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April 26, 2021
Defense Health Primer: Military Vaccinations
The Department of Defense (DOD) administers a variety of
Table 1. Mandatory Vaccinations for All
force health protection (FHP) measures to “promote,
Servicemembers
protect, improve, conserve, and restore” the health and
Adenovirus
Meningococcal
well-being of servicemembers. These measures include
health promotion and education programs, periodic health
Hepatitis A & B
Poliovirus
assessments, preventive therapies, medical
countermeasures, and vaccinations. The U.S. military
Influenza
Tetanus-Diphtheria
instituted its first vaccination program in 1777 when
Measles/Mumps/Rubella
Varicella
General George Washington directed the inoculation of the
Continental Army to protect personnel from smallpox.
Source: Joint Service Regulation on Immunizations and
Since then, DOD has implemented a variety of enduring or
Chemoprophylaxis for the Prevention of Infectious Diseases,
situational FHP measures to protect servicemembers from
October 7, 2013, p. 29.
health threats. Certain vaccines are required for all
DOD Immunization Program
servicemembers, while others may only be required for
The Defense Health Agency (DHA) manages the DOD
those deploying to particular locations. Other vaccines may
Immunization Program. Based on the military departments’
be available based on public health recommendations or on
and combatant commands’ vaccination requirements, as
a voluntary basis.
well as CDC and ACIP recommendations, DHA
Since at least the late 1990s, Congress has expressed
coordinates the administration of vaccines to
interest in DOD vaccination policies, specifically those on
servicemembers and other DOD beneficiaries. Vaccinations
compulsory vaccinations. Similar interest among certain
are typically available in military treatment facilities,
Members of Congress has arisen as DOD administers the
certain military-specific settings (e.g., basic training), or
Coronavirus (COVID-19) vaccine to servicemembers on a
from participating TRICARE providers. DHA is also
voluntary-basis. This In Focus describes DOD’s military
responsible for relevant medical documentation, patient
vaccination policies and immunization program, and offers
safety surveillance, and coordination with the Defense
issues for congressional consideration.
Logistics Agency and commercial manufacturers to procure
such vaccines. DOD health care providers typically
DOD Policies on Military Vaccinations
document servicemember vaccinations and any related
DOD Instruction 6205.02 establishes the DOD
adverse health events in the electronic health record system
Immunization Program. The policy generally directs
(e.g., MHS Genesis), paper medical records, and the
combatant commands and the military departments to
respective military departments’ medical readiness
identify and define “mandatory immunization
information system.
requirements” for servicemembers. The Joint Regulation on
Opting Out of a Vaccination
Immunization and Chemoprophylaxis for the Prevention of
Infectious Diseases outlines specific vaccination
A servicemember may request to opt out of a mandatory
requirements for servicemembers, as well as service-
vaccination. Upon request by a servicemember, DOD may
specific procedures for administering such requirements. In
authorize a temporary or permanent medical or
general, DOD vaccination requirements follow the
administrative exemption to a required vaccine. DOD
recommendations of the U.S. Centers for Disease Control
health care providers may authorize a medical exemption
and Prevention (CDC) and the Advisory Committee on
when a servicemember has an underlying health condition
Immunization Practices (ACIP). DOD vaccination
or known adverse reaction contraindicated with a certain
requirements fall into one of three categories:
vaccine. Unit commanders may authorize an administrative
exemption for a servicemember who is within 180 days
vaccinations during initial entry or basic training;
from separating or retiring from the military or within 30
routine adult vaccinations; and
days of departing a permanent assignment location.
special risk-based, or occupation-specific vaccinations.
Pursuant to the Religious Freedom Restoration Act (42
Table 1 lists the mandatory vaccinations required for all
U.S.C. §2000bb-1), administrative exemptions for religious
servicemembers upon entering initial entry or basic
reasons may also be granted. DOD policy requires that:
training. In addition to these vaccinations, combatant
the unit commander seek input from medical, legal, and
commands establish further requirements for
chaplain representatives;
servicemembers, other DOD personnel, and certain family
members, based on specific health threats in a geographic
the unit commander counsel the servicemember on
region.
potential adverse impact to “deployability, assignment,
or international travel”; and
https://crsreports.congress.gov
Defense Health Primer: Military Vaccinations
a military physician counsel the servicemember on the
compulsory vaccinations and may support congressional
benefits and risks of forgoing a required vaccination.
oversight of the DOD Immunization Program.
