Immigrant Women, Seeking Status Adjustment, Face Forced Vaccination

This July, the U.S.
Citizenship and Immigration Services (USCIS) announced new requirements, including five new vaccinations for individuals seeking adjustment of immigration status. One of these vaccinations is Gardasil, the human papillomavirus (HPV) vaccine. Gardasil, manufactured by
Merck, is the only HPV vaccine in the U.S.–also the most expensive
vaccine on the market and the only vaccine to be approved for use in only one sex. The
CDC’s Advisory Committee on Immunization Practices (ACIP) is the only
federal body that makes recommendations about immunizations; the
committee’s recommendations serve as the template that USCIS uses to
determine immunization requirements for immigration procedures. These new requirements put increased barriers and additional
burdens on women’s access to adjustment of immigration status and
applications for visas to enter the U.S. and stoke the already reverberating anxieties
among communities of color about the HPV vaccine.

Most immigration applicants are currently required to undergo a medical
exam by a certified "civil surgeon." These civil surgeons complete
an I-693 medical
examination and vaccination record. The new
that require the HPV vaccine apply to female applicants between
the ages of 11 to 26. This is the only sex-specific vaccination requirement,
putting particular burden on immigrant women applying for a visa or
adjustment of status, further marginalizing a group that already has reduced
access to health information and services that are affordable, accessible and
culturally and linguistically competent.

According to the Census, there are approximately 17.5 million immigrant
women in the United States
today, 3 million of whom are undocumented, and 16 percent that live in
poverty.  These women encounter obstacles to employment and health access; they
also face violence and discrimination.  Immigrant rights and reproductive
justice are intrinsically linked because the reproductive health of immigrant
women is profoundly affected by immigration policy.  For women seeking
adjustment of status, the USCIS’ additional vaccine requirements create tremendous
barriers to one of the many steps towards a pathway to citizenship.

While women of color, many who
are immigrants, face disproportionate rates of cervical cancer in the U.S.
(Latina women get cervical cancer at twice the rate of white women; and Vietnamese
women get cervical cancer at five-times the rate of white women), efforts
should be made to increase access and education about HPV and the vaccine,
rather than creating further impediments to the already onerous immigration
process.  The HPV vaccine is out of
reach for many women with its high price tag: at a minimum, it costs $360 for
the three shot regimen.  Publicly-funded access to the HPV vaccine varies
state-to-state, although all low-income adolescents between the ages of 9
through 19 who are either uninsured, Medicaid-eligible, American Indian, or
Alaska Native, have access to the vaccine through the federal Vaccines for
(VFC) program. Immigrant women over the age of 19 may have greater
challenges in obtaining the vaccine.  According to the Kaiser
Commission on Medicaid and Uninsured and the National Council of La Raza
between 45% and 51% of immigrants lack health coverage in the US.
The lack of health insurance, coupled with the high cost of the vaccine, limits
access to the vaccine for low-income immigrant women.  In addition, for
immigration visa applicants abroad, the global availability and accessibility of
the vaccine is questionable.

States also use the CDC’s Advisory Committee on Immunization Practices
recommendations when developing their own vaccine requirements for
entry. Calls for state school mandate bills for this vaccine seem to
have calmed down, allowing advocates the opportunity to provide
much-needed education and
advocacy around HPV and cervical cancer prevention. Now this new
threatens that critical work. 

Instead of mandating vaccines for immigrant
women’s bodies, the U.S.
government should increase access to health information and services that are
unbiased, age-appropriate, culturally-competent and non-coercive.  Mandating a
vaccine that specifically targets young non-citizen women is both sexist and
xenophobic.  It will only add to the current anxieties among many communities
of color about the vaccine and the government’s interest in vaccinating a
particular community, in this case, immigrant women.

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  • heather-corinna

    Good god.


    I had no idea this was going on, Jessica.  Thanks so much for alerting us to this. I absolutely agree that this sounds completely driven by sexism and xenophobia.


    While I think this is a horrendous requirement, period, I wonder if you know if there is anything about exceptions for those who have health issues or histories which would make being vaccinated dangerous?

  • invalid-0

    Dear Jessica,
    I can tell by the tone of this article you know are young and no little about diseases and vaccination. It was my generation that was plagued and saw disability and death with the likes of measles, mumps, meningitis, and polio. Several of my relatives suffered disabilities from these diseases. I, myself, am a survivor of cervical cancer. Requiring anyone, whether they are an immigrant or not, to be fully vaccinated, is prudent public health policy. Last February we had a measles outbreak in San Diego that sent 3 seriously ill children to the hospital and put 70 people in quarantine. The cost of that effort, taking into account the hospitalizations, public health staff hours, wages lost by those quarantined, was staggering. And, that was a small outbreak. It is not until you or a loved one is sticken with one of these dreadful diseases that you understand why immunizations are incredibly important. When I was diagnosed with cervical cancer in 1980, I was in treatment for 3 years. At risk was not only my ability to conceive and bear children but my very life. Conservatively, it is estimated that 25% of women between 19 & 49 have been exposed to the HPV virus. How can you advocate for any women not to have access to this or any other vaccination?

