The U.S. Centers for Disease Control and Prevention (CDC) has a new requirement that will affect all green card applicants. Starting October 1, 2021, intended immigrants must receive full doses of the COVID-19 vaccine to immigrate to the U.S. This new requirement affects eligibility for permanent residence on health-related grounds.

This is episode 12: COVID-19 Vaccination Required for Green Card Applicants, Starting October 1st
Hello and welcome to the Legal Immigrant. My name is Dyan Williams, your host and U.S. immigration attorney at Dyan Williams Law.

COVID-19 has been added as a Class A medical condition that bars a person from the United States. Class A inadmissibility includes a communicable disease of public health significance per regulations under the Department of Health and Human Services; and a failure to present documentation of having received vaccinations against vaccine-preventable diseases.

As of October 1st, the COVID-19 vaccine will be among the vaccines required for applicants to obtain lawful permanent residence, either through the I-485 green card application with USCIS or through an Immigrant Visa application at the U.S. Embassy.

The CDC says COVID-19 meets the definition of a quarantinable communicable disease under 42 USC 264 and various executive orders. It is classified as a severe acute respiratory syndrome.

Executive Order 13674, issued in July 2014, by the Obama Administration, states “severe acute respiratory syndromes are diseases that are associated with fever and signs and symptoms of pneumonia or other respiratory illness, are capable of being transmitted from person to person, and that either are causing, or have the potential to cause, a pandemic, or, upon infection, are highly likely to cause mortality or serious morbidity if not properly controlled. This subsection does not apply to influenza."

Section 212(a)(1)(A)(ii) of the Immigration and Nationality Act states applicants for permanent residence must present proof that they are vaccinated against vaccine-preventable diseases, which include mumps, measles, rubella, polio, tetanus and influenza type B and hepatitis B, and any other vaccinations against vaccine-preventable diseases recommended by the Advisory Committee for Immunization Practices.

The ACIP has now recommended COVID-19 vaccination for the age-appropriate, general US population. The CDC says this means the COVID-19 vaccination is now required to immigrate to the U.S.

There is conflicting information on whether the current vaccines prevent COVID-19 altogether. The vaccines are primarily intended to reduce symptoms and the probability of hospitalization and death. The vaccines do not offer full protection or sterilizing immunity to this respiratory illness, especially with the emergence of variants, including Delta.

As an internal CDC slide presentation shows, the Delta variant is more transmissible than MERS, SARS, ebola, seasonal flu and 1918 Spanish Flu, and smallpox. It is, however, not as deadly.

CDC officials have said, inoculated people infected with the Delta variant carry tremendous amounts of the virus in the nose and throat. The vaccine-induced antibodies largely remain in the blood, so vaccinated individuals won’t have local immunity in the nose or throat. Vaccinated persons may transmit the virus to others while they are infected and contagious, just like the unvaccinated. You can check out the article on Health Policy Watch. The link is in the show notes.

Vaccinated – not just unvaccinated - individuals are being advised to physically distance, avoid crowds, mask up and take other special precautions.

At present -- except for the newly FDA-approved Pfizer MRNA vaccine -- the current vaccines are authorized only for emergency use. In general, the unvaccinated tend to have more severe symptoms, especially when they are older and have comorbidities. But the current COVID-19 vaccines do not altogether stop the spread or transmission of the virus, which the other required vaccines tend to do.

Some studies show natural immunity works just as well if not better than the current vaccines.

Still, the CDC says Lab Confirmation of Immunity is not enough. Its instructions for immigrant medical examinations state, “Laboratory tests for COVID-19 immunity must not be used for the civil surgeon exam. The applicant is required to receive the vaccine series regardless of evidence of immunity or prior COVID-19 infection.” It asserts, “The duration of immunity due to natural infection is still being investigated and might not protect the applicant throughout the immigration process.”

What is an Acceptable COVID-19 Vaccine and Proof of Vaccination?

Approved COVID-19 vaccines are those authorized for use in the United States or those listed for emergency use by the World Health Organization.

Personal attestation that you have been vaccinated is not enough.

Showing immunity or recovery from a prior COVID-19 infection is not a permissible basis for a vaccination waiver.

Acceptable evidence of vaccination includes:

An official vaccination record;

A medical chart with physician entries pertaining to the vaccination, including dates you received the vaccine, name or manufacturer and lot number; or,

Appropriate medical personnel attestation.

What is the COVID-19 Vaccination Requirement?

The designated civil surgeon who performs the medical examination and completes the Form I-693, Report of Medical Examination and Vaccination Record, must confirm the applicant received all doses of the COVID-19 vaccine. The I-693 is part of the green card application within the United States. A similar medical exam process is performed by a panel physician and required for Immigrant Visa applicants abroad.

