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FAX 202 456 5581
DOMESTIC POLICY COL
001
The White House
the
DOMESTIC POLICY
FACSIMILE TRANSMISSION COVER SHEET
TO: Nicole Rabner
FAX NUMBER: 62878
TELEPHONE NUMBER: 62263
FROM: Essence Washington
TELEPHONE NUMBER:
-
67732
PAGES (INCLUDING COVER): 4
COMMENTS: Today Conference Call
Material 11:30AM 66766 # 4441
09/15/97 JION 10:52 FAX 202 456 5581
DOMESTIC POLICY COL
002
United States Department of State
Washington, D.C. 20520
Dear Mr. Nadler:
This letter is to respond to your request for the views of the State Department on
draft legislation exempting immediate relative immigram orphans from the vaccination
requirement imposed in Section 212(a)(1) of the Immigration and Nationality Act.
I
The proposed language will accomplish the objective of exempting immediate
relative immigrant orphans from the vaccination requirement It will not impose any
operational difficulties on overseas consular operations and will not require any
additional expenditure of resources.
while we Are
supportive of this exemption,
Although the Department does not express any opinion as to whether this
logislation in needed, R'C do wish to point OUR that while 12,000 children are expected TO
immigrate as immediate relative immigrant orphans, an additional 28,000 children are
expected 10 insulgrate as non-orphan children of American citizons. The Department
estimates that a further 50,000 children will immigrate in other categories or as
dependents of their immigrant parents. Under these circumstances the Department would
expect that some members of the public will question the equity of exempting only
immediate relative immigrant orphans and not these other children )-ducto?
1
The Clinton Administration maintains a
strong commitment and record to promoting
adoption and supporting measures to
ease the foreign adoption process.
Itshould be noted that
2 Many of The health concerns raised by the
adoption community regarding the vaccination
requirement to other children have broader applicability
categories as well migrating we hope we in can other
The Honorable,
Jerrold Nadler,
work with The committees to
House of Representatives. address some of these
issues.
09/15/97 MON 10:53 FAX 202 456 5581
DOMESTIC POLICY COL
003
2
The Office of Management and Budget advises that from the standpoint of the
Administration's program, there is no objection to this language.
I hope this information is useful to you. Please do not hesitate to contact me if
you have additional questions.
Sincerely,
Barbara Larkin
Assistant Secretary
Legislative Affairs
09/15/97
MON 10:53 FAX 202 456 5581
DOMESTIC POLICY COL
4
004
SECTION 1. EXCEPTION FROM VACCINATION REQUIREMENT.
Section 212(a)(1) of the Immigration and Nationality Act (8 U.S.C. 1182(a)(1)) is
amended--
(1) in subparagraph (A)(ii), by inserting `except as provided in subparagraph (C),' after
`(ii)'; and
(2) by adding at the end the following:
`(C) EXCEPTION FOR ADOPTED CHILDREN- Subparagraph (A)(ii) shall
not apply to a child who is--
(i) described in section 101(b)(1)(F);
(ii) seeking an immigrant visa as an immediate relative under section
201(b); and
(iii) 10 years of age or younger at the time 8 petition is filed in the child's
behalf to accord a classification as an immediate relative under such
section.'.
SEP-09-1997 08:11 TO:N RABNER
FROM:GAYMON, D.
P. 2/5
LRM ID: IMS138
SUBJECT: OMB Report on HR2267 Commerce, Justice, and State, the
Judiciary, and Related Agencies Appropriations, FY 1998
RESPONSE TO
LEGISLATIVE REFERRAL
MEMORANDUM
If your response to this request for views Is short (e.g., concur/no comment), we prefer that you respond by
e-mail or by faxing us this response sheet. If the response is short and you prefer to call, please call the
branch-wide line shown below (NOT the analyst's line) to leave a message with a legislative assistent.
You may also respond by:
(1) calling the analyst/attorney's direct line (you will be connected to voice mail if the analyst does not
answer); or
(2) sending us a memo or letter
Please include the LRM number shown above, and the subject shown below.
TO:
Ingrid M. Schroeder Phone: 395-3883 Fax: 395-3109
Office of Management and Budget
Branch-Wide Line (to reach legislative assistant): 395-3454
FROM:
9/10/97
(Date)
Nicole Rabner /Jennifer (Name)
DPC
(Agency)
456-7263
(Telephone)
The following is the reponse of our agency to your request for views on the above-captioned subject:
Concur
No Objection
No Comment
1
See proposed edits on pages
Other:
FAX RETURN of 1 pages, attached to this reponse sheet
SEP-09-1997 08:11 TO:N RABNER
FROM: GAYMON, D.
P. 3/5
United States Department of State
Washington, D.C. 20520
Dear Mr. Nadler:
This letter is to respond to your request for the views of the State Department on
draft legislation exempting immediate relative immigrant orphans from the vaccination
requirement imposed in Section 212(a)(1) of the Immigration and Nationality Act.
The proposed language will accomplish the objective of exempting immediate
relative immigrant orphans from the vaccination requirement. It will not impose any
operational difficulties on overseas consular operations and will not require any
additional expenditure of resources.
Although Ox the Department However, does not express any opinion as to whether this particular
legislation is needed, we do wish to point out that while 12,000 children are expected to
immigrate as immediate relative immigrant orphans, an additional 28,000 children are
expected to insulgrate as non-orphan children of American citizens. The Department
estimates that a further 50,000 children will immigrate in other categories or as
dependents of their immigrant parents. Under these circumstances the Department would
expect that some members of the public will question the equity of exempting only
immediate relative immigrant orphans and not these other children.
The Clinton Administration maintains a strong
1
commitment to promoting adoption and supporting a doptive
parents. While the Clinton Administration supports
measures to ease the foreign adoption process,
2
The Honorable,
Jerrold Nadler,
House of Representatives.
1
SEP-09-1997 08:11 TO:N RABNER
FROM GAYMON, D.
P. 1/5
Total Pages:
LRM ID: IMS138
EXECUTIVE OFFICE OF THE PRESIDENT
OFFICE OF MANAGEMENT AND BUDGET
Washington, D.C. 20503-0001
Monday, September 8, 1997
LEGISLATIVE REFERRAL MEMORANDUM
TO:
Legislative Liaison Officer - See Distribution below
FROM:
James J. Jukes (for) Assistant Director for Legislative Reference
OMB CONTACT:
Ingrid M. Schroeder
PHONE: (202)395-3883 FAX: (202)395-3109
Ji-
SUBJECT:
OMB Report on HR2267 Commerce, Justice, and State, the Judiciary, and
Related Agencies Appropriations, FY 1998
DEADLINE:
Noon Tuesday, September 9, 1997
In accordance with OMB Circular A-19, OMB requests the views of your agency on the above
subject before advising on its relationship to the program of the President. Please advise us If this
item will effect direct spending or receipte for purposes of the "Pay-As-You-Go" provisions of Title
XIII of the Omnibus Budget Reconciliation Act of 1990.
COMMENTS: State Department advises that the vaccination amendment (referenced in the letter)
may be added to H.R. 2267 during House floor consideration, which may begin as early as 9/9/97.
DISTRIBUTION LIST
AGENCIES:
52-HHS Sondra S. Wallace - (202) 690-7760
61-JUSTICE - Andrew Fois - (202) 514-2141
83-National Security Council - Glyn T. Davies - (202) 456-9221
EOP:
Steven M. Mertens
Joseph G. Pipan
Evan T. Farley
N-
Nicolette Highsmith
Robert J. Pellicci
Debra J. Bond
Can you call
Andrew Abrams
Robert E. Barker
mi about this?
Leanne A. Shimabukuro
Jose Cerda III
WARNATH_S
J
Scott Busby
Jennifer L. Klein
Nicole R. Rabner
Charles E. Kieffer
SEP-09-1997 08:11 TO:N RABNER
FROM: GAYMON, D.
P. 4/5
2
The Office of Management and Budget advises that from the standpoint of the
Administration's program, there is no objection to this language.
I hope this information is useful to you. Please do not hesitate to contact me if
you have additional questions.
Sincerely,
Barbara Larkin
Assistant Secretary
Legislative Affairs
SEP-09-1997 08:11 TO:N RABNER
FROM:GAYMON, D.
P.5/5
servi 01:33:37
96472762
P.03
H.I.C.
AMENDMENT TO H.R. 2267, AS REPORTED
Complete BY MR. NADLER OF NEW YORK
Page 38, after line 11, insert the following new sec-
tion:
1
EXCEPTION FROM VACCINATION REQUIREMENT FOR
2
ORPTIAN CITILDREN
3
SEC. 110. Section 212(a)(1) of the Insurigration and
4 Nationality Act (8 U.S.C. 1182(a)(1)) is amended-
$
(1) tn subperagraph (A)(ii), by inserting "ex-
6
cept as provided in subparagraph (C) after "(ii)",
7
and
8
(2) by adding at the end the following new sub-
9
paragraph:
.10
"(C) EXCEPTION FOR ORDIAN CHIL-
11
DREN.-Clause (ii) of subparagraph (A) shall
12
not apply to a child who is described in section
13
101(b)(1)(F) and is seeking an Sumigrant visa
14
as as Immediate relative under section
15
201(b).".
August 20. ar. 1897 (Sult a.m.)
AFL/CIO-ECON RES-DEPT
ID:2025086967
SEP 04'97
16:52 No. 024 P.01
nicality fach
breaker his
FAX TRANSMISSION
AFL-CIO
+
015 OTH STREET, N.W., ROOM 504
WASHINGTON, D.C. 20006
(202) 637-5178
FAX: (202) 508-6967
To:
Melanne Verveer
Date:
Sept. 4, 1997
Fax #:
202-456-6244
Pages:
4 including this cover sheet.
From:
Christine L. Owens
Subject: AFL-CIO Child Care Initiative
COMMENTS:
Following up on the meeting you had with Karen and me a few weeks ago
about a possible AFL-CIO Child Care Initiative, I am forwarding a copy of the press release we
issued today, in advance of tomorrow's Ask A Working Woman Conference. The final page
includes statements from President Sweeney to the effect that expanding the nation's supply of
affordable, accessible and high quality child care will be a new priority for the AFL-CIO, and
committing the AFL-CIO to work at the national and local levels to achieve this goal.
