English should be accompanied by a translation. The civil surgeon will review the records and determine which vaccines are documented.

Some foreign vaccination programs use different vaccine names or schedules than U.S. programs. The civil surgeon will evaluate whether foreign vaccines are equivalent to the required ACIP vaccines. In most cases, standard childhood vaccines administered abroad are accepted.

Vaccination Waivers

A waiver of the vaccination requirement is available on two grounds: (1) medical contraindication — the required vaccine is medically contraindicated for the applicant, or (2) religious or moral objection — the required vaccine is contrary to the applicant's religious beliefs or moral convictions.

The medical contraindication waiver requires documentation from the civil surgeon certifying that the vaccine is contraindicated. The religious/moral objection waiver requires a detailed personal statement and evidence that the objection is sincere and longstanding. Attorneys handling vaccination waiver cases should work with the civil surgeon to obtain the appropriate documentation.

Attorney Checklist for Vaccination Issues

Attorneys should advise clients to: (1) gather all vaccination records before the exam, including foreign records and childhood immunization records, (2) contact prior healthcare providers to obtain vaccination records if originals are unavailable, (3) be prepared for the possibility that some vaccines will need to be administered at the exam, and (4) if a multi-dose vaccine series is needed, plan for a longer timeline before Form I-693 can be completed.