Vaccinations in Costa Rica for Foreigners: What the Law Requires

With the number of foreigners moving to Costa Rica, many families naturally wonder what the rules are regarding vaccinations—especially when children are involved. Earlier in the year, this topic gained broader attention due to the measles outbreak in the United States. By February 6th, there were 121 confirmed cases across 17 states, and 108 of those cases were traced to Disneyland.

I decided to write about this topic because I have friends and acquaintances in Costa Rica who do not vaccinate their children. That raises a fair question that many foreign parents eventually ask:

What is Costa Rica’s position on vaccinations?

The main purpose of this article is to explain the legal situation in Costa Rica regarding vaccinations, particularly as it applies to foreigners and families with children. Inevitably, it also includes personal views, but I will frame them from a public-interest perspective—namely, the wellbeing of the population at large, including children, elderly persons, and vulnerable individuals who depend on herd immunity.

(Important note: This article is informational and legal in nature, and not a substitute for medical advice. Families should consult qualified healthcare professionals for medical guidance.)

VIRUSES BY NUMBERS

Vaccinations exist because the historical record is not abstract. Many diseases that are now preventable once caused widespread death, disability, and generational harm. To understand why governments adopt mandatory vaccination policies, it helps to keep the scale of past outbreaks in view.

Measles

It has been estimated that measles killed 200 million people in the last 150 years.

Rubella

Rubella does not typically cause death to the host, but it can cause severe complications in pregnant women, including miscarriages, therapeutic abortions, and congenital diseases in fetuses. Between 1964–65, the United States had an estimated 12.5 million rubella cases, which led to 11,000 miscarriages or therapeutic abortions and 20,000 cases of congenital rubella syndrome. Of these: 2,100 died as neonates, 12,000 were deaf, 3,580 were blind, and 1,800 were mentally affected. In New York alone, congenital rubella syndrome affected 1% of all births.

Mumps

Similar to rubella, mumps is not commonly a direct cause of death, but it can lead to serious outcomes, including infertility, hearing loss, and meningitis (which can be fatal).

Smallpox

In the 20th century, between 300 and 500 million people died of smallpox. As late as 1967, the WHO estimated 15 million deaths in that year alone. After vaccination campaigns throughout the 19th and 20th centuries, the WHO certified the eradication of smallpox in 1979.

Influenza

Influenza spreads around the world in yearly outbreaks, resulting in about three to five million cases of severe illness and about 250,000 to 500,000 deaths. Death occurs mostly among the young, the elderly, and those with other health problems. In the 20th century, three influenza pandemics occurred—Spanish influenza (1918), Asian influenza (1958), and Hong Kong influenza (1968)—each resulting in more than a million deaths.

Polio

The World Health Organization estimates there are 10 to 20 million polio survivors worldwide. In 1977, there were 254,000 persons living in the United States who had been paralyzed by polio. According to doctors and local polio support groups, some 40,000 survivors with varying degrees of paralysis live in Germany, 30,000 in Japan, 24,000 in France, 16,000 in Australia, 12,000 in Canada and 12,000 in the United Kingdom.

Diphtheria

Diphtheria is fatal in 5% to 10% of cases. In children under five and adults over 40, fatality rates may be as high as 20%. In 2010 it caused about 2,900 deaths.

I reference these diseases because they are examples of conditions that can be prevented through vaccination. Different pandemics and outbreaks throughout history prompted governments to enact vaccination policies to protect populations from death, long-term disability, and the collapse of public health systems during outbreaks.

THE COSTS OF NON-VACCINATION

Outbreaks like the one traced to Disneyland are not rare exceptions. When vaccination rates drop in a community, outbreaks become more likely—particularly among children, immunocompromised individuals, and those who cannot be vaccinated for medical reasons.

Below are examples of outbreaks and community impacts historically associated with reduced vaccine compliance.

Stockholm, smallpox (1873–1874)

An anti-vaccination campaign motivated by religious objections, concerns about effectiveness, and concerns about individual rights led to vaccination rates in Stockholm dropping to just over 40%, compared to about 90% elsewhere in Sweden.

UK, pertussis (1970s–80s)

Vaccine uptake in the UK decreased from 81% to 31%, and pertussis epidemics followed, leading to the deaths of children.

Sweden, pertussis (1979–1996)

Sweden suspended vaccination against whooping cough (pertussis) from 1979 to 1996. 60% of the country’s children contracted the potentially fatal disease before age 10; the death rate was about one per year. Pertussis remains a major health problem in developing countries. WHO estimates it caused 294,000 deaths in 2002.

Netherlands, measles (1999–2000)

An outbreak at a religious community and school illustrates the effect of measles in an unvaccinated population. The affected provinces had high immunization levels except within one religious group that traditionally does not accept vaccination. Three measles-related deaths and 68 hospitalizations occurred among 2,961 cases—showing that measles can still be severe and deadly even in industrialized countries.

UK and Ireland, measles (2000)

Following the MMR controversy, vaccination compliance dropped sharply in the UK after 1996. From late 1999 until summer 2000, a measles outbreak in North Dublin occurred. National immunization levels fell below 80%, and in parts of North Dublin to around 60%. There were more than 100 hospital admissions from over 300 cases. Three children died and several others were critically ill.

Nigeria, polio, measles, diphtheria (2001–present)

Due to religious opposition to vaccines, polio reappeared in multiple formerly polio-free neighboring countries. Nigeria reported nearly 20,000 measles cases and nearly 600 deaths from measles from January through March 2005. In 2006, Nigeria accounted for over half of all new polio cases worldwide. Later outbreaks continued, including a late-2007 measles outbreak in Borno State in which at least 200 children died.