AFL/CIO-ECON RES-DEPT
ID 2025086967
SEP 04'97 16:52 No. 024 P.02
WASHINGION,
20008
202-637.5064
FAX 202-508-6902
WORKING
WOMA
AFLECIO
WORKING
NEWS RELEASE
TOGITHER
CONTACT: Lisa Lederer
September 4, 1997
Gretchen Wright
202/371-1999
Deborah Dion
202/637-5036
FIRST PUBLIC OPINION SURVEY TO EXPLORE WOMEN'S VIEWS
SINCE THE ECONOMIC RECOVERY FINDS
FAIR PAY, JOB SECURITY AMONG WOMEN'S TOP PRIORITIES
AFL-CIO Launches Working Women Working Together Network
WASHINGTON, DC -- Working women say that, despite the economic recovery, making ends
meet has become more difficult in the last five years and their job security is getting worse rather
than better. Those are among the findings of a major new study released today by the AFL-CIO.
Part of an unprecedented outreach campaign run by the AFL-CIO Working Women's
Department, the Ask A Working Woman study supplemented a popular survey that was returned by
50,000 working women with a scientific telephone survey of 725 working women that was
conducted by the public opinion research firm of Lake, Sosin, Snell, Perry and Associates July 30 to
August 3, 1997.
Nearly two-thirds of working women say they provide "about half or more" of their
household income, according to the scientific survey. Equal pay is a top concern for working
women, and time and respect are scarce commodities. The survey found that, by an overwhelming
margin, women believe that joining together to work for change in the workplace is more effective
than working individually for change.
"Sixty-one million American women work for pay, and their families rely on their
paychecks," AFL-CIO President John Sweeney said in releasing the study. "By overwhelming
margins, working women told us they want paychecks that let them make ends meet, better benefits
and security, and respect on the job. The economic recovery alone will not solve these issues for
working women. We intend to do even more organizing to address their concerns."
The scientific survey, which included oversamples of African American, Hispanic and Asian
American working women, found that:
Sixty-four percent of working women, 52 percent of married working women and 40 percent
of part-time women workers provide about half or more of their household income. Two in
five working women (41 percent) head their households.
more
to join the Working Women Working Together Network call toll-free 1-888-971-9797
AFL/CIO-ECON RES-DEPT
ID:2025086967
SEP 04'97 16:53 No. 024 P.03
Add One
More women (37 percent) say that making ends meet has become more difficult in the last
five years than say that it has gotten easier (29 percent).
Nearly every working woman (99 percent) cites equal pay for equal work as important. Yet,
nearly one-third of women workers (32 percent) say that their own job does not provide
equal pay for equal work. Half of African American (50 percent) and two in five clerical and
secretarial women workers (42 percent) say they do not have equal pay for equal work right
now.
Nine in ten working women (92 percent) say protection from lay-offs and down-sizing is
important. Yet, just one in three respondents (34 percent) say they are protected from layoffs
in their current jobs. Forty-one percent say job security has gotten worse for women in the
last five years, while just 26 percent say it has gotten better. Many more union (55 percent)
than non-union women (32 percent) say their current job is secure.
Eighty-two percent of working women say sick leave is important to them, but three in ten
(29 percent) do not have paid sick leave.
Sixty-two percent of working mothers with children under age six say child care is "very
A
important" to them. Just 13 percent of these mothers have jobs that provide child care.
African American and Hispanic women are most likely to want and not have child care.
Three in four working women (78 percent) say that punishment for sexual harassment is very
important to them. Yet, 35 percent say this protection is not provided by their employer
today.
Four in five respondents (79 percent) say the best way to solve workplace problems is for
women to "join together and work as a group" rather than to "work separately as
individuals." At least three in four working women want employers, working women's
organizations, government, community and civic groups, and labor unions to help solve the
problems they face'at work.
In addition to the scientific and popular surveys, the Ask A Working Woman campaign
included meetings around the country with working women. Designed to listen to working women,
the meetings featured a single mother who works the night-shift at a factory in Maine, hotel workers
in Honolulu describing their struggles to meet family and work demands, flight attendants in Atlanta
describing how they are treated on the job. and much more. The popular survey was distributed at
worksites, grocery stores, beauty parlors, soccer games, prayer breakfasts, and other places where
women gather.
To address the other issues women raised, the AFL-CIO launched a new Working Women
Working Together Network. Already 50,000 members strong, the Network will work to organize at
the local, state and federal levels, press for passage of legislation of concern to women, and promote
women's involvement in elections at every level of government. Women can join the Working
Women Working Together Network by calling toll free, 888/971-9797.
more
AFL/CIO-ECON RES-DEPT
ID:2025086967
SEP 04'97 16:54 No. 024 P.04
Add Two
"Our goal is to start a national conversation on working women's issues," AFL-CIO
Working Women's Department Director Karen Nussbaum said. "Working women face deadlines at
home and at work. A sick child or a demanding boss. A new muffler or the electric bill. Through
this initiative, working women have expressed their priorities. They want pay and protection,
benefits and economic security, and control of their time. The AFL-CIO stands ready to respond."
AFL-CIO Vice President and Chair of the Committee on Women Workers Gloria Johnson
said the union will launch a new campaign to promote equal pay for women. "Equal pay is women's
top concern, and we will respond with a grassroots campaign that makes women's wages the public
issue it deserves to be," Johnson said. "Each woman should not have to fight individually for fair
pay. The system needs to treat women fairly. Women can call 888/971-9797 for information on
how to fight for equal pay." The AFL-CIO will also plan local actions on fair pay, and press for
passage of two bills now before Congress -- the Fair Pay Act and the Paycheck Fairness Act.
The AFL-CIO also announced that expanding the nation's supply of high quality, affordable,
and accessible child care will be a priority. "Working parents tell us they need safe, affordable, and
+
convenient child care," Sweeney said. "Unions have worked hard to provide that to our members.
But the labor movement's commitment is to all of the nation's children and to all working parents.
That is why we are expanding our child care focus."
The AFL-CIO's child care program will combine support for greater federal funding for
child care with local union activity to promote and shape new community-based initiatives designed
to increase supply, set high standards, and raise providers' pay. Expanding the supply of school age
care will be a priority. Today, seven out of ten public schools offer no pre- or after-school child care
programs. After-school care also can provide educational help, including tutoring in kcy subjects.
To be effective, such educational programs need to be staffed by qualified personnel, related to the
regular school program, and make use of educational programs known to work. "We will be
working to secure both adequate funding and standards of quality for such programs," Sweeney said.
A Working Women Working Together conference with more than 1,500 working women
from around the country will be held September 5 7 in Washington, D.C. Speakers will include
Vice President Al Gore, U.S. Secretary of Labor Alexis Herman, U.S. Senator Barbara Mikulski (D-
MD), former Texas Governor Ann Richards, AFL-CIO President John Sweeney, and other Members
of Congress and high-ranking labor officials. Plenary and workshop topics will address living wage
campaigns, pay equity, flextime and flexible hours, bargaining for work and family issues, child and
elder care, sexual harassment, workplace safety, welfare reform, organizing health care providers,
and much more. The conference is open to the mcdia.
AFL-CIO President John Sweeney created the Working Women's Department last year.
Women make up almost one-half the workforce today, and their numbers are increasing. Ninety-
nine percent of women in the U.S. will work for pay at some time in their lives. The AFL-CIO is the
nation's largest working women's organization with 5.5 million women members.
-30-
NOTE:
Copies of the Ask A Working Woman study are available to the media from Lisa
Lederer or Gretchen Wright at 202/371-1999. The report is available to the public
from the AFL-CIO Working Women's Department at 888/971-9797.
State Department letter to Hon. Jerold Nadler
Re: Exemption from Vaccination Requirement for Immigrating Adoptive Children
PARAGRAPH 3:
Strike language until "we do wish" on line 2
Begin with:
Adm
/Ctinto
measures to ease
ne 6
The Clinton Administration maintains a strong commitment to promoting adoption and
supporting adoptive parents. While the Department is supportive of the intent of this legislation
to ease the foreign adoption process, the Department does-not express any opinion as-to whether--
this legislation is needed, However, do wish [continue language]
particular
R
Jen-
1.9 - med pro.
what do you think?
2. equity
Lets descuss; its tricky.
2
Nok -> for disassion purposes.
WED 11:33 FAX 202 456 5581
DOMESTIC POLICY COL
001
The White House
DOMESTIC POLICY
FACSIMILE TRANSMISSION COVER SHEET
TO: Niwle Rabner
FAX NUMBER: 69412
TELEPHONE NUMBER:
FROM: learn Shimatuken
TELEPHONE NUMBER:
PAGES (INCLUDING COVER):
COMMENTS:
09/10/97 WED 11:34 FAX 202 456 5581
DOMESTIC POLICY COL
002
WORKING DRAFT -- 8/22/97
Chronology/Summary/Purpose of Amendment
Summary of Overall Purpose
The purpose of this amendment is to address the growing public health problem In the United States
by ensuring proper medical screening of arriving immigrants, and by educating arriving immigrants
on the importance of vaccinations. This public education effort hopes to achieve the same success
enjoyed by the vaccination program in the United States.
Chronology
December 1995: In December 1995, INS, DOS, HHS and CDC met with the subcommittee
members to discuss section 154 in S. 1664, which created a new medical ground of inadmissibility
under section 212 of the Act relating to vaccinations.
April 1996: The agencies expressed serious concerns about the vaccination requirements as a
new medical ground of inadmissibility. The Administration was particularly concerned about certain
implementation and other difficulties that may actually jeopardize the public health in the United
States. An excerpt of the views letter submitted to Senator Bob Dole dated April 16, 1996, is
attached.
May 1996: The Administration drafted an alternative amendment, which was offered on the Senate
floor and adopted in Section 154 of S. 4743. A copy of the relevant excerpt from the Congressional
Record dated May 6, 1996 is attached.
The amendment offered by the Administration took the vaccination requirements out of section 212
of the Act, where they would be a ground of inadmissibility, and put them in section 234
(subsequently redesignated as section 232(b) by the Illegal Immigration Reform and Immigrant
Responsibility Act (IIRIRA)). The idea was to ensure proper medial screening of arriving aliens, by
incorporating a vaccination assessmentint the medical examination process and educating arriving
aliens on the importance of vaccinations, and by creating a new medical examinations fee account
to be used for training and overseeing the physicians who conduct the medical examinations.
