On January 20, 2022, the U.S. Department of Homeland Security updated its travel advisory to require all foreign national travelers (except U.S. permanent residents) to present proof of COVID-19 vaccination when seeking entry to the United States via land ports of entry and ferry terminals. The new guidance expands upon already existing COVID-19 travel requirements and establishes similar COVID-19 vaccination requirements for non-U.S. travelers seeking entry to the United States by both air and land.

Vaccination Requirements: Air and Land

With limited exceptions, all foreign nationals (except U.S. permanent residents) are now required to be fully vaccinated to travel to the United States by air, land, or ferry points of entry. Travelers are required to provide proof of vaccination for entry. According to the U.S. Centers for Disease Control and Prevention’s (CDC) guidance, acceptable proof of vaccination includes: (1) a vaccination certificate with QR code or digital pass via smartphone app with QR code; (2) a printout of the COVID-19 vaccination record or certificate; or (3) digital photos of the traveler’s vaccination card, record, or certificate. Travelers seeking entry must also attest to their COVID-19 vaccination status. Air travelers are further required to complete a passenger attestation form.

Testing Requirements: Air

All passengers traveling to the United States by air are required to present proof of a negative COVID-19 viral test. The CDC recommends that this test be taken no more than one day prior to air travel to the United States, regardless of vaccination status. An individual who has recently recovered from COVID-19 may present a positive COVID-19 viral test result from not more than ninety days before his or her flight’s departure, as well as a letter issued by a licensed healthcare provider documenting recovery from COVID-19. Children under two years of age are not required to submit COVID-19 viral test results.

Travelers seeking entry to the United States by land or ferry ports of entry are not required to present proof of negative COVID-19 tests or documentation of recovery.

Vaccination Exceptions

Current guidance includes limited exceptions for unvaccinated nonimmigrant visa holders seeking entry to the United States by air, land, rail, or ferry points of entry. These exceptions include, but are not limited to the following individuals:

• children under 18 years of age;

• certain COVID-19 vaccine trial participants;

• those with medical contraindications to COVID-19 vaccines;

• those who need to travel for emergency or humanitarian reasons (with a U.S. government-issued letter affirming the urgent need to travel);

• those who have passports issued by a foreign country with limited COVID-19 vaccine availability (as determined by the CDC) and a nonimmigrant visa that is not a B-1 or B-2 visa; and

• those whose entry would be in the national interest, as determined by the secretary of state, secretary of transportation, or secretary of homeland security (or their designees).

The CDC provides a complete list of vaccine exceptions.

Key Information About the Medical Contraindication Exemption

An individual with a medical contraindication to the COVID-19 vaccine may be granted an exemption that allows travel to the United States by air or land if he or she can present a signed letter from a licensed physician that documents a medical contraindication to receiving a COVID-19 vaccine.

What is a medical contraindication?

The National Library of Medicine defines “contraindication” as “a specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the person.”

Documentation requirements to request a medical contraindication exemption

An individual seeking a medical contraindication must obtain a letter from a licensed physician. The letter must:

• be signed and dated on official letterhead that contains the name, address, and phone number of the licensed physician who signed the letter;

• clearly state that the traveler has a contraindication to receiving a COVID-19 vaccine;

• list the name of the COVID-19 vaccine and the medical condition causing contraindication;

• contain sufficient personally identifiable information that matches with the traveler’s passport or other travel documents, to confirm that the traveler is the person referenced in the letter; and

• include personally identifiable information with the traveler’s full name and at least one other identifier, such as the traveler’s date of birth or passport number.

Important Reminders

Travelers may want to note that:

• Current guidelines do not allow objections to vaccination based on religious or moral convictions to qualify for an exception under Presidential Proclamation 10294, “Advancing the Safe Resumption of Global Travel During the COVID–19 Pandemic,” and the CDC’s order implementing the proclamation.

• Airlines and aircraft operators may, at their discretion, require medical consultation by a third party for persons requesting an exception based on a medical contraindication to receiving a COVID-19 vaccine.

• Airlines or aircraft operators must also confirm that the passenger has provided a covered individual attestation.