If the COVID-19 vaccine is available, the designated surgeon or panel physician may vaccinate applicants who are partially vaccinated. If the applicant is unvaccinated, the process may be delayed as applicants must receive all doses of the COVID-19 vaccine before the medical exam can be completed.

The applicant must complete the COVID-19 vaccine series and provide documentation of vaccination to the civil surgeon in person before completion of the medical exam. The entire vaccine series (1 or 2 doses depending on formulation) must be completed in addition to the other routinely required vaccines.

COVID-19 vaccination can now be given at any time, without regard to the timing of other vaccinations. Some example timelines for the Pfizer-BioNTech, Moderna, and Janssen (Johnson & Johnson) COVID-19 vaccines and other required vaccinations are shown in the CDC instructions.

Are there Exemptions to the Vaccination Requirement?

Blanket waivers are available in three situations:

1) Applicants who are not age-appropriate or too young to receive the vaccine. The age for which a certain COVID-19 vaccine can be given depends on the formulation. If the applicant is younger than the lowest age limit for the formulations in use (which is currently younger than 12 years old), this blanket waiver should be documented.

2) Applicants with medical contraindication to the vaccine. If an applicant has a contraindication or precaution to the current vaccine available, the “Contraindicated” reason should be documented, and the vaccine should not be given. If the applicant has had a severe reaction to the first dose that is considered a contraindication to receiving a second dose, the first dose should be documented in addition to the blanket waiver.

3) Applicants who do not have access to one of the approved COVID-19 vaccines. If no COVID-19 vaccine is routinely available in the state where the Civil Surgeon practices, the “Not routinely available” reason should be documented. If the vaccine is available to the applicant but due to limited supply, it would cause significant delay for the applicant to receive their vaccination, then this situation would also be considered “Not routinely available.”

An Individual Waiver is also available to applicants who refuse the vaccination requirement on religious or moral conviction grounds.

This is not a blanket waiver. Waivers based on religious or moral convictions are considered on a case-by-case basis. The applicant has to submit the waiver request to USCIS. USCIS - not the civil surgeon or CDC - will determine whether to give this individual waiver.

If an applicant refuses one or more doses of a COVID-19 vaccine series and is not eligible for a waiver of this requirement, the civil surgeon will document the vaccine requirements as incomplete. On health-related grounds, the applicant will be deemed inadmissible for a Class A condition and will be found ineligible for permanent residence.

The CDC instructions are to be followed for COVID-19 vaccination among applicants from all countries and are effective as of October 1st, 2021. The CDC requirements for immigrant medical examinations are available at cdc.gov. The link is in the show notes.

Back in December 2020, a month before his Administration began, President Biden said he didn’t think COVID-19 vaccine should be mandatory. In his inaugural speech he asked us to commit to mask wearing for 100 days.

A lot has changed over the last several months, with vaccines becoming mandatory for federal workers and in a growing number of organizations and situations, from getting into a restaurant to keeping your job and now to getting a green card.

Although the vaccines do help to reduce symptoms, it’s still not clear whether they render COVID-19 a vaccine-preventable illness. The COVID-19 vaccination requirement will apply equally to all foreign nationals who apply for permanent residence.

If you are in the process of filing your Form I-485 application for permanent residence, you will not be required to take the COVID-19 vaccine if you complete the medical exam before October 1st.
USCIS considers a completed Form I-693 to be valid for two years after the date the civil surgeon signed the form, as long as the date of the civil surgeon’s signature is no more than 60 days before the applicant filed the I-485 application with USCIS.

As of August 12, 2021, USCIS temporarily extended the validity period for Form I-693 from two years to now four years. For decisions on Form I-485 green card applications issued on or before September 30th, 2021, USCIS may accept an otherwise valid Form I-693 if:

• The civil surgeon’s signature is dated no more than 60 days before the applicant filed the I-485; and
• No more than four years have passed since the date of the civil surgeon’s signature

You do not have to file the Form I-693 medical exam report at the same time you file your I-485 green card application. Many applicants bring their completed Form I-693 to their interview. USCIS, however, may waive the interview requirement in certain cases. If the I-693 is submitted with the I-485 application, USCIS does not have to issue a Request for Evidence to obtain the medical report if it determines an interview is not required.

In sum, if you have weighed the risks and benefits, and do not want to take the COVID-19 vaccine for US immigration purposes, you will have to get a completed medical exam report before October 1st. Then you must file your I-485 application within 60 days. As of that date, all green card applicants will have to take the vaccine unless they qualify for a waiver or exemption.

This is general information only. To request a consultation on the I-485 green application and the new I-693, COVID-19 vaccine requirement, you may contact me through my website at dyanwilliamslaw.com.
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