Controversy Over Requiring HPV Vaccination in Immigration Medical Exams  Posted Apr 17, 2009
©MurthyDotCom
There has been some controversy regarding the vaccination requirements for immigration medical examinations. Specifically, the addition of the requirement for young women and girls to receive a vaccination for human papillomavirus (HPV) has raised protests by immigrants’ rights groups, as well as women’s groups and others involved in matters of public health. The drug currently used for this vaccination is Gardasil. In response to these concerns, on April 8, 2009 the Center for Disease Control (CDC), which is part of the U.S. Department of Health and Human Services (HHS), published a notice in the Federal Register which proposed changes in the criteria for immigration-related vaccination requirements.
©MurthyDotCom
Background of Vaccination for Human Papillomavirus
©MurthyDotCom
On August 1, 2008, the HHS and USCIS added five new required vaccinations as a condition of approval of an I-485 Application to Adjust Status, or an immigrant visa. The vaccination for HPV was one of the five new vaccinations. Our August 1, 2008 article, New Vaccinations and Revised Medical Form for Green Cards reported this requirement. The HPV vaccination applies to women and girls, ages 11 to 26. The immigration-related controversy of this vaccination is explained below.
©MurthyDotCom
Determining Vaccination Requirements
©MurthyDotCom
The Advisory Committee on Immunization Practices (ACIP) develops recommendations for vaccinations within the U.S. population generally. These recommendations then are adopted by the CDC and HHS as general standards of medical practice. These recommendations are not intended to be mandatory, however.
©MurthyDotCom
The recommendations of the ACIP, including the HPV vaccination, were translated into immigration requirements. This occurred because the Immigration and Nationality Act (INA) requires intending immigrants to be vaccinated against a specific list of conditions, as well as any vaccine-preventable diseases recommended by the ACIP. However, it was not the intention of the ACIP to make Gardasil mandatory, as explained in an October 1, 2008 article of the Wall Street Journal.
©MurthyDotCom
Controversy Over HPV Vaccinations
©MurthyDotCom
From an immigration standpoint, the HPV vaccination is controversial for a number of reasons. It does not prevent communicable diseases; rather it is intended to prevent the development of cervical cancer. The vaccination can be quite expensive, adding to the already significant immigration-related costs involved in the "green card," process. Many health policy experts view the requirement as excessive. Several immigrants' rights, women's rights, public health, and medical organizations have joined together to petition the CDC to address this matter. These interest groups are aiming to have ACIP remove Gardasil from the recommended list, in part because of the inadvertent burden it imposes on intending immigrants. Additionally, many from the petitioning organizations feel any health concerns about this vaccination, as with many other drugs, are best placed in the hands of the patients and their physicians.
©MurthyDotCom
HHS Proposes New Criteria for Determining Required Vaccinations
©MurthyDotCom
In order to address these concerns, on April 8, 2009 the CDC proposed changes (PDF 47.2KB) in the criteria for immigration vaccinations. The notice is open to public comment until May 8, 2009. If approved, it would change the way the CDC determines which of the vaccines recommended by the ACIP would be required for foreign nationals applying for adjustment of status or an immigrant visa. The CDC proposes analyzing the following criteria to determine whether certain vaccinations for immigrants seeking admission or adjustment should be required.
©MurthyDotCom
a) whether the vaccine is age-appropriate
b) whether it has the potential to protect against an outbreak
c) whether the vaccine protects against a disease that has been or is in the process of being eliminated
©MurthyDotCom
Under this new framework, HHS possibly could determine that Gardasil is not an appropriate vaccination requirement for the immigration process. However, this determination cannot be made until the final rule is published and the CDC analyzes Gardasil and HPV under these new criteria.
©MurthyDotCom
Conclusion
©MurthyDotCom
There is often a complex interplay between immigration laws and other laws and regulations. In this situation, the ACIP’s recommendations for good medical practice have created an unintended consequence for immigrants. We at the Murthy Law Firm hope that this matter will be resolved favorably, through new criteria that better reflect the purpose of the vaccination requirements.