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The law requires that aliens submit documentation that they have received vaccinations against each of the above diseases. It is expected that, in particular, documentation of the Hepatitis B vaccine may cause problems and delays since this vaccine is unavailable in many countries and is administered in two shots given six months apart.
On January 17, 1997, INS issued a wire implementing the vaccination requirement. However, the wire stressed the agency was awaiting guidance from the CDC and focused on the applicable waivers.
INS issued a memo on April 10, 1997 after receiving guidance from the CDC. The INS memo indicates that the blanket waivers mentioned above as waivers A and B do not require the completion of a form or the payment of a fee. The civil surgeon must, however, endorse the alien's medical examination report (form I-693 and supplement) to record the alien's vaccination history. The CDC has issued Technical Instructions for the Medical Examination of Aliens in the United States as a guide for civil surgeons concerning: (1) reviewing an alien's vaccination history; and (2) determining whether a particular vaccination is not medically appropriate.
The civil surgeon will endorse the supplement to form I-693 to indicate that all of the alien's vaccination records have been reviewed and demonstrate: (1) that the alien fully complies with the law; (2) that it is not medically appropriate that the alien take certain vaccinations; or (3) that the alien has indicated that he is not in full compliance on either religious or moral grounds.
The CDC has determined that a vaccination is not medically appropriate if: (1) the particular vaccine is not recommended by the ACIP for the alien's specific age group; (2) the vaccine is contraindicated (For example, if the alien would suffer an allergic reaction to the vaccine.); (3) the alien has taken the initial vaccine, but cannot complete the recommended series of vaccines within a reasonable period of time; or (4) with regard to the influenza vaccine, the medical examination is not being conducted during the fall or flu season.
The INS memo indicates that no blanket waivers will be available when an alien advises the civil surgeon that he cannot comply with the vaccination requirement on religious or moral grounds. The civil surgeon will simply note this on the supplement to form I-693, and the alien will complete and submit form I-601 to the INS along with the proper fee. The INS memo provides that all I-693s which are dated and signed by the civil surgeon after May 1, 1997 which are not accompanied by the CDC's vaccination supplement should be returned to the alien who should be instructed to return to the civil surgeon.
In an April memorandum signed by Secretary of State Madeline Albright, all immigrant visa applicants who are interviewed on or after July 1, 1997 are required to meet the vaccination requirements despite the absence of the above-referenced INS regulations.
It is instructive to note that the State Department memorandum is far from inflexible. For example, section 8 provides that "based on the CDC instructions, panel physicians will determine which vaccinations are medically appropriate for the individual applicant". The same section also states that "applicants are not required to receive a full series of vaccinations if this would delay their immigration, and can request a waiver. They are, however, urged to complete the series after their arrival in the U.S."
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