Unit commanders may revoke a religious exemption “if the
Program Administration
Are the military departments receiving adequate support
individual and/or unit are at imminent risk of exposure to a
from DHA to meet their medical readiness
disease for which an immunization is available.”
requirements?
Commanders may also administratively separate, or initiate
How do DOD and CDC share pertinent health
disciplinary proceedings under the Uniformed Code of
information documented in the Vaccine Adverse Event
Military Justice, servicemembers without an authorized
Reporting System?
exemption, if they are non-compliant with a mandatory
What health communication strategies are used to
vaccination.
educate or solicit feedback from servicemembers on
Authority to Waive Informed Consent
DOD’s vaccination requirements or other FHP
DOD Instruction 6205.02 directs the “preferential use of
measures?
immunizations approved by the U.S. Food and Drug
Administration” (FDA)
Military Readiness
; however, non-FDA approved
Does DOD have adequate authorities and processes in
drugs, biologics (e.g., vaccines), or medical products may
place to protect the health and well-being of
be administered for FHP purposes. DOD may administer an
“
servicemembers and other DOD personnel conducting
investigational new drug” or “drug unapproved for its
the full range of military operations?
applied use” to servicemembers after obtaining prior
What were the lessons learned from the Anthrax
consent (also referred to as informed consent). Under 21
Vaccine Immunization Program and how were those
U.S.C. §355(i)(4) and related regulations, the informed
lessons used to improve the DOD Immunization
consent process typically requires human subjects to agree
Program?
to the receipt of drug, biologic, or medical product upon a
disclosure that the product in question is not yet FDA
COVID-19 Vaccinations
approved and that the receipt of such product is voluntary.
What is DOD’s long-term strategy to mitigate risks from
For example, though the FDA has granted emergency use
COVID-19 and of future pandemics?
authorization for several COVID-19 vaccines, they are
Will DOD’s COVID-19 mitigation strategy require
investigational vaccines and remain voluntary for
compulsory vaccination of servicemembers? Is DOD
servicemembers pursuant to statutory informed consent
considering requesting a waiver of informed consent for
requirements.
the COVID-19 vaccine?
In certain instances, DOD may request a waiver to statutory
and regulatory informed consent requirements in order
Relevant Statutes and Policies
make an investigational drug, biologic, or medical product
10 U.S.C. §1107 – Notice of use of an investigational new
mandatory for servicemembers participating “in a particular
drug or a drug unapproved for its applied use
military operation.” Section 1107 of Title 10, U.S. Code:
21 U.S.C. §355 – New drugs
authorizes the Secretary of Defense to request a waiver;
DOD Directive 6200.04 – Force Health Protection (FHP)
assigns approval authority to the President of the United
DOD Instruction 6200.02 – Application of Food and Drug
States; and
Administration Rules to Department of Defense Force Health
if a waiver is approved, directs a congressional
Protection Programs
notification process.
DOD Instruction 6205.02, DoD Immunization Program
If a waiver of informed consent is approved, the statute also
Joint Service Regulation on Immunizations and
requires DOD, prior to administering the investigational
Chemoprophylaxis for the Prevention of Infectious Diseases
product, to notify servicemembers that a non-FDA
approved product is being administered, the reasoning for
CRS Products
such use, information on known side effects, and other
information that the “Secretary of Health and Human
CRS In Focus IF10530, Defense Primer: Military Health System,
Services may require to be disclosed.” A waiver of
by Bryce H. P. Mendez
informed consent does not abrogate the Feres doctrine. If a
CRS Legal Sidebar LSB10300, An Overview of State and Federal
servicemember is harmed from an administered drug,
Authority to Impose Vaccination Requirements, by Wen W. Shen
biologic, or medical product, Feres generally prohibits
CRS In Focus IF11102, Military Medical Malpractice and the
active duty servicemembers from filing medical malpractice
Feres Doctrine, by Bryce H. P. Mendez and Kevin M. Lewis
lawsuits against the United States. However,
servicemembers may seek alternative recourse through a
CRS Legal Sidebar LSB10584, Compensation Programs for
DOD administrative process, the National Vaccine Injury
Potential COVID-19 Vaccine Injuries, by Kevin J. Hickey and Erin
Compensation Program, the Countermeasures Injury
H. Ward
Compensation Program, or disability compensation
administered by the Department of Veterans Affairs.
Issues for Congress
Bryce H. P. Mendez, Analyst in Defense Health Care
The following lines of inquiry may assist Congress in
Policy
obtaining further clarification on the administration of
Erin Tompkins, Defense Health Fellow
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Defense Health Primer: Military Vaccinations
IF11816
Disclaimer
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