An immigrant visa applicant is required to have an overseas medical examination by a panel physician. The examination includes confirming that the applicant has received certain vaccinations. Effective Oct. 1, 2021, the Centers for Disease Control (CDC) requires applicants to receive a full COVID-19 vaccine series prior to being issued an immigrant visa. This article summarizes the CDC’s COVID-19 Technical Instructions for Physicians.
Approved vaccines include those listed by the U.S. Food and Drug Administration (FDA) or by the World Health Organization (WHO).
The FDA has authorized for emergency use or approved the following vaccines:
- Comirnaty and Pfizer-BioNTech COVID-19 Vaccine
- Moderna COVID-19 Vaccine
- Janssen COVID-19 Vaccine
The WHO has listed for emergency use the following vaccines:
- AstraZeneca/Oxford vaccine
- Johnson and Johnson
- Sinopharm (国药集团), developed by the Beijing Institute of Biological Products Co. Ltd. (北京生物制品研究所有限责任公司)
- CoronaVac (克尔来福), developed by SinoVac (科兴中维生物技术有限公司)
The entire vaccine series (1 or 2 doses depending on formulation) must be completed. “Mix and match” is allowed. In other words, an individual will be considered fully vaccinated if they have received a combination of two doses of different listed vaccines.
CDC considers a person to be “fully vaccinated” 14 days after a person received:
- one dose of an accepted single-dose-series COVID-19 vaccine (e.g., Janssen/J&J);
- a second dose in a 2-dose series of an accepted COVID-19 vaccine; or
- a second dose of any “mix-and-match” combination of accepted COVID-19 vaccines administered at least 17 days apart.
Note that laboratory tests for COVID-19 immunity or evidence of prior COVID-19 infection will not be accepted in lieu of evidence of vaccination.
Note on Unapproved Chinese Vaccinations
Of the top 5 COVID vaccinations approved in China, only the 2 mentioned above have been listed by WHO for emergency use.
The others, not listed by WHO for emergency use and so not acceptable for purposes of U.S. immigration law, include:
- Sinopharm, developed by the Wuhan Institute of Biological Products
- Convidecia, developed by CanSino Biologics; Academy of Military Medical Sciences
- Anhui Zhifei, developed by Anhui Zhifei Longcom; Chinese Academy of Sciences
The Physician Will Review Vaccination Records
- An applicant should show the panel physician documentation of receiving a COVID-19 vaccine series. Acceptable vaccination documentation must come from a vaccination record, either a personal vaccination record or a copy of a medical chart with entries made by a physician or other appropriate medical provider. The documentation must include the dates of receipt (month, day, and year). The name or manufacturer and lot number should be included if available.
- If COVID-19 vaccine is available to panel physicians, the panel physician may vaccinate applicants and document the doses.
- The panel physician will record vaccination history on the DS-3025 Form, which will become the applicant’s permanent vaccination record.
Blanket Waivers Applicable to COVID-19 Vaccination:
A “blanket waiver” is an exemption from the vaccination requirement that can be granted by the panel physician:
- Not age-appropriate
For COVID-19 vaccines, the age at which a particular vaccine can be administered differs by formulation. If the applicant is younger than the lowest age limit set by the FDA or WHO for the approved COVID-19 vaccine formulations in use, this blanket waiver should be documented. At this time, the WHO has only approved vaccines for people 18 years of age and older; however, the FDA has authorized Pfizer vaccine for emergency use in children, and is required for applicant children if available to them in the country of the exam. If, in the country where the exam is performed, there is an age restriction (for example, the vaccine is only being given to people over the age of 65 and the applicant is younger than 65), this blanket waiver should be documented.
If an applicant has a contraindication or precaution to the approved COVID-19 vaccine formulation available, the physician should grant a blanket waiver on the basis that vaccination is “Contraindicated.” 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. For more about contraindications and precautions, see Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States.
- Not routinely available
If none of the approved COVID-19 vaccines are routinely available in the country where the panel physician practices, and are not expected to be available within 4 months following the medical exam date, the panel physician should grant the blanket waiver for “Not routinely available.” If, due to limited supply, an approved COVID-19 vaccine is not available to the applicant within the country of exam within 4 months after the exam date, then this situation would also be considered “Not routinely available.” If an applicant has already been vaccinated with a non-approved COVID-19 vaccine, and regulations or laws in the country of exam prevent the applicant from being revaccinated with an approved formulation, this would also be considered “Not routinely available.” Applicants cannot be granted this waiver due to cost or inconvenience.
Other Reasons Why an Applicant Might 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, the panel physician will note that. The applicant will have to submit a waiver request to USCIS. USCIS will determine if this type of waiver is granted, not the panel physician or CDC.
- Applicant refuses a COVID-19 vaccine series in part or entirety
If an applicant refuses one or more doses of an approved COVID-19 vaccine series that is medically appropriate for and available to the applicant, it should be documented that the vaccine requirements are not complete and that the applicant refuses vaccination. This applicant is inadmissible to the United States.
Panel physicians should ask about symptoms and contact history when scheduling appointments, at time of check-in, and at the beginning of the visit with the physician. The examination should be postponed for those with a suspected or confirmed diagnosis until the criteria to end isolation have been met or post-exposure quarantine has been completed.
Symptoms of COVID-19 are highly variable and include fever, chills, shortness of breath, fatigue, muscle and body aches, headache, new loss of taste or smell, sore throat, nasal congestion, runny nose, nausea, vomiting, and diarrhea.
Optional Laboratory Testing
In addition to symptom screening for COVID-19, panel physicians may choose to also require laboratory testing of all applicants 2 years of age and older to improve the safety of their clinics and the quality of the exam. It is recommended that this test be performed and results be available in the 24 hours prior to the panel physician examination. If testing is performed, the test must be performed within the 3 days prior to the examination. This will ensure the most accurate results are available for the exam, and patients who have positive test results can be rescheduled to complete their examination after recovery.