https://crsreports.congress.gov
Updated August 6, 2021
Defense Health Primer: Military Vaccinations
The Department of Defense (DOD) administers a variety of
force health protection (FHP) measures to “promote,
protect, improve, conserve, and restore” the health and
well-being of servicemembers. These measures include
health promotion and education programs, periodic health
assessments, preventive therapies, medical
countermeasures, and vaccinations. The U.S. military
instituted its first vaccination program in 1777 when
General George Washington directed the inoculation of the
Continental Army to protect personnel from smallpox.
Since then, DOD has implemented a variety of enduring or
situational FHP measures to protect servicemembers from
health threats. Certain vaccines are required for all
servicemembers, while others may only be required for
those deploying to particular locations. Other vaccines may
be available based on public health recommendations or on
a voluntary basis.
Since at least the late 1990s, Congress has expressed
interest in DOD vaccination policies, specifically those on
compulsory vaccinations. Similar interest among certain
Members of Congress has arisen as DOD administers the
Coronavirus Disease 2019 (COVID-19) vaccine to
servicemembers on a voluntary basis. This In Focus
describes DOD’s military vaccination policies and
immunization program, and offers issues for congressional
consideration.
DOD Policies on Military Vaccinations
DOD Instruction 6205.02 establishes the DOD
Immunization Program. The policy generally directs
combatant commands and the military departments
(MILDEPs) to identify and define “mandatory
immunization requirements” for servicemembers. The Joint
Regulation on Immunization and Chemoprophylaxis for the
Prevention of Infectious Diseases outlines specific
vaccination requirements for servicemembers, as well as
service-specific procedures for administering such
requirements. In general, DOD vaccination requirements
follow the recommendations of the U.S. Centers for Disease
Control and Prevention (CDC) and the Advisory
Committee on Immunization Practices (ACIP). DOD
vaccination requirements fall into one of three categories:
vaccinations during initial entry or basic training;
routine adult vaccinations; and
special risk-based, or occupation-specific vaccinations.
Table 1 lists the mandatory vaccinations required for all
servicemembers upon entering initial entry or basic
training. In addition to these vaccinations, combatant
commands establish further requirements for
servicemembers, other DOD personnel, and certain family
members, based on specific health threats in a geographic
region.
Table 1. Mandatory Vaccinations for All
Servicemembers
Source: Joint Service Regulation on Immunizations and
Chemoprophylaxis for the Prevention of Infectious Diseases,
October 7, 2013, p. 29.
DOD Immunization Program
The Defense Health Agency (DHA) manages the DOD
Immunization Program. Based on the MILDEPs’ and
combatant commands’ vaccination requirements, as well as
CDC and ACIP recommendations, DHA coordinates the
administration of vaccines to servicemembers and other
DOD beneficiaries. Vaccinations are typically available in
military treatment facilities, certain military-specific
settings (e.g., basic training), or from participating
TRICARE providers. DHA is also responsible for relevant
medical documentation, patient safety surveillance, and
coordination with the Defense Logistics Agency and
commercial manufacturers to procure such vaccines. DOD
health care providers typically document servicemember
vaccinations and any related adverse health events in the
electronic health record system (e.g., MHS Genesis), paper
medical records, and the respective MILDEPs’ medical
readiness information system.
Opting Out of a Vaccination
A servicemember may request to opt out of a mandatory
vaccination. Upon request by a servicemember, DOD may
authorize a temporary or permanent medical or
administrative exemption to a required vaccine. DOD
health care providers may authorize a medical exemption
when a servicemember has an underlying health condition
or known adverse reaction contraindicated with a certain
vaccine. Unit commanders may authorize an administrative
exemption for a servicemember who is within 180 days
from separating or retiring from the military or within 30
days of departing a permanent assignment location.
Pursuant to the Religious Freedom Restoration Act (42
U.S.C. §2000bb-1), administrative exemptions for religious
reasons may also be granted. DOD policy requires that:
the unit commander seek input from medical, legal, and
chaplain representatives;
the unit commander counsel the servicemember on
potential adverse impact to “deployability, assignment,
or international travel”; and
a military physician counsel the servicemember on the
benefits and risks of forgoing a required vaccination.