Under the amendment passed in S. 4743, the vaccination assessment was to be incorporated into
the existing medical examination requirements, and was to include a review of the alien's record of
vaccination against mumps, measles, rubella, polio, tetanus, diphtheria toxoids, pertussis,
Hemophilus-influenzae type b, hepatitis B, any other vaccines recommended by the ACIP.
The new Medical Examinations Fee Account was intended to provide a direct funding mechanism
to cover the cost of creating viable civil surgeon programs (for medical examinations performed in
the United States) and panel physician programs (for medical examinations performed abroad),
09/10/97 WED 11:34 FAX 202 456 5581
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13:31
202 842 9220
HQIRT
which includes, but is not limited to, training and quality control.¹ The fee account was to be funded
through fees imposed by INS on adjustment of status applications field in the U.S. and by DOS on
visa applications filed at U.S. consular posts abroad. The fee was to be determined by the
Department of Health and Human Services, and was to be collected when the Attorney General
conferred upon the Secretary of HHS the authority to designate the civil surgeons who perform the
required medical examinations in the U.S.
The approach taken in section 154 of S. 4748 was one of public education, because the public
education approach taken towards vaccination programs in the U.S. had been so successful.
[MAYBE HHS CAN ADD A BLURB HERE].
September 1996: The vaccination provisions in the final legislation, section 341 of IIRIRA, did not
adopt the approach taken in section 154 of S. 4743. The vaccination requirements were retained
in section 212 of the Act, which makes them a medical ground of inadmissibility. The fee account,
which was needed to delegate to CDC the authority to oversee the civil surgeon and panel physician
programs, also was not adopted.
March 1997 - Present: The adoption advocacy groups vehemently protested the vaccination
requirements adopted in the final legislation because of the following concerns, which include:
The accuracy of health records of orpahn children living in orpahnages
The potential use of unsterilized needles
Adverse reactions to live virus vaccines resulting from malnutrition, or bad vaccines
CDC published a study on TB in the April 1995 issue of the New England
Journal of Medicine This study reported an increase of TB among the foreign born
population living in the United States from 21.6% in 1986 to 29.6% in 1993. This study
also called for "major improvements" in TB screening, to include improvements in the
medical screening process. The underlying problem, however, lies in existing law. The
law currently states that PHS medical officers should perform the medial exam, and that
in the absence of available PHS medical officers, INS сап designate civil surgeons who
have at least 4 years of experience. Because PHS medical officers have not been
available since the early 1970s (only 8 U.S. ports of entry are staffed by PHS medical
officers), INS became responsible for designating the civil surgeons in the United States
and for monitoring their activities. (Panel physicians performing the medical screening
abroad are designated by DOS consular officers in consultation with CDC). Because of
the dramatic increase of the number of designated civil surgeons in the United States,
the resurgence of TB, and the emergence of HIV and AIDS, the need for enhanced
quality control over the medical examination process is absolutely essential. INS,
however, lacks the needed medical expertise. Provisions for a special CDC medical
exam fee account were therefore included in the legislation so that the necessary funds
can be made available for HHS/CDC to oversee the designated civil surgeons in the
United States and the panel physicians abroad. This measure, in turn, will contribute
immensely to the effort to curtail the spread of TB in the United States, and to public
health in general.
-2-
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Inability to test children for immune dysfunctions while abroad
Lack of informed consent for vaccines.
The panel physician may not be a pediatrician and may not realize that the child is
immunocomrpmised.
The Administration's Concerns About the McCain and Kyl Amendment No. 1015
The McCain-Kyle Amendment proposes to amend section 212 of the Act to add a new paragraph
(p) stating that the attorney General should exercise the waiver authority provided in subsection
(g)(2)(B) for any alien orphan applying for an IR3 or IR4 category visa. The administration has
concerns with this amendment, because section 212(g)(2)(B) of the Act provides that the Attorney
General may waive the requirement for one or more of the specified vaccines when the panel
physician or civil surgeon or panel physician certifies, in accordance with HHS regulations, that the
vaccine would not be medically appropriate. The McCain-Kyle amendment is directing the Attorney
General to exercise discretion in IR3 and IR4 orphan cases independently of the examining
physician. All findings of inadmissibility on medical grounds, however, are made by the Attorney
General based on the information provided by the examining physician. The examining physician,
in turn, must prepare that information according to the specific regulations prescribed by HHS. The
Attorney General, therefore, cannot and should not second-guess the findings made by the medical
experts. the Attorney General does not have the medical expertise needed to make independent
medical assessments. Moreover, the McCain-Kyle amendment covers only orphans and not other
children or adults who might be exposed to the same potential dangers as orpahns, such as live
vaccines and unsterile needles.
Purpose and Scope of the Administration's Proposed Amendment
The Administration appreciates the concerns about the current vaccination requirements raised by
the adoption advocacy groups but wishes to point out to Congress that the issues are not only of
concern to orphans, but to all children, and even to adults in some cases. For these reasons, the
Administration would favor legislation that would not only promote vaccinations in a positive way,
by encouraging arriving immigrants to participate in the system, but also address other health
concerns, such as TB and the need to assure adequate quality control measures in the overall
medical examination process.
[HHS SHOULD ADD HERE WHY THE ENFORCEMENT MEASURES CALLED FOR IN PENDING
LEGISLATION WOULD NOT BE AS EFFECTIVE AND DESIRABLE AS THE PUBLIC
EDUCATION EFFORTS PRESCRIBED BY THE ALTERNATIVE AMENDMENT RECOMMENDED
BY THE ADMINISTRATION. CITE SUCCESS OF U.S. VACCINATION PROGRAM, I.E., RECENT
WHITE HOUSE ROLL-OUT OF VACCINATION STATISTICS, RECORD HIGH NUMBER OF
DOMESTIC VACCINATIONS, THAT SUCCESS OF THE PROGRAMWAS DUE IN LARGE PART
TO AN EXTENSIVE PUBLIC EDUCATION EFFORT, AND THAT THIS IS WHAT WE HOPE TO
DUPLICATE HERE IN THE ALTERNATIVE AMENDMENT OFFERED.]
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WORKING DRAFT #2 8/21/97
Sec. VACCINATION REQUIREMENTS FOR IMMIGRANTS
(a) Section 212(a)(1)(A) of the Immigration and Nationality Act (8 U.S.C. 1182(a)(1)(A)) is
amended--
(1) by striking clause (ii); and
(2) by redesignating clauses (iii) and (iv) as clauses (ii) and (iii), respectively.
(b) Section 212(g) of the Immigration and Nationality Act (8 U.S.C. 1182(g)) is amended--
(1) by striking paragraph (2); and
(2) by redesignating paragraph (3) as paragraph (2).
(c) Section 232 of the Immigration and Nationality Act (8 U.S.C. 1252) is amended--
(1) by revising the title of section 232 to read "PHYSICAL AND MENTAL
EXAMINATION OF ALIENS"; and
"(2) by amending paragraph (b) to read as follows:
"(b) Physical and Mental Examination of Aliens.--
"(1) ALIENS COVERED.-- Each alien within any of the following classes of aliens who
is seeking admission into the United States shall undergo a physical and mental examination in
accordance with this subsection and section 221(d) of this Act:
"(A) Aliens applying for visas for admission to the United States for permanent
residence;
"(B) Aliens seeking admission to the United States for permanent residence for whom
examinations were not made under paragraph (1) of this subsection;
"(C) Aliens within the United States seeking adjustment of status under section 209, 210,
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residence; and
"(D) Any other alien or class of aliens, including alien crewmembers, applying for a visa,
seeking admission to or transiting the United States, applying for an immigration benefit or in
detention in the United States, for whom the Anomey General, the Secretary of State, or the
Secretary of Health and Human Services requires an examination.
"(2) DESCRIPTION OF EXAMINATION.- (A) Each examination required by
paragraph (1) of this subsection shall include--
"(i) An examination of the alien for any physical or mental condition that is a ground of
inadmissibility under section 212(a)(1)(A) of this Act; and
"(ii) An assessment of the vaccination record of the alien in accordance with paragraph
(5) of this subsection.
"(B) The Secretary of Health and Human Services shall prescribe such regulations as
may be necessary to carry out the medical examinations required by paragraph (1) of this
subsection.
"(3) MEDICAL EXAMINERS.-
"(A) MEDICAL OFFICERS.- (i) Except as provided in subparagraphs (3)(B) and (C)
of this subsection, the medical examinations shall be conducted by medical officers of the United
States Public Health Service.
"(ii) Medical officers of the United States Public Health Service shall be detailed for duty
or employed at such ports of entry as the Secretary of Health and Human Services may designate,
in consultation with the Attorney General.
"(B) CIVIL SURGEONS.-- (i) Whenever medical officers of the United States Public
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Health Service are not available to perform examinations under this subsection, the Attorney
General, in consultation with the Secretary of Health and Human Services, shall designate civil
surgeons to perform the examinations.
"(ii) Each civil surgeon so designated shall--
"(I) Have at least 4 years of professional experience unless the Secretary of Health and
Human Services determines that special or extenuating circumstances justify the designation of
an individual having a less professional experience; and
"(II) Satisfy such other eligibility requirements as the Secretary of Health and Human
Services may prescribe.
"(C) PANEL PHYSICIANS.-- In the case of examinations abroad under this subsection,
the medical examiner shall be a panel physician designated by the Secretary of State, in
consultation with the Secretary of Health and Human Services.
"(4) CERTIFICATION OF MEDICAL FINDINGS.-- The medical examiners shall
certify for immigration officers, immigration judges, or consular officers, as the case may be, any
communicable disease of public health significance or physical or mental disorder or behavior
described in section 212(a)(1)(A) of this Act.
"(5) VACCINATION ASSESSMENT.-- (A) The assessment referred to in
subparagraph (2)(A)(ii) of this subsection is an assessment of the alien's record of vaccination
against vaccine-preventable diseases including mumps, measles, rubella, polio, tetanus,
diphtheria toxoids, pertussis, haemophilus-influenzae type b, and hepatitis B, as well as any
vaccination against other diseases specified as vaccine-preventable by the Advisory Committee
on Immunization Practices.
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"(B) Medical examiners shall inform aliens of the importance of immunizations and shall
create an immunization record for the alien at the time of examination.
