Vaccination programs are important to military public health and readiness. Sometimes, however, an individual may be considered exempt from a particular vaccination. There are two general types of vaccine exemptions: medical and administrative. A medical exemption may be validated by a health care professional. An administrative exemption is a non-medical function that may be considered by an individual's command or employer.
Where can I get more information?
For general guidance, please see the Joint Instruction (AR 40-562, BUMEDINST 6230.15B, AFI 48-110_IP, CG COMDTINST M6230.4G) Immunizations and Chemoprophylaxis for Prevention of Infectious Disease.
Health care professionals may be consulted regarding medical exemption recommendations. Both health care professionals and service members may contact the DHA Immunization Healthcare Support Center at 877-438-8222 (DSN 761-4245), Option 1, for vaccine medical exemption guidance.
What are the different types of immunization exemptions in the military?
Note: The following descriptions and terminology apply to immunization requirements for military service members and federal civilian employees who support the military. Although the principles of immunization exemption may apply to other vaccine requirements (e.g., schools or other employment), please consult your organization’s specific policies on this topic.
Medical
- Temporary Exemptions* may be granted for brief periods of time, no longer than 365 days, based on:
- Temporary conditions (e.g., acute illness or, for some vaccines, pregnancy or certain medications may prompt deferral of vaccination to a later time)
- Pending completion of an ongoing medical evaluation that would affect a vaccine decision
- Temporary challenges with vaccine supply
- Permanent Exemptions* may be granted indefinitely based on:
- Contraindication to a specific vaccine, as defined by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (CDC ACIP) and/or a determination by a medical provider that vaccination will seriously endanger a patient's health
- "Medical, Reactive" exemption may be based on previous severe reaction (e.g., anaphylaxis) after a specific vaccine
- "Medical, Immune" exemption may be based on evidence of existing immunity to a vaccine-preventable infection. Note: CDC ACIP defines which vaccine-preventable infections are applicable to this kind of vaccine exemption. For example, a history of laboratory-confirmed measles or a blood test (serology) demonstrating measles antibodies is considered by CDC ACIP to meet the criteria for measles immunity; exemption from measles vaccine may apply to patients meeting these criteria. There are many vaccine-preventable infections (e.g., influenza and many others) for which CDC ACIP has determined that history of prior infection or serologic testing cannot be used to define immunity; vaccine exemptions are not appropriate in these cases.
* Medical exemptions, either temporary or permanent, may be revoked based on changes in infection risk, immunization options, or other changes that impact risk-benefit decisions.
Administrative
- Planned separation or retirement within 180 days, provided the following conditions are met:
- Service member is not assigned, deployed or scheduled to perform duties in an area where specific immunization is indicated
- The commander has not directed immunization because of overriding mission requirements
- Religious:
- Granted according to Service-specific policies
- Command decisions may be made with medical, judge advocate and/or chaplain consultation
How is an exemption documented?
Electronic and paper health records must annotate temporary and/or permanent medical exemptions.
All exemptions, administrative or medical, must be documented in the immunization section and clinical notes of individual medical records. For military members, exemptions must also be documented in readiness systems (Navy/Marine Corps/Coast Guard Medical Readiness Reporting System [MRRS], Army Medical Protection System [MEDPROS], or Air Force Aeromedical Services Information Management System [ASIMS]).
What happens when patients disagree with an exemption decision?
Military members should follow guidance from their chain of command for appealing an exemption decision. Federal civilian employees should work within their respective commands to appeal decisions about vaccine exemption. Healthcare providers who have clinical questions about whether or when to authorize medical exemptions from vaccination may consult directly with specialists, including the DHA Immunization Healthcare Support Center clinical team.