The current pandemic of COVID-19 has been determined by the World Health Organization (WHO) to be a public health emergency of international concern (PHEIC) under the International HealthRegulations, and it creates unique challenges for the immigration-related medical evaluation.  COVID-19 meets the definition of a quarantinable communicable disease under 42 USC 264 and Executive Order 13295, as amended by Executive Order 13375 and 13674. Specifically, COVID-19 meets the definition of severe acute respiratory syndromes as specified by Presidential Executive Order 13674external icon(issued July 31, 2014), thus making it a Class A Inadmissible Condition. 

Applicants, defined in these TechnicalInstructions as people applying for adjustment of status for US permanent residence, are medically screened well in advance of adjustment of status. Thus, a negative screening for COVID-19 at the time of the medical evaluation does not guarantee the applicant will not have COVID-19 at the time the applicant becomes a Lawful Permanent Resident. 

A combination of vaccination and routine infection control practices will provide the best protection from COVID-19 for applicants and US communities. These instructions provide information about COVID-19 vaccination for applicants.  The instructions in this document are to be followed for COVID-19 vaccination among applicants from all countries and are effective as of October 1, 2021. 

COVID-19 Vaccination Requirement 

The Advisory Committee on ImmunizationPractices (ACIP) has recommended COVID-19 vaccination for the age-appropriate, general US population. Therefore, COVID-19 vaccination now meets the criteria for required vaccinations and is a requirement for applicants eligible for the vaccine. 

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 examination.  The COVID-19 vaccination requirement will differ from previous requirements in that the entire vaccine series (1 or 2 doses depending on formulation) must be completed in addition to the other routinely required vaccines. COVID-19 vaccinations can now be given at any time, without regard to the timing of other vaccinations.  

Blanket Waivers Applicable to COVID-19 vaccinations: 

-Not age-appropriate 

For COVID-19 vaccines, the age for which a particular vaccine can be administered differs by formulation. If the applicant is younger than the lowest age limit for the formulations in use (less than 12years of age at the time of posting), this blanket waiver should be documented. 

-Contraindication 

If an applicant has a contraindication or precaution to the COVID-19 vaccine formulation available, the "Contraindicated" reason should be documented, and the vaccine should not be administered. 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. Please refer to Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States for COVID-19 specific information about contraindications and precautions. 

-Not routinely available 

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 vaccines 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." 

Other reasons why an applicant does not complete a COVID-19 vaccine series: 

-Applicant may request a waiver based on religious or moral convictions. 

If an applicant objects to vaccination based on religious or moral convictions, it must be documented that the applicant is requesting an individual waiver based on religious or moral convictions. This is not a blanket waiver, and the applicant will have to submit a waiver request to US Citizenship and Immigration Services (USCIS).USCIS will determine if this type of waiver is granted, not the civil surgeon or CDC. 

-Applicant refuses a COVID-19 vaccine series in part or entirety 

If an applicant refuses one or more doses of a COVID-19 vaccine series that is medically appropriate for the applicant, it should be documented that the vaccine requirements are not complete and that the applicant refuses vaccination. This applicant is Class A and is inadmissible to the United States.