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
regulations 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
Children (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
(NCLR), 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.