"(C)(i) Adjustment of status applicants.-- Each alien applying for adjustment of status
shall submit to the civil surgeon any available documents relating to the vaccinations described
in subparagraph (5)(A) of this subsection. If the alien has not received the entire series of
vaccines, the civil surgeon shall document on the vaccination record what steps, if any, the alien
has taken to obtain the vaccines for the preventable diseases described in subparagraph (5)(A) of
this subsection.
"(ii) Immigrant visa applicants.-- Each alien applying for an immigrant visa shall submit
to the panel physician any available documents relating to the vaccinations described in
subparagraph (5)(A) of this subsection. If the alien has not received the entire series of vaccines,
the panel physician shall document on the vaccination record what steps, if any. the alien has
taken steps to obtain the vaccines for the preventable diseases described in subparagraph (5)(A)
of this subsection.
"(6) APPEAL OF MEDICAL EXAMINATION FINDINGS.- Any alien found by a
medical examiner described in subparagraph (b)(3) of this subsection to have a medical condition
that is a ground of inadmissibility under 212(a)(1)(A) of this Act may appeal that determination
to a board of medical officers of the Public Health Service, which shall be convened by the
Secretary of Health and Human Services. The alien may introduce at least one expert medical
witness before the board at his or her own cost and expense.
"(7) FUNDING.- (A)(i) The Attorney General shall impose a fee upon any person
applying for adjustment of status to that of an alien lawfully admitted for permanent residence
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under section 209, 210, 245, or 24SA of this Act, and the Secretary of State shall impose a fee on
any person applying for a visa at a U.S. consulate abroad who is required to have a medical
examination under paragraph (1) of this subsection.
"(ii) The amounts of the fees required by subparagraph (7)(A)(i) of this subsection shall
be established by the Secretary of Health and Human Services, after obtaining the concurrence of
the Attorney General or the Secretary of State, as the case may be, and shall be set at such
amounts as may be necessary to recover the full costs of establishing and administering the civil
surgeon and panel physician programs, including the costs to the Immigration and Naturalization
Service, the Department of State, and the Department of Health and Human Services for any
additional expenditures associated with the administration of the fees collected.
"(B)(i) The fees imposed under subparagraph (7)(A)(i) of this subsection may be
collected as separate fees or as surcharges to any other fees that may be collected in connection
with an application for adjustment of status under section 209, 210, 245, or 245A of this Act, for
a visa, or for a waiver of inadmissibility under paragraph (1) or (2) of section 212(g) of this Act,
as the case may be.
"(ii) The provisions of the Act of August 18, 1856 (Revised Statutes 1726-28. 22 U.S.C.
4212-14), concerning accounting for consular fees, shall not apply to fees collected by the
Secretary of State under this section.
"(C)(i) There is established on the books of the Treasury of the United States a separate
account on behalf of the Secretary of Health and Human Services which shall be known as the
'Medical Examinations Fee Account.'
"(ii) There shall be deposited as offsetting receipts into the Medical Examinations Fee
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Account all fees collected under subparagraph (7)(A) of this subsection, to remain available until
expended.
"(iii) Amounts in the Medical Examinations Fee Account shall be available only to
reimburse any appropriation currently available for the programs established by this section."
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U.S. Department Justice
Office of Legislative Affairs
Office of the Assistant Attorney General
Hashington. ac 20530
April 16, 1996
Honorable Robert Dole
Majority Leader
United States Senate
Washington, D.C. 20510
Dear Senator Dole:
This letter presents the views of the Administration
concerning S. 1564, the "Immigration Control and Financial
Responsibility Act of 1996", as reported by the Committee on the
Judiciary on March 21, 1996.
Many of the provisions in S. 1564 advance the
Administration's four-part strategy to control illegal
immigration. This strategy calls for regaining control of our
borders; protecting U.S. workers and removing the job magnet
through worksite enforcement; aggressively removing criminal and
other deportable aliens; and securing from Congress the resources
to support the Administration's illegal immigration enforcement
strategy and to assist states with the costs of illegal
immigration. Many of the provisions of S. 1664 are identical cr
similar to provisions in the Administration's bill, S. 754, the
"Immigration Enforcement Improvements Act ci 1995.
While the Administration strongly supports reform of the
current immigration law that deters illegal immigration, and S.
1564 contains many provisions that are similar or identical =0
the Administration's legislative proposal, enforcement
initiatives, and overall strategy, 5. 1664 raises serious
concerns in specific areas that we hope the Senate will examine
thoroughly during floor consideration of the bill. The
Administration's concerns include, but are not limited to the
following:
If S. 1664 were presenced to the President with provisions
that would jeopardize any child's right to full participation in
public elementary and secondary education, including pre-school
and school lunch programs, the Secretary of Education and the
Attorney General would recommend that the bill be vetoed.
The Administration opposes broadening the application ci
deeming rules from a well-defined set of programs to all means-
tested programs including Medicaid, the Maternal and Child Health
Services program, the School Lunch program. student financial
assistance programs for postsecondary education and scores ::
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they must submit a feasibility report to the House and Senate
Committees on the Judiciary, and the House and Senate Committees
on Armed Service:
The use of closed military bases would make additional
detention space available to INS. For years, INS has been forced
to release many aliens who are awaiting proceedings due to lack
of detention space. We have worked with the Department of
Defense in conjunction with the Bureau of Prisons and other
agencies to explore the use of closed bases. Conversion costs
and staffing have been the most difficult problems to resolve.
Accordingly. this provision does not address the underlying
obstacles that would permit such a pilot to be conducted.
Sec. 154 would amend section 212 of the INA to exclude
aliens seeking permanent residency who have not received
immunizations against vaccine-preventable diseases.
While reducing the number of unvaccinated persons in the
United States is a laudable goal, the mechanism outlined in this
section would present a number of implementation and other
difficulties that may actually jeopardize the public health in
the United States.
In many countries, the vaccines specified under this section
might not be licensed. Even if these vaccines are licensed, they
may not be readily available or the costs of these vaccines may
be prohibitive for some prospective immigrants. In addition, an
immigrant's visa could be delayed as much as 18 months in order
to allow time to receive all recommended doses of the specified
vaccines, over the interval recommended by the Advisory Committee
Immunization Practices (ACIP)
The ACIP- recommended vaccine schedule is complex and lengthy
and subject to regular revisions. It would be difficult and
labor intensive for Department of State and INS officials to
check individual immunizations records against ACIP schedule and
to ensure that U.S. government officials are using the most up-
to-date revisions. Neither the Department of State nor the INS
have the resources to verify the authenticity of most vaccination
certificates.
The requirements outlined in section 154 could subject
immigrants to serious delays. considerable expense, and the
prospect OÉ having to choose between emigrating as a family or
splitting up the family to allow, for example, an adult CO
emigrate to begin employment in the United States while other
family members stay behind to complete the immunization
requirements. The result might be that the immigrant will choose
:: secure Salse immunization records rather than attempt to
comply with the requirements imposed by section 154. If that
were == happen, the immigrant. once admitted to the U.S., would
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be thought to have been vaccinated. Yet, the immigrant could
become infected and could transmit a vaccine-preventable disease
-
to others in the U.S. To further confound the matter, the
unimmunized person may be unwilling to admit he was not
vaccinated, fearing that he could become subject to deportation.
We also note that because of the lack of centralized immunization
records in most countries, it would be difficult, if not
impossible, for the INS and the State Department officials to
detect fraudulent vaccination certificates.
Under current state laws, children in the U.S. are required
to comply with immunization requirements before they enter
school. Therefore, the current public health system would
"capture" school-aged immigrant children almost immediately upon
entry into the U.S. Even without the proposed provision in the
immigration bill, these children would be vaccinated once they
came to the U.S. In addition, in many states, licensed day care
establishments also have immunization requirements.
We suggest modifying this provision and making immunization
part of the medical examination process now covered by section
see-
234
134 of the INA. In working with Senate staff, we understand that
an amendment may be offered on the Senate floor that addresses
our concerns regarding this section, which we support.
Sec. 155 requires immigrants and nonimmigrants, except
physicians, who seek CO work in the U.S. to obtain a
qualifications certificate from the Commission on Graduates of
Foreign Nursing Schools (CGFNS) or from an equivalent independent
credentialing organization approved by the Attorney General in
consultation with the Secretary of Health and Human Services.
Such certificate must verify that (1) the individual's education,
training, license, and experience meet statutory and regulatory
requirements for admission to the U.S. under the classification
specified, are comparable to that required for U.S. workers in
the health care occupation. and any foreign license submitted is
authentic and unencumbered; (2. the individual has English
language proficiency as shown =y passing a nationally recognized
standardized test of speaking and writing ability; and (3) if a
majority of states licensing the profession recognize a test
predicting success on the profession's licensing and
certification examination, the alien has passed such a test.
The imposition of the credentialing requirement may not be
in conformity with certain U.S. international obligations. We
recommend that the Senate adopt an amendment that would permit
the Administration to address these concerns.
Sec. 156 increases the bar = reentry for aliens previously
removed under an exclusion order from one year to five years and
to twenty years for any second == subsequent removal. This
section also makes technical changes to section 275 of the INA.
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May 6, 1996
CONGRESSIONAL RECORD-SENATE
S4743
SEC. 152. PILOT PROGRAM ON INTERIOR REPA.
training in the diagnosis of Insanity and mental
"(2)(A) The sees imposed under paragraph (1)
TRLATION AND OTHER METHODS TO
defects shall be detailed for duty or employed at
may be collected as separate fees or as SUT-
DETER MULTIPLE UNLAWFUL EN.
such ports of entry as the Secretary may der-
charges to any other sees that may be collected
TRIES.
igrate, in consultation with the Attorney Gen-
in connection with an application for adjust-
(a) ESTABLISMMENT-Not later than 180 days
eval.
ment of status under section 209. 210. 245. or
after the date of the enactment of this ACL. the
"(2) CIVIL SURGEONS-(A) Whenever medical
245A. for a visa, or for a waiver of excludability
Attorney General. after consultation with the
officers of the United States Public Health Serv-
under paragraph (1) or (2) of section 212(g), as
Secretary of State, shall establish a pilot pro-
ice are not available to perform examinations
the case may DE.
gram for up to two years which provides for
under this section, the Attorney General. in
''(B) The provisions of the ACL of August 18,
methods to deter multiple unlawful entries by
consultation with the Secretary. shall designate
1856 (Revised Statutes 1726-28, 22 U.S.C. 4212-
aliens into the United States. The pilot program
dull surgeons to perform the examinations.