  • invalid-0

    I am offended that because you assume I am “young” that I haven’t been exposed to the pain and suffering of losing loved ones to cancer. Just this week, I lost a dear professor and mentor to colon cancer. On Saturday, our organization proudly participated and co-sponsored a Cervical Cancer Walk-a-Thon “Walk to Beat the Clock! Help End Cervical Cancer”, coordinated by Tamika & Friends (, to raise awareness about the impact of cervical cancer on women’s lives. Tamika is an amazing woman who survived cervical cancer and we support her tremendous work on preventing other women from sharing her experience. We are not anti-vaccine and feel that the HPV vaccine could be a powerful public health tool that can save many lives. However, as advocates for reproductive justice, we believe in autonomous decision-making based upon full information that is unbiased, culturally and linguistically competent and is centered on the needs of Latinas, immigrants and other women of color. National Latina Institute for Reproductive Health (NLIRH) supports Latina’s full access to new reproductive technology when it is coupled with unbiased information and implementation that is free from coercive policies and practices. The USCIS policy to mandate this vaccine for women applying for a visa or adjustment of status is a violation of that principle, particularly when access is costly and out of reach for the targeted community.

  • invalid-0

    I am a women’s health care provider and strong advocate for reproductive rights and equal education/access rights for all women, regardless of color/ethnicity/citizenship status. End-stage or highly invasive cervical cancer is not only pervasive and devastating, but an entirely preventable cancer that demonstrates failure of the preventative care network in screening women at risk (anyone who is sexually active). It would be wonderful if the current HPV vaccine was the answer and could prevent cervical cancer, however, we have only limited knowledge of this cancer’s etiology (HPV strains 16 and 18 are considered the most high-risk) but they can mutate and develop immunity to the vaccine, and also, another unknown strain could cause cervical cancer.
    Thus, the only sure way to prevent cervical cancer is to have regular pap screenings (starting 3 years after one’s sexual debut or at age 21, whichever if first) which can detect cellular changes that can be biopsied/treated/watched over time. I can certainly understand the frustrations on both sides, that which knows first-hand the devastating effects of Cervical Cancer as well as that which feels the mandate for immigrant women to be vaccinated is xenophobic and a violation of women’s rights.
    I feel that again, our government is spending a tremendous amount of time/energy/money barking up the wrong tree, and the answer is ALWAYS is more education more access, whether it is for the HPV vaccine or Pap testing, or both or an informed decision for neither. Women’s bodies have historically and continue to be used as tools for control and political gain. Thanks to all involved for bringing this important event to the attention of the community at large. I am going to work this issue as part of a policy project so will make my findings available once I finish.

  • invalid-0

    good discussion of issue, highlights problems such as complaints/deaths associated with HPV, not mandated for US women who can weigh costs and benefits and also states:

    “Given Gardasil’s high cost, and the fact that there does not seem to be a public health justification for this particular mandate, I’m concerned that its real purpose is to create a financial barrier for immigrant women who seek to lawfully enter this country.”


  • invalid-0

    The HPV vaccine is dangerous, and already appears to have caused numerous serious side effects, including death in some recipients. Like the condom, it gives people a false sense of security when they fornicate, which is behavior that is likely to transmit disease.

    Not only should immigrant women not have to get the HPV vaccine — no one should have to take it.

  • invalid-0

    I agree that women should not have to take the HPV vaccine. I am a white middle class married woman with a new baby and the price of the vaccine would be hard for me to make. I cannot imagine being an imagrant woman trying to enter this country legally or becoming a legal citizen and encountering this obstacle. I don’t believe that anyone should be forced to be given this vaccine. Not to down play cervial cancer or HPV but the vaccine doesn’t protect you from all types of HPV so it may not even be effective for many women.
    The decision to get the vaccine should be up to the young woman not the government.

  • invalid-0

    You cannot compare Gardasil to a polio or MMR vaccine. This vaccine only protects against one of many strains of HPV. It has also been linked to deaths.

    “In May 2007, it was reported that over 1,600 adverse reactions, including three deaths, had been linked to Gardasil, Merck’s new vaccine for human papillomavirus (HPV).Among those reactions, 371 were classified as serious, and, of the 42 women who received the vaccine while pregnant, 18 experienced side effects including spontaneous abortion and fetal abnormalities.” (The Heartland Institute August 1, 2007 and Renew America July 22, 2007)


    “These are hefty risks for a vaccine that only sometimes protects against HPV, which is virtually 100 percent avoidable without a vaccine.

