U.S. To Require COVID-19 Vaccines For Green Card Applicants

Aug 26, 2021 | Raluca Vais-Ottosen

Published 8.26.2021

Immigrants to the U.S., meaning those applying for permanent residence or a green card, will soon be required to show proof of a completed COVID-19 vaccination or risk having their green card case denied.  This new requirement will be incorporated into the medical examination that immigrants are already required to undergo as part of the permanent residence process.

What is the medical examination for immigration purposes?

The Immigration and Nationality Act (INA), the main immigration law in the U.S., includes a wide list of grounds upon which an applicant for permanent residence or green card may be found inadmissible.  One of those inadmissibility grounds is health related.  Specifically, Section 212(a)(1) of the INA renders inadmissible on health-related grounds four types of individuals:

  1. those who are determined to have a communicable disease of public health significance;
  2. those who fail to present documentation to establish they already received vaccinations against vaccine-preventable diseases;
  3. those who have (or have had) a physical or mental disorder and behavior that may pose a threat to property, safety, or welfare of self or others; and
  4. those who are determined to be a drug abuser or addict.

These health-related determinations are made through a medical history and physical examination by a physician who is specifically certified by the U.S. government to perform medical exams for immigration purposes.  At the completion of the examination, the physician issues a medical report and provides it to the applicant in a sealed envelope, to be submitted with the applicant’s green card application. If the U.S. Citizenship and Immigration Services (USCIS) receives the envelope unsealed or open, the agency will render the medical report invalid and will request a new one to be submitted sealed.

What vaccinations are already required?

The law lists the following vaccine-preventable diseases for which immigrants must show proof of vaccination: “mumps, measles, rubella, polio, tetanus and diphtheria toxoids, pertussis, influenza type B and hepatitis B, and any other vaccinations against vaccine-preventable diseases recommended by the Advisory Committee for Immunization Practices.”  Therefore, the law lists specific vaccines that are mandatory, and also leaves the door open for adding new vaccines for vaccine-preventable diseases. 

The recommendations for adding new vaccines to the list comes from the Advisory Committee for Immunization Practices, a group of medical and public health experts within the Center for Disease Control (CDC).

Why is the COVID-19 vaccine added to the immigration medical exam?

The CDC has added COVID-19 to the list of vaccine-preventable diseases required for immigration because it meets the definition of a quarantinable communicable disease under the law.

Can I be cleared after the first dose of the COVID-19 vaccine in a two-dose treatment?

Generally, no. To avoid a finding of inadmissibility, and therefore a denial of the green card application, applicants must have completed the entire COVID-19 vaccination regimen before the physician signs off on the medical examination report.  Therefore, if opting for a two-dose vaccine such as Pfizer or Moderna, the applicant must complete both vaccine doses before the physician issues the medical report. An exception may be made if the applicant suffers a severe reaction after the first dose, and the second dose is not medically recommended (see more information on waivers, below).

Therefore, applicants should plan their medical examinations accordingly, to allow for sufficient time to complete the COVID-19 regimen prior to the medical report being issued and avoid unnecessary delays.

Can I get a waiver of the COVID-19 vaccine?

Yes, if eligible.  There are two types of waivers for the vaccination requirements: blanket waiver approved by the physician based on medical grounds, and religious or moral convictions waiver decided by USCIS.

The physician performing the medical examination may issue a blanket waiver for any of the vaccination requirements (including COVID-19), for any of the following reasons:

  • the vaccine is not age appropriate – in the context of COVID-19, this would apply for young children for whom the FDA has not yet approved a COVID-19 vaccine;
  • the vaccine is contraindicated – this would include individuals suffering from an underlying medical condition for which the vaccine is not recommended, or those who already took the first dose of a COVID-19 vaccine but had a severe enough reaction that a second dose is not recommended;
  • the vaccine is not routinely available – this could apply if the COVID-19 vaccine is not routinely available in the state where the physician performing the exam practices.

For any of the three factors above, the determination is made by the physician, not by the applicant.

If the applicant objects to the COVID-19 vaccine on religious or moral grounds, rather than having a health-related basis for rejecting it, then the physician will note on the medical exam that the applicant is requesting a religious waiver.  The applicant must then make a separate waiver request to USCIS, the agency processing the green card application.  USCIS will then determine whether the religious or moral objection is legitimate to justify a waiver of the vaccination requirements. 

In making a determination on the applicant’s religious or moral objection, USCIS will consider the following factors:

  • whether the applicant is opposed to all vaccinations in any form, or just to a particular vaccine;
  • whether the objection is based on religious belief or moral conviction; and
  • whether the religious belief or moral conviction is sincere, and not just a preference against vaccination.

If the applicant simply refuses the COVID-19 for reasons other than those mentioned above, then USCIS would find the applicant to be inadmissible to the U.S. and the green card application could be denied.

Am I required to take the vaccine if I already got the COVID-19 virus and an immunity test shows I already have the COVID-19 antibodies without the vaccine?

Yes, vaccination is still required even if you already contracted the COVID-19 virus, because the duration of immunity due to natural infection is not yet conclusive and may not last long enough.

Am I required to take the COVID-19 vaccine if I test negative for the virus?

Yes, a negative COVID test at the time of the medical examination does not eliminate the requirement for the vaccine.  That is because the medical examination that will incorporate the COVID-19 information is done weeks or months prior to the green card application being decided. 

When does the COVID-19 requirement take effect?

The COVID-19 vaccination requirement for permanent residence applications will be in force for all forms I-693 Report of Medical Examination and Vaccination Record submitted to USCIS on or after October 1, 2021.

We will continue to monitor these developments and will provide periodic updates.  If you have any immigration-related questions in general, or specific to the state of U.S. immigration during the coronavirus outbreak, please contact Attorney Raluca (Luca) Vais-Ottosen at or 608-252-9291.