14). concerning accounting for consular fees,
may include the development and use of interior
"(8) Each civil surgeon designated under sub-
shall not apply to sees collected by the Secretary
repatriation. third country repatriation. and
paragraph (A) shall-
of State under this section.
other disincentives for mulliple unlaw/ul entries
"(i) have at least 1 years of professional espe-
"(I)(d) There is established or the books of
into the United States.
rience unless the Secretary determines that spe-
the Treasury of the United States a separate ac-
(b) REPORT.-Not later than 35 months after
cial or extenuating circumstances justify the
count which shall be known as the Medical EI-
the date of the enactment of this Act, the Attor-
designation of an individual having a lesser
aminations Fee Account.
ney General. together with the Secretary of
amount of professional experience: and
"(B) There shall be deposited as offsetting re-
State. shall submit a report to the Committees on
"(ii) satisfy such other eligibility requirements
cripts into the Medical Examinations Fee Ac-
the Judiciary of the House of Representatives
as the Secretary may prescribe.
and of the Senate on the operation of the pilot
"(3) PANEL PHYSICIANS.-11 the case of exami-
count all fees collected under paragraph (1), to
nations under this section abroad. the medical
remain available until expended.
program under this section and whether the
pilot-program or any part thereof should be eI-
examiner shall de a panel physician designated
"(C) Amounts in the Medical Examinations
by the Secretary of State, in consultation with
Fee Account shall be available only to reimburse
tended or made permanent.
the Secretary.
any appropriation currently available for the
SEC. 153- PROT PROGRAM ON USE OF CLOSED
MILITARY BASES FOR THE DETEN.
"(d) CERTIFICATION OF MEDICAL FINDINGS.-
programs established by this section.
TION OF EXCLUDABLE OR DEPORT.
The medical examiners shall certify for the in-
"(h) DEFINITIONS.-As used in this section-
formation of immigration officers and special in-
"(1) the term medical examiner refers to a
ABLE ALIENS.
guiry officers. or consular officers, as the case
medical officer. civil surgeon. OF panel physi-
(a) ESTABLISMMENT-The Attorney General
may be, any physical or mental defect or disease
cian, as described in subsection (c): and
and the Secretary of Defense shall jointly estab-
lish.a pilet program for up to two years to deter-
observed by ruch examiners in any such alien.
(a) the term 'Secretary' means the Secretary
"(E) VACCINATION ASSESSMENT:-(I) The at
of Health and Human Services.
mine the feasibility of the use of military bases
available through the defense base realignment
sessment referred to in subsection (b)(1)(B) 4 an
SEC 155. CERTIFICATION REQUIREMENTS FOR
assessment of the alien's record of required DOC-
FOREIGN HEALTHCARE WORKERS.
and closure process as detention centers for the
Immigration and Naturalization Service.
cines for preventable diseases, including mumps,
(a) IN GENERAL-Section 212(a) (8 U.S.C.
measles. rubella, Dolio. telanus, diphtheria Lor-
1182(a)) 4 amended
(b) REPORT-Nes later than 35 months after
the date of the enactment of this ACL. the Attor-
olds. perfussis. honophilus-influensa type B,
(1) redesignating paragraph (9) as para-
ney General, together with the Secretary of
hepatitis type B. as well as any other diseases
graph (10): and
State. shall submit a report to the Committees on
specified as vaccine-preventable by the Advisory
(2) by inserting after paragraph (8) the follow
Committee on Immunization Practices.
ing new paragraph
the Judiciary of the House of Representatives
"(2) Medical examiners shall educate aliens
"(9) UNCERTIFIED FOREIGN HEALTH-CARE
and of the Senate. the Committee on National
on the importance of immunizations and shall
WORKERS.-(A) Any alien who seeks to enter the
Security of the House of Representatives. and
create on immunization record for the olien at
United States for the purpose of performing.
the Committee on Armed Services of the Senate.
the time of examination.
labor as a health-care worker. other than a
on the feasibility of using military bases closed
"(3)(A) Each alien who has not been pac-
physician. is exclusiable unless the alten pre-
through the defense base realianment and clo-
cinated against measles. and each alien under
sents to the consular officer RI. in of case of
sure process as defension centers by the Immi-
the age of 5 years who has not been vaccinated
assustment of status, the-Attorney General,
gration and Naturalization Service.
against Dolio. must receive such vaccination,
a certificate from the Commission OR Graduates
SEC 154, PHYSICAL AND MENTAL EXAMINATIONS
unless walved by the Secretary. and must TE-
of Foreign Nursing Schools, or e certificate from
Section 237 1 U.S.C. 1226) is amended to read
ceive any other seccination determined Rec-
an-equivalent idependeni credentialing organi-
as follows:
essary by the Secretary prior to arrival in the
zation-approved by the Attorney General in con-
"PHYSICAL AND MENTAL EXAMINATIONS
United States.
miliation with the Secretary of Health and
"SEC. 234. (a) ALIENS COVERED.-Each alien
'(B) Aliens who have not received the entire
Human Services. verifyingthat=
within any of the following classes of aliens
series of vaccinations prescribed in paragraph
"71) the alien's education. training. license.
who is seeking entry into the United States shall
(1) (other than measles) shall return to 4 des-
and experience-
undergo a physical and mental examination in
ignated civil surgeon within 30 days of arrival
"() meet all applicable statutory and regu-
accordance with this section:
in the United States, or within 30 days of ad-
latory requirements for entry into the United
"(1) Allens applying for visas for admission to
justment of status, for the remainder of the vac-
States under the classification specified in the
the United States for permanent residence.
cinations.
application;
"(2) Aliens seeking admission to the United
"(f) APPEAL OF MEDICAL EXAMINATION FIND
"(II) are comparable with that required for an
States SOT permanent residence for whom exami-
INCS.-Any alten determined to have a health-
American health-care worker of the same type:
nations LETE not made under paragraph (1).
related grounds of exclusion under paragraph
and
"(3) Aliens within the United States seeking
(1) of section 212(a) may appeal that determina-
"(III) are authentic and, in the Case of a li-
adjustment of status under section 245 to that of
tion to a board of medical officers of the Public
cense, unencumbered;
aliens lawfully admitted to the United States for
Health Service, which shall be convened by the
"(ii) the alien has the level of competence in
permanent residence.
Secretary. The allen may introduce at least one
oral and written English considered by the Sec-
"(() Alien creamen entering or in transit
arpert medical witness Defore the board at his or
retary of Health and Human Services, in con-
across the United States.
her own cost and expense.
sullation with the Secretary of Education, to be
"(b) DESCRIPTION OF EXAMINATION-(1) Each
"(g) FUNDING.-(1)(A) The Allorney General
appropriate for health care work of the kind in
examination required by.rubsection (a) shall in-
shall impore a fee upon any person applying for
which the atien will be engaged, as shown by an
clude-
adjustment of status to that of an alien lawfully
appropriate score on one OF more nationally rec-
"(A) an examination of the allen for any
admitted to permanent residence under section
ognized. commercially available, standardized
physical or mental defect or disease and a CET-
209. 210. 245. of 245A. and the Secretary of State
assessments of the applicant's ability to speak
tification of medical Andings made in accord-
shall impose a see upon any person applying for
and write; and
once with subsection (d): and
a visa at a United States consulate abroad who
"(lil) V a majority of States licensing the pro-
"(B) on assessment of the vaccination record
is required to have a medical examination in ac-
Jession in which the alien intends to work recog-
of the alien in accordance with subsection (c).
cordance with subsection (a).
nize a test predicting the success on the profes-
"(2) The Secretary of Health and Human
"(8) The amounts of the fees required by rub-
sion's licensing and certification examination.
Services shall prescribe nich regulations as may
paragraph (A) shall be established by the See-
the alien has passed ruch a test.
be necessary to carry out the medical examina-
relary, in consultation with the Attorney Gen-
"(B) For purposes of subperagraph (A)(iD, de-
lions required by subsection (a).
eral and the Secretary of State. dr the case may
termination of the standardized tests required
TO MEDICAL EXAMINERS-
be. and shall be set at such amounts as may be
and of the minimum scores that are appropriate
"()) MEDICAL OFFICERS.-(A) Except as pro-
necessary to recover the full costs of establishing
are within the sole discretion of the Secretary of
vided in paragraphs (2) and (1). esaminations
and administering the civil surgeon and panel
Health and Human Services and are not subject
under this section shall be conducted by medical
physician programs, including the costs to the
to further administrative or judicial review.".
officers of the United States Public Health Serv-
Service, the Department of State. and the De-
(b) CONFORMING AMENDMENTS.-
ices.
partment of Health and Human Services for any
(1) Section 101(f)(3) is amended by striking
"(8) Medical officers of the United States
additional expenditures associated with the ad-
"(9)(A) of section 212(a)" and Inserting "(10)(A)
Public Health Service who have had specialized
ministration of the sees collected.
of section 212(a)".
7-22-1997 4 1 1PM
FROM
P.2
DRAFT
Administration
Q:
What is the Department doing in repsonse to the requirement in the 1996
Immigration law requiring immunizations for children being adopted
DRAFT
internationally?
Administration
A:
The Department has been made aware of the concerns voiced in the international adoption
community regarding the immunization requirements in the 1996 Immigration Law. The
CDC is exploring this requirement from a public health perspective to ensure that technical
guidance provided to the Immigration and Naturalization Service and the Department of
State to assist in implementing this law does not interfere with the ability of doctors to
exercise sound medical judgement regarding their patients.
Background
The 1996 amendments to the Immigration Act requires immunizations for the first time as part of
the medical examination immigrants must pass before they are given a permanent resident visa.
We provided technical and medical guidance to INS and DOS. INS decided that the new
requirement would go into effect on July 1, 1997.
The international adoption community believe that children adopted abroad and brought to the
United States by American parents should be exempt from the new requirement. They argue that
vaccines and vaccine practice may not be safe in some foreign countries and that the scanty
medical records of foreign orphans are generally insufficient to allow determination of whether a
medical contraindication might exist. INS believes they do not have authority to grant a blanket
waiver to adoptees.
The Department is receiving many calls from the Hill and others on this issue. We are working
with INS, DOS, and the Hill to determine, what, if anything can be done to assuage the concerns
for the international adoption community.