    It’s essential to get the facts about HPV before considering this or any potentially dangerous vaccine. First off, although there are more than 6 million cases of HPV each year, just 2 percent of the patients in a recent study were infected by the kinds of HPV that put them at high risk for developing cervical cancer.

    Furthermore, about 90 percent of HPV cases clear up on their own within two years.

    You need to be aware that if you eat right, exercise and keep stress in your life under control, your immune system is typically healthy enough to clear up the vast majority of HPV infections.

    In addition, the vaccine is not fool-proof. You can still get “non-vaccine” types of HPV even if you get vaccinated. In fact, a study in the Journal of the American Medical Association found that only 3 percent of their study participants were infected with the types of HPV that Gardasil was concocted to prevent.

    Finally, remember that HPV is a sexually transmitted disease, which means that it is also easily preventable by modifying your lifestyle habits.”

  • invalid-0

    As a public health researcher, educator and direct service provider in the field of refugee and migrant health, I strongly disagree with this comment. No-one here is ‘advocat[ing] for any wom[a]n not to have access to this…vaccination.’ What Jessica is doing is (rightfully) questioning the reasoning behind imposing this particular extra financial burden on an already intimidating and expensive process. While vaccination coverage is, overall, a public good, imposing this condition on migrant women and children is something that needs to be considered from the point of view of those who are most affected, particularly because they form an already marginalised and disadvantaged group. The bottom line is, the entity that benefits most from this policy is a multinational corporation in the form of enormous revenue. If the policy were truly in place to protect the health of these women, there would be emphasis on education and respecting women’s autonomy over their own bodies. These factors are absent, and instead we have a coercive policy in place that does nothing to take into account women’s right to choice.

    Again, as a public health professional, I have made the educated decision not to receive Gardasil, even though I could have done had the vaccine at no cost to myself. I find it to be unconscionable to support a policy that would deprive other women the opportunity to make the same choice regarding the autonomy of their bodies.

  • invalid-0

    As an English resident native of Wyoming now teaching midwifery & pubilc health it is interesting to see the double standard here. The issue is not just one of gender inequity but abaondoning of the values placed on individuals’ freedoms to consent to treatment or decline it vs. the right of the states to impose treatment if the people involved are generally less able to challenge that power easily. Compulsion is a worrying idea here. This is not like screening for typhoid or BCG immunisation against TB in terms of public health protection. Is this “Payola” ?Who benefits fincanially from this ruling and do Pharmaceutical industry lobbyists have power to shape such government decisions on gardasil.Where is the ethical stance?
    The UK governemnt has just begun a programme for HPPV immunisation of 12 year olds in public school, starting in Scotland. This is with full prior individual parental + child consent & seems to be well accepted by families…
    The “forced” immunisation of women is a whole different & worrying question.

  • invalid-0

    On the one hand, conservatives’ resistance to immunizing American girls is based on the claim it will promote promiscuity. If that’s in the back of the right-wing’s mind, what does it say about their attitude toward women who take the legal path to reside here, many to become citizens? Aren’t they assuming a woman who crosses the border is SO promiscuous, she must get the vaccine, whose effectiveness has to be doubted for reasons mentioned on the other posts above: no it’s different from polio and measles because there’s no guarantee it will stop the particular HPV that comes the way of these presumptive “whores.” What I find most disturbing is the illegal alien female doesn’t jump through this hoop when she jumps the fence, thus enabling a culture that rewards breaking the law even more.
    One should wonder how social conservative males would think immigrant women bed a lot of men to the point where HPV-vaccination is a necessity but verboten for our presumed virginal girls. Maybe they’ve been watching too many reality porn sites depicting such stereotypes. I know, they’re anti-porn…until someone examines their hard drive.

  • invalid-0

    On the one hand, conservatives’ resistance to immunizing American girls is based on the claim it will promote promiscuity. If that’s in the back of the right-wing’s mind, what does it say about their attitude toward women who take the legal path to reside here, many to become citizens?

    That’s a good point, Christopher, one I hadn’t considered.

  • invalid-0

    This is strictly a violation to rights… Not just human rights… womens rights.

    Gardasil is still an experiment… we don’t know the long term effects, and its a new vaccination. Not to mention the fact that it isn’t a disease that one can get airborn… you have to sleep with someone to get it, and there are many more strains of HPV than the vaccination even covers.

    What is this I hear about HPV vaccination causing genital warts… this just tells me the vaccination is spreading a sexual disease to innocent women and girls… and its mandatory for anyone coming into the US… sick and twisted!

    Now the real question… what can we do to stop it?