U.S. Requiring Controversial Vaccine

No opt-out provision exists for immigrants. USCIS enforces the vaccination guidelines of the CDC prepared by the Division of Global Migration and Quarantine, which refers to the Immigration and Nationality Act, or INA, as the legislation requiring the recommendations of the ACIP to be implemented.

"It is not a deliberated decision on a vaccine-by-vaccine basis either by CDC or ACIP," CDC spokesman Curtis Allen said.

Homeland Security spokesman Bill Wright had no comment on the vaccination mandate.

A list of diseases for which vaccination is required can be found in section 212 of the INA. It calls for "vaccinations against vaccine-preventable diseases" recommended by the CDC's ACIP.

The State Department's form DS-3025, or "vaccination documentation worksheet," says vaccination against "Human Papillomavirus is required for U.S. immigrant visa applicants."

ACIP recommends routine vaccination for all 11- and 12-year-old girls in the U.S., not only immigrants, based on considerations including studies suggesting the HPV vaccine is safe and effective at that age. Vaccination is also recommended for females 13 to 26 years old who have not been previously vaccinated or completed the full series.

Condemnation of the immigration policy is widespread, from Abramson, who said he didn't know the policy was introduced under his chairmanship, to Charlotte Haug, editor in chief of the influential Journal of the Norwegian Medical Association, who said "this is very surprising and makes no sense. Whether this vaccine works is still being discussed."

Merck isn't aware of Homeland Security's policy, according to spokeswoman Amy Rose.

According to the CDC's Morbidity and Mortality Weekly Report, HPV infection rates in the U.S. are 6.2 million a year, and 3,700 deaths are attributed to cervical cancer. Pap-smear screening and treatment have effectively reduced cervical cancer incidence by 75% and death rates by 70% since the 1950s, and must be continued even after an HPV vaccination. According to a New York Times article, the vaccine costs from about $400 to about $1,000, depending on the country and the fees for doctors' visits.