DRAFT
7-22-1997 4: 1 PM
FROM
P.2
DRAFT
Administration
Q:
What is the Department doing in repsonse to the requirement in the 1996
Immigration law requiring immunizations for children being adopted
DRAFT
internationally?
Administration
A:
The
Department has been made aware of the concerns voiced in the international adoption
community regarding the immunization requirements in the 1996 Immigration Law. The
CDC is exploring this requirement from a public health perspective to ensure that technical
guidance provided to the Immigration and Naturalization Service and the Department of
State to assist in implementing this law does not interfere with the ability of doctors to
exercise sound medical judgement regarding their patients.
Background
The 1996 amendments to the Immigration Act requires immunizations for the first time as part of
the medical examination immigrants must pass before they are given a permanent resident visa.
We provided technical and medical guidance to INS and DOS. INS decided that the new
requirement would go into effect on July 1, 1997.
The international adoption community believe that children adopted abroad and brought to the
United States by American parents should be exempt from the new requirement. They argue that
vaccines and vaccine practice may not be safe in some foreign countries and that the scanty
medical records of foreign orphans are generally insufficient to allow determination of whether a
medical contraindication might exist. INS believes they do not have authority to grant a blanket
waiver to adoptees.
The Department is receiving many calls from the Hill and others on this issue. We are working
with INS, DOS, and the Hill to determine, what, if anything can be done to assuage the concerns
for the international adoption community.
DRAFT
Leanne A. Shimabukuro 07/11/97 08:20:20 PM
Record Type:
Record
To:
Jennifer L. Klein/OPD/EOP
CC:
Jose Cerda III/OPD/EOP, Nicole R. Rabner/WHO/EOP
Subject: Immunization and immigration
I'm sorry that you had to miss the meeting today-- I hope everything is ok with the baby.
The meeting went pretty well: we had representatives from State, INS, HHS, and CDC. In a
nutshell, there is general consensus that we do not think we have the ability to waive the new
immunization requirement in the immigration law for adopted children. Moreover, equity issues
over the immunization requirement were raised with respect to children coming in on other,
non-adoption visas. For instance, if vaccinations are unsafe for adopted children abroad, they are
probably unsafe for all immigrant children coming from that country, and possibly adults as well.
The State Department said that they have been doing outreach to their consular offices on this
specific issue and have not heard that implementation of the new requirement is turning into a big
problem. They are sending/posting on the Internet some really useful questions and answers
aimed at parents adopting children, which should clear up some of the confusion. I have red-dotted
a copy of this to you.
I have also tasked HHS (Traci Endo, Irene Bueno) to help coordinate our positions on the 7 key
concerns that the adoptions community keep raising. Different agencies have been responding to
different pieces of the puzzle and I thought it would be useful to pull it all together in one
document. I think they should have something next week.
I told the participants at the meeting that the WH was expecting to have an immunization event
soon. I heard this afternoon from Christa that it is scheduled for the 23rd. HHS (Traci Endo) will
be coordinating with some of the other agencies to get some Q&A to you on this issue which could
be raised in the context of the event.
The people who will be expecting your call are:
Traci Endo at HHS: 690-6786
Bob Hannan at State: 663-1251
You should also give Steve Warnath a call. Sorry this is so long
Leanne
sen-
from State Dept
7147
LMS is
a state Dept
document.
Thanks,
Learne
212(a)(1)(A)(ii) Vaccination Requirement and Adoptions
Adoptive parents and adoption agencies have raised concerns about the impact of the
immigrant vaccination requirement on adopted children. These concerns, and our
responses, are outlined below for your reference and use in responding to inquiries.
Can't you waive this requirement for my adopted child?
Consular officers do not have the authority to exempt adopted children from the
requirement. The legal authority for granting and denying waivers rests with the
Immigration and Naturalization Service INS. The law does authorize waivers in
situations where the panel physician determines that it would be medically inappropriate
for an applicant to receive a specific vaccine, whether due to the applicant's age or
medical history/condition, or the local unavailability of the vaccine. INS has delegated
authority to Consular officers to grant blanket waivers in these cases. This means that the
waiver can be granted without the need for the applicant to file an application form or to
pay a fee.
Can I get a waiver if I have moral or religious objections to my child receiving
vaccinations?
Persons who have religious or moral objections to receiving vaccinations can apply for an
individual waiver from the INS. Individual waivers are adjudicated by INS on a case-by-
case basis, and can take significant time to process.
We' re afraid our child will be vaccinated using unsterilized needles.
Reports concerning the use of unsterilized needles involve vaccinations administered to
children in orphanages, either as a result of the institution's policy or local government
law. We have no reason to believe that the U.S. vaccination requirement will encourage
these institutions to administer vaccinations if they do not already do so. Panel
physicians, who administer the vaccinations in accordance with the Center for Disease
Control (CDC) guidelines, use sterilized needles and syringes.
Parents who are considering taking their own syringes and needles to the medical exam
should be warned that they could face problems entering a foreign country with what
might appear to be drug paraphernalia.
Who are panel physicians?
Panel physicians are local practitioners who have been selected by the Embassy or
Consulate to conduct immigrant medical exams in accordance with CDC guidelines, and
whose performance is monitored to ensure compliance with these guidelines. In many
countries, the Embassy or Consulate's staff rely on the same physicians for their own
medical care. Consular officers have been working closely with their panel physicians to
ensure that they understand the CDC guidelines and have identified potential problems.
We are confident that panel physicians will follow basic safe medical practices in
administering the vaccines, starting with the use of sterilized needles. Should we learn
that a panel physician is not practicing safe procedures, we would take immediate action
to remedy the situation.
I know that a child who is immunocompromised should not receive the required
vaccinations. It takes extensive and highly sophisticated tests, however, to determine
that a child is immunocompromised. I am afraid that my child will experience a
major adverse reaction to a vaccination on the flight home.
Such medical issues should be referred to the CDC, which is responsible for
promulgating the technical instructions which panel physicians follow in implementing
the vaccination requirement.
I don't want to fly back to the U.S. with a child who has just received a battery of
vaccinations.
We strongly encourage adoptive parents to take their child(ren) into the panel physician
for the medical exam and vaccination assessment as early as possible. This should ensure
that children have adequately recuperated from any minor reactions to the vaccinations by
the time they travel.
(ATTACHED) 6/6/97 from William Pierce, Pres., National
Council For Adoption, requesting your assistance regarding
regulations for vaccinating children coming to the U.S.,
scheduled to take effect July 1. He encloses L.A. Times
story which nicely summarizes the issue.
To Melanne + Nicole r Jen for review/response pultre
Melanne Verveer
Nicale -ony
word on this ?
1
06/06/1997 14:01
2023320935
NCFA
PAGE 01
MM
National Council For Adoption
"Help Build Happy Families"
DETERMINED TO BE AN
PERSONAL AND CONFIDENTIAL
ADMINISTRATIVE MARKING
June 6, 1997
INITIALS: a DATE: 10/17/12
The First Lady
The White House
By fax 456-6244
Dear Mrs. Clinton:
At our recent event, I had the opportunity to thank you publicly for your work on
adoption. Again, many thanks. I can also report to you that one of our staff was at an
HHS briefing this morning and it appears that the MEPA regulations are on target.
I am also writing about a unique opportunity for you to get involved on behalf of
adoption. In brief, last year's changes in the immigration law require vaccinations for all
children coming to the U.S. Except for children who are to be adopted, this may be
sound policy. To my knowledge, the entire adoption community and that part of the
medical community which specializes in pediatrics and international medical issues
agrees that it would be a health error of major proportions to allow the regulation
implementing this requirement to take effect July 1. You can help avert this crisis.
Many groups and people have been working on this, each in their own way. I've been
trying to find some simple, non-confrontive administrative solution but although people
at State and elsewhere have been very understanding, the law does not provide enough
flexibility to deal with the problem.
The issue is nicely summarized in a Los Angeles Times story by Marlene Cimons, a copy
of which (from the internet) is provided for you with this letter.
At this stage, it seems to me what would work would be for you to get personally
involved and present the case to the President, seeking an Executive Order keeping the
regulation from going into effect. It would be wonderful to have you and the President
make the announcement as soon as possible, or in a Saturday radio address before July 1;
for instance.
The practical effects? Imagine taking a child who's just had 11 shots on a 14-hour plane
ride. Or waiting five extra days in Moscow, while your child gets these shots that make
her sick, paying an extra $200 a day. We're talking about 2,500 children, 200 a month.
Sincerely
William Brown Pierce, President
Enclosure: as stated
1930 Seventeenth Street, N.W.
Washington, D.C. 20009-6207
202-328-1200
FAX 202-332-0935
06/06/1997 14:01
2023320935
NCFA
PAGE 02
From: "Brenda McParland" <[email protected]>
To: [email protected]
Critics Finding Holes in Overseas Vaccination Law
By MARLENE CIMONS, Times Staff Writer
WASHINGTON--A first glance, the regulation seems beyond debate. As
part of the immigration law passed last year, all individuals
seeking permanent entry into this country must prove that they have
been inoculated against all vaccine-preventable diseases.
But health experts, especially those who specialize in medical
issues for children adopted from abroad. are alarmed that the rule
will do more harm than good to the thousands of foreign-born
youngsters who arrive here for adoption.
Among other things the experts are worried about the quality of the
vaccines available, as well as the possibility that substandard
medical practices will contribute to the transmission of dangerous
diseases as vaccines are administered.
"Sometimes, things that seem like good ideas really aren't," said
Dr. Dana Johnson, director of the University of Minnesota's division
of neonatology. "Apparently no one thought through all the
ramifications."
The requirement, which goes into effect July 1, "potentially
endangers vulnerable children," said Dr. Laurie C. Miller, director
of the International Adoption Clinic at New England Medical Center in
Boston. "The risk is very real in most countries from which
international adoptees come."
...
Johnson said he would prefer that the State Department assume
responsibility for overseas vaccination programs rather than trusting
local physicians to do the job, but this is considered unlikely.
An alternative touted by some health experts is to waive the
requirement for infants and children and allow adoptive families to
have the shots administered by their own pediatricians when children
arrive--which already occurs in most instances, he said.
Last year, 11,316 children were adopted from overseas, the
Immigration and Naturalization Service says. The numbers of sudh
adoptions have been on the upswing in recent years. As it has become
more difficult to adopt U.S.-born babies, Americans have turned to
other countries, among them Russia, Romania, India. China and Latin
06/06/1997
14:01
2023320935
NCFA
PAGE 03
American nations.
Many of these children live in poverty, or have been in orphanages
where medical care is scarce or nonexistent. Often there is little
or no medical history available on the youngsters, according to the
Joint Council on International Children's Services, a coalition of
international adoption agencies.
A chief fear among health experts is that the required injections
will be administered with unsterile needles--a frequent practice
outside the United States because of a shortage of disposable
needles and syringes. This can transmit such potentially deadly
blood-borne infections as Hepatitis B and C and HIV. Diseases like
Hepatitis B, rare in U.S.-born children, are endemic to Asia and
Eastern Europe.
Furthermore, many countries cannot afford high-quality vaccines
more readily available here. Instead, they use biologically impotent
products, those that have expired or have not been properly
refrigerated or stored.
The experts also are worried that foreign orphanages may not be
equipped to deal with medical emergencies that could result from
vaccinations. Some children, for example, are allergic to certain
vaccines. And some vaccines, such as polio, are made from live but
weakened virus and actually can cause the disease in a small number
of children.
Rep. Bill McCollum (R-Fla), House sponsor of the vaccination
provision, expressed surprise at the concerns being raised. He said:
"It certainly wasn't meant to put anyone's health at risk. If that's
the case, then maybe we ought to explore It and, if necessary,
correct it."
But a spokesman for Sen. Jon Kyl (R-Ariz.), who sponsored the
provision in the Senate, said the law provides for waivers to the
requirement in certain circumstances. These include religious
objections or cases where the injections are deemed "medically
inappropriate."
The latter includes situations in which a child is too young to be
vaccinated or in which an individual is known to be allergic to a
vaccine. However, the waiver provisions do not appear to apply to
questionable vaccine standards or sterilization practices.
Copyright Los Angeles Times
06/23/1997 17:53 2023320935
NCFA
PAGE 01
Jerri Ann Jenista, MD
551 Second Street
Ann Arbor, MI 48103 USA
313-668-0419
313-668-9492 (fax)
May 27, 1997
Ms. Mary Ryan
Deputy Assistant Secretary of State for Consular Affairs
US Department of State
2430 E Street NW
Washington, DC. 20037-2800
Dear Secretary Ryan,
I am writing to express concern about the new requirements for immunization of permanent
resident allens, scheduled to go Into effect on July 1, 1997. These rules are inappropriate for
the processing of visas for children adopted abroad by US citizens. As an adoptive parent,
pediatrician specializing in Infectious diseases and long-time researcher on the health of
children adopted from abroad. I find significant areas of concern in these new requirements.
The safety of children may be compromised. Most immigrant children are traveling
with family members or adults who know their past medical history. Even unaccompanied
refugee children have spent some time in B processing center under medical observation.
Different from these other immigrant or refugee children. adopted children are accompanied by
perents who have had only a few days contact with the children and, for the most part. are
unaware of the child's past medical history. Even when the child has been under appropriate
medical supervision; the records typically do not accompany the child or are in a language the
parents cannot read.
Adoptive parents may be unaware of any history of allergies or adverse
reactions to past immunizations. Distressing and possibly even life-threatening
reactions to vaccines would be very difficult to manage while staying in a hotel in a
foreign country without access to familier medical care. Most families travel
immediately after the visa is issued and thus might have to deal with these serious
problems while on a long intercontinental flight.
Children may be immunocompromised by any number of hidden problems
such as:
HIV infection
undisgnosed tuberculosis
chronic stress due to social problems and/or institutional living
mainutrition
other chronic disease
Good Immunization practice requires a careful assessment of the child's health and
immunologic status. This type of evaluation is neither appropriate nor possible in the
cypical visa medical evaluation. Numerous studies have shown that the majority of
adopted immigrant children have significant health concerns which are not discovered
until after errival in the US. Giving immunizations hastily to these children is not only
a
waste of vaccine resources but also may risk Infection from live vaccines such as polic,
measles or varicella.
Nicole RAdnor F:456-2878
P. of 3
06/23/1997 17:53
2023320935
NCFA
PAGE 02
There are significant concerns about the vaccine administration process itself.
Children coming from orphanages and other Institutions typically have the least access to good
medical care.
Even if vaccines and clean needles and syringes are available in the
country, the adopted child may have no access to those resources. Adoptive
parents cannot be expected to transport vaccines which may have to be refrigerated 01
otherwise handled carefully. Adoption agencies and lawyers cannot ethically supply
vaccines to an orphanage for the sole use of children to be adopted, ignoring the other
children unavailable for adoption. Some countries prohibit the use of unapproved
vaccines or administration of vaccines by anyone except special government clinics.
Again, adopted children are unlikely to have access to these resources.
The quality of vaccines is in question In some countries. There is no way to
assess the quality of any vaccine given to an individual child. In some regions where
refrigeration cannot be guaranteed, the child may be vaccinated with a defective and
ineffective product.
Adoptive parents are not allowed the opportunity to give a fully informed
consent before the child is Immunized Many adoptive parents will not have
parented a child before and will not know the pros and cons of each vaccine. Vaccine
Information sheets, required in the US, are not likely to be available to adoptive perents
Even If attempts are made to inform parents, the visa examination is the end of a long and
stressful adoption journey and It is likely that parents will be unable to evaluate the
information in a thoughtful manner.
The costs of this program are potentially great. Because of the questions of quality and
effectiveness of vaccines given in other countries under less than optimal circumstances and 1:0
children of unknown Immune status, most US physicians repeat the entire series. Thus, a child
will have to receive many more doses of vaccines, increasing the cost and the potential for
adverse resctions. In addition, it is unlikely that US health Insurance plans will cover the cast
of vaccines administered overseas, Increasing the out-of-pocket costs in an already very
expensive adoption process.
The immunization process will cause unnecessary stress to children and
parents. Typically, the visa medical examination is the lest step before the adoptive family is
ready to travel to the US. Overwhelmed by the process of becoming a new family and the stress
of travel in a foreign country, often under very physically difficult circumstances, the last
thing a family needs is to have to subject their new son or daughter to a painful (and probably
unnecessary) medical procedure. Unable to communicate to the child in his own language,
parents will have to deal with a child whose first impressions of his new family will be colored
by a painful experience.
Immunizations given just prior to travel will not prevent cases of incubating
infection such B9 messles or varicella. Thus, the Intent of the law, to prevent
importation of Infectious diseases, will not be accomplished.
Adoptive parents are an extraordinarily health conscious group. in my 20 years of
experience in dealing with this special group of parents, I know that they are usually in the
doctor's office within hours of arrival in the US and are the first to demend any preventive
health measure for their precious new child. Thus, it is unlikely that they will fail to complete
the required immunization series.
06/23/1997 17:53 2023320935
NCFA
PAGE 03
Adoptive parents are US citizens and their children are US citizens by virtue of
adoption. Unlike other immigrant children, adopted children do not have to undergo the legal.
process of naturalization to gain citizenship. Like any child born to an American citizen abroad,
the child merely makes an application for a certificate of citizenship. Thus, adopted immigrant
children should be treated as US citizens, not as Immigrants, from the moment of adoption. They
should receive the same consideration as any child born to an American parent, that is,
immunization at the parent's discretion, with informed consent, following an appropriate
medical evaluation To treat adopted children as other immigrants is depriving them of rights
they gained by adoption into a US family.
Increasing flexibility in the granting of waivers to the Immunizations will not resolve the above
issues. It is very likely that the rules for waivers would be interpreted differently in different
countries, thus subjecting perents to an uncertain process, depending on which physician Is
providing the medical examination. The most appropriate solution to the question of
immunization far adopted immigrant children is to provide a blanket waiver For
all IR-3/IR-4 visas. By adding snother box to the list of reasons for a blanket walver, the
examining physician need do nothing more than place a check and complete the usual process.
This would allow for consistent processing worldwide for all adopted children, would eliminate
the unnecessary risks to these new US citizens and would not prolong the visa process at the end
of a long and stressful journey.
Thank you very much for your consideration., Please feel free to contact me for additional
Information.
Sincerely,
Jerri Ann Jenista, MD
Editor, Adoption/Medical News
Member, Committee on Early Childhood, Adoption and Dependent Care, American Academy of
Pediatries
cc: US Represenative Lynn Rivers
Robert Wainwright MD, National Center for Infectious Diseases
Neal Halsey, MD, American Academy of Pediatrics Red Book Committee
US Senator Jon Kyl
US Representative Bill McCollum
US Senator Spencer Abraham
06/24/1997 10:48 2023320935
NCFA
PAGE 01
TEL 301-588-3091
Jun 24.97
9:08 No. 002 P.01
Nicole Radnor-
Cradle of Hope
FYI
Adoption Center, Inc.
Bill
TO: BILL PIERCE
MAUREEN EVANS
FR: LINDA PERILSTEIN
RE: IMMUNIZATION REQUIREMENTS
DT: 24 JUNE 87
Dear Maureen and Bill:
I want to share with you the first immunization nightmare
that's been reported to me out of Moscow. This incident
allegedly occurred to non-Cradle of Hope families, 80 I cannot
independently confirm it, but here goes:
Several couples presented their chidren's immunization
records to the US Embassy in Moscow, even though the requirement
is not yet in effect. The children were lacking several
immunizations, including Hep B. The Embassy told them to take
the children to the American Medical Center in Moscow to obtain
the missing shots. The American Medical Center said they
wouldn't give the shots without authorization of the Russian
Ministry of Health, which I don't understand because the children
were already adopted and their new parents should be able to
order any medical procedure they like. The Ministry of Health
refused to authorize the shots, because the Hep B immunizations
haven't been approved in Russia yet, and because of the concern
of giving three different shots at one time.
I'm not sure how or if this problem was resolved, but it
illustrates the kinds of hassles we're in for.
Linda
Post-it Fax Note
7671
To
Date 6-24
# of
pages
Nicole Radner
/
Co./Dept.
From William Pierce
Co. NCFA
Phone #
Phone # 202.328.1200
Fax # 202.456.2878
Fax # 202.332.0935
Main Office . 8630 Penton Street Sulte 310 Silver Spring MD 20910 301.587.4400 FAX 301.588.3091
D.C. Office 1815 H Bureet, N.W. Subte 600 Washington. D.O. 20008 202.288.4700
06/20/1997 14:22
2023320935
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PAGE 02
Melanne Verveer
MM
National Council For Adoption
Nicale - Do
"Help Build Happy Families"
we know anything
more?
?
June 20, 1997
The First Lady
The White House
Washington DC
Dear Mrs. Clinton:
I am writing once again about the vaccination requirements due to take effect July 1. It
has been helpful talking with your staff, who have recommended - - as have others that
we take the issue up with the Congressional Committees that were responsible for the
change in the procedure.
We've done that, but frankly the sense of urgency that is felt by the adoption community
is not fully reflected on the Hill. I've been told July 1 may come and go, without a
resolution - - and that perhaps INS has the power to do what's needed without additional
tweaking of the Immigration and Nationality Act.
Therefore, we've informally said that we would wait until the end of June 23 for INS or
other non-legislative action to solve the problem, but if that deadline passes our word to
the adoption field will be: press for a Congressional solution before July 1. We do expect
that people will be petitioning The President and you for help, as the July 1 deadline
approaches either to seek a response from INS or an Executive Order. That is why I
wanted to give you an update.
On the adoption subject, but closer to home, Carolyn Lamm told me at her reception June
17th that she was excited about your interest in helping improve the situation in D.C. I
told Carolyn that NCFA would be glad to help in any way, including in an off-the-record
and behind the scenes fashion. Do call on us if we can be of assistance.
Thank you, as always, for your deep concern about adoption.
Bill Pierce
WP/ms
hrc62097
1930 Seventeenth Street. N.W.
Washington. D.C. 20009-6207
202-320-1200
FAX 202-332-0935
06/20/1997 14:22
2023320935
NCFA
PAGE 03
MM
National Council For Adoption
Nicole Rodnos
"Help Build Happy Families"
FYF -
June 20, 1997
The First Lady
RM Pmin
The White House
Washington DC
Dear Mrs. Clinton:
I am writing once again about the vaccination requirements due to take effect July 1. It
has been helpful talking with your staff. who have recommended - - as have others - that
we take the issue up with the Congressional Committees that were responsible for the
change in the procedure.
We've done that, but frankly the sense of urgency that is felt by the adoption community
is not fully reflected on the Hill. I've been told July 1 may come and go, without a
resolution - and that perhaps INS has the power to do what's needed without additional
tweaking of the Immigration and Nationality Act.
Therefore, we've informally said that we would wait until the end of June 23 for INS or
other non-legislative action to solve the problem, but if that deadline passes our word to
the adoption field will be: press for a Congressional solution before July 1. We do expect
that people will be petitioning The President and you for help, as the July 1 deadline
approaches - - either to seek a response from INS or an Executive Order. That is why I
wanted to give you an update.
On the adoption subject, but closer to home, Carolyn Lamm told me at her reception June
17th that she was excited about your interest in helping improve the situation in D.C. I
told Carolyn that NCFA would be glad to help in any way, including in an off-the-record
and behind the scenes fashion. Do call on us if we can be of assistance.
Thank you, as always, for your deep concern about adoption.
Bill Pierce
WP/ms
hrc62097
1930 Seventeenth Street, N.W.
Washington, D.C. 20009-6207
202-328-1200
FAX 202-332-0935
06/20/1997 14:22
2023320935
NCFA
PAGE 04
AM
National Council For Adoption
"Help Build Happy Families"
Melanue Verveu-
FYI -
-
June 20, 1997
Bill Pien
The First Lady
The White House
Washington DC
Dear Mrs. Clinton:
I am writing once again about the vaccination requirements due to take effect July 1. It
has been helpful talking with your staff, who have recommended as have others - that
we take the issue up with the Congressional Committees that were responsible for the
change in the procedure.
We've done that, but frankly the sense of urgency that is felt by the adoption community
is not fully reflected on the Hill. I've been told July 1 may come and go, without a
resolution - - and that perhaps INS has the power to do what's needed without additional
tweaking of the Immigration and Nationality Act.
Therefore, we've informally said that we would wait until the end of June 23 for INS or
other non-legislative action to solve the problem, but if that deadline passes our word to
the adoption field will be: press for a Congressional solution before July 1. We do expect
that people will be petitioning The President and you for help, as the July 1 deadline
approaches - either to seek a response from INS or an Executive Order. That is why I
wanted to give you an update.
On the adoption subject, but closer to home, Carolyn Lamm told me at her reception June
17th that she was excited about your interest in helping improve the situation in D.C. I
told Carolyn that NCFA would be glad to help in any way, including in an off-the-record
and behind the scenes fashion. Do call on us if we can be of assistance.
Thank you, as always, for your deep concern about adoption.
Bill Pierce
WP/ms
hrc62097
1930 Seventeenth Street, N.W.
Washington, D.C. 20009-6207
202-328-1200
FAX 202-332-0935
Patrick Purtill
06/10/1997 09:25
2023320935
NCFA
PAGE 02
MM
National Council For Adoption
"Help Build Happy Families"
FAXE
PERSONAL AND CONFIDENTIAL
June 6, 1997
DETERMINED TO BE AN
The First Lady
ADMINISTRATIVE MARKING
The White House
By fax 456-6244
INITIALS: @ no DATE: 10/17/12
Dear Mrs. Clinton:
At our recent event, I had the opportunity to thank you publicly for your work on
adoption. Again, many thanks. I can also report to you that one of our staff was at an
HHS briefing this morning and it appears that the MEPA regulations are on target.
I am also writing about a unique opportunity for you to get involved on behalf of
adoption. In brief, last year's changes in the immigration law require vaccinations for all
children coming to the U.S. Except for children who are to be adopted, this may be
sound policy. To my knowledge, the entire adoption community and that part of the
medical community which specializes in pediatrics and international medical issues
agrees that it would be a health error of major proportions to allow the regulation
implementing this requirement to take effect July 1. You can help avert this crisis.
Many groups and people have been working on this, each in their own way. I've been
trying to find some simple, non-confrontive administrative solution but although people
at State and elsewhere have been very understanding, the law does not provide enough
flexibility to deal with the problem.
The issue is nicely summarized in a Los Angeles Times story by Marlene Cimons, a copy
of which (from the internet) is provided for you with this letter.
At this stage, it seems to me what would work would be for you to get personally
involved and present the case to the President, seeking an Executive Order keeping the
regulation from going into effect. It would be wonderful to have you and the President
make the announcement as soon as possible, or in a Saturday radio address before July 1,
for instance.
The practical effects? Imagine taking a child who's just had 11 shots on a 14-hour plane
ride. Or waiting five extra days in Moscow, while your child gets these shots that make
her sick, paying an extra $200 a day. We're talking about 2,500 children, 200 a month.
William Brown Pierce, President
Sincerely
Enclosure: as stated
1930 Seventeenth Street, N.W.
Washington, D.C. 20009-6207
202-328-1200
FAX 202-332-0935
06/10/1997 09:25
2023320935
NCFA
PAGE 03
L.A. Times
From: "Brenda McFarland" <[email protected]>
To: [email protected]
Critics Finding Holes in Overseas Vaccination Law
By MARLENE CIMONS, Times Staff Writer
WASHINGTON--A first glance, the regulation seems beyond debate. As
part of the immigration law passed last year, all individuals
seeking permanent entry into this country must prove that they have
been inoculated against all vaccine-preventable diseases.
But health experts, especially those who specialize in medical
issues for children adopted from abroad. are alarmed that the rule
will do more harm than good to the thousands of foreign-born
youngsters who arrive here for adoption.
Among other things, the experts are worried about the quality of the
vaccines available, as well as the possibility that substandard
medical practices will contribute to the transmission of dangerous
diseases as vaccines are administered.
"Sometimes, things that seem like good ideas really aren't," said
Dr. Dana Johnson, director of the University of Minnesota's division
of neonatology. "Apparently no one thought through all the
ramifications."
The requirement, which goes into effect July 1, "potentially
endangers vulnerable children," said Dr. Laurie C. Miller, director
of the International Adoption Clinic at New England Medical Center in
Boston. "The risk is very real in most countries from which
international adoptees come."
Johnson said he would prefer that the State Department assume
responsibility for overseas vaccination programs rather than trusting
local physicians to do the job, but this is considered unlikely.
An alternative touted by some health experts is to waive the
requirement for infants and children and allow adoptive families to
have the shots administered by their own pediatricians when children
arrive--which already occurs in most instances, he said.
Last year, 11,316 children were adopted from overseas, the
Immigration and Naturalization Service says. The numbers of sudh
adoptions have been on the upswing in recent years. As it has become
more difficult to adopt U.S.-born babies, Americans have turned to
other countries, among them Russia, Romania, India. China and Latin
06/10/1997 09:25
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American nations.
Many of these children live in poverty, or have been in orphanages
where medical care is scarce or nonexistent. Often there is little
or no medical history available on the youngsters, according to the
Joint Council on International Children's Services, a coalition of
international adoption agencies.
A chief fear among health experts is that the required injections
will be administered with unsterile needles--a frequent practice
outside the United States because of a shortage of disposable
needles and syringes. This can transmit such potentially deadly
blood-borne infections as Hepatitis B and C and HIV. Diseases like
Hepatitis B, rare in U.S.-bom children. are endemic to Asia and
Eastern Europe.
Furthermore, many countries cannot afford high-quality vaccines
more readily available here. Instead, they use biologically impotent
products, those that have expired or have not been properly
refrigerated or stored.
The experts also are worried that foreign orphanages may not be
equipped to deal with medical emergencies that could result from
vaccinations. Some children. for example, are allergic to certain
vaccines. And some vaccines, such as polio. are made from live but
weakened virus and actually can cause the disease in a small number
of children.
Rep. Bill McCollum (R-Fla), House sponsor of the vaccination
provision, expressed surprise at the concerns being raised. He said:
"It certainly wasn't meant to put anyone's health at risk. If that's
the case, then maybe we ought to explore it and, if necessary,
correct it."
But a spokesman for Sen. Jon Kyl (R-Ariz.), who sponsored the
provision in the Senate, said the law provides for waivers to the
requirement in certain circumstances. These include religious
objections or cases where the injections are deemed "medically
inappropriate."
The latter includes situations in which a child is too young to be
vaccinated or in which an individual is known to be allergic to a
vaccine. However, the waiver provisions do not appear to apply to
questionable vaccine standards or sterilization practices.
Copyright Los Angeles Times
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