Indiana, United States, measles (2005)

A 2005 measles outbreak in Indiana was attributed to parents who refused vaccination. Most cases of pediatric tetanus in the U.S. occur in children whose parents objected to vaccination.

Multiple states, United States, measles (2013–present)

Measles was declared eliminated from the United States in 2000; remaining cases were due to importation. The CDC reported that major outbreaks in 2013 were attributed to clusters of unvaccinated individuals due to philosophical or religious beliefs. As of August 2013, outbreak pockets in New York City, North Carolina, and Texas contributed to 64% of reported cases in 16 states.

Philadelphia, United States, measles (1990–1991)

Between October 1990 and June 1991, more than 1,400 people in Philadelphia were infected with measles and nine children died. Children were unvaccinated; when they became ill, parents relied on prayer rather than medical treatment, including supportive hospital care that could have saved lives in severe cases.

UK, Swansea, measles (2013)

In 2013, an outbreak of measles occurred in Swansea, Wales. One death was reported. MMR uptake for two-year-olds was 94% in Wales in 1995 but fell as low as 67.5% in Swansea in 2003, creating a vulnerable age group. This decline has been linked to the MMR vaccine controversy and fear among parents.

These examples illustrate a recurring reality: when vaccination policies are not followed, outbreaks become more likely—and consequences are often borne by children and vulnerable people first.

VACCINATIONS IN COSTA RICA

Vaccinations in Costa Rica are mandatory by law.

There are three relevant bodies of law regarding vaccinations in Costa Rica:

1. Law 5395 (Ley General de Salud)

2. Law 8111 (National Vaccination Law, which mirrors Law 5395)

3. Vaccination Regulation (Norma Nacional de Vacunación)

Law 5395 establishes broad vaccination policy, and the Regulation sets forth implementation details. Let’s begin with the law, as foreigners often find the structure and enforcement mechanisms particularly important.

Section 150

Section 150 states that all vaccinations, as determined by the Ministerio de Salud (MS), are mandatory.

Two key points follow:

• Vaccination is not framed as optional under the law.

• The MS has authority to determine which vaccines are required for the population.

Section 151

Section 151 places responsibility on parents and guardians to ensure children receive required vaccinations. This does not mean parents have legal discretion to opt out; it means parents are responsible for taking children to be vaccinated. The law does not depend on the MS going door to door.

Section 152

Section 152 requires every person to provide a Vaccination Certificate (VC) when requested. This emphasizes recordkeeping and becomes relevant in practical settings such as travel and school enrollment.

Section 153

Section 153 requires parents or guardians to present a VC for school enrollment each year. It also assigns responsibility to school principals to enforce the policy. Importantly, it applies to both public and private schools.

In practical terms: children attending school must be vaccinated under Costa Rican law.

Section 154

Section 154 states that valid vaccination certificates may be issued only by health professionals, whether public or private, and that the records must contain legitimate information. Forgery is prohibited.

Together, these sections establish that vaccination is mandatory, that vaccination certificates are the enforcement mechanism, and that schools have an explicit legal role in verification.

VACCINATIONS FOR FOREIGNERS

For foreigners, the law includes additional provisions tied to immigration and entry into the country.

Section 172

Section 172 requires foreigners to provide their vaccination certificate along with the application to immigration authorities.

Section 173

Section 173 requires people entering Costa Rica at a port of entry to provide proof of vaccination showing compliance with required vaccines. This applies to foreigners entering as tourists or residents.

It also provides that if a person cannot provide proof of vaccination, authorities may proceed to vaccinate the person at the port of entry. If the person refuses, the law contemplates quarantine.

As a practical matter, enforcement has historically been uneven. However, the legal framework exists, and enforcement could become more active if an outbreak or public-health event creates legal or political pressure.

MANDATORY VACCINATIONS

A natural next question is: which vaccinations are mandatory?

The Vaccination Regulation sets forth the mandatory vaccinations required for children prior to entering school at age 6.

(Note: In your original post, this section references a list that was visually included. When you paste this into WordPress, you can insert the current vaccine schedule from the Ministry of Health or CCSS, or a table summarizing the vaccine series.)

WHAT TO DO?

This blog is primarily targeted to foreigners and expat families, so it is worth addressing the situation directly.

If you are an expat and you have not vaccinated yourself or your children, there are essentially three paths:

1. Comply with the law and obtain required vaccinations for yourself and your children.

2. Relocate to a jurisdiction whose legal framework aligns more closely with your beliefs.

3. Challenge the law, bringing a case to court to request the ability to opt out.

When considering these options, it helps to keep one concept clear: Costa Rica has a socialized public-health system, and vaccination laws are designed for the protection of the population at large—not exclusively for the protection of any one individual.

A decision not to vaccinate may feel personal, but it can affect others, including infants, the elderly, and medically vulnerable individuals who rely on community-wide immunization for protection. This point is reflected historically in the outbreak examples above.

THE AUTISM CONTROVERSY – WHO ANALYSIS

Concerns about a possible link between the MMR vaccine and autism were raised in the late 1990s. The WHO, on the recommendation of GACVS (Global Advisory Committee on Vaccine Safety), commissioned a literature review by an independent researcher regarding the risk of autism associated with the MMR vaccine.

Autistic spectrum disorder represents a continuum of cognitive and neurobehavioral disorders including autism. Prevalence varies with case ascertainment, ranging from 0.7 to 21.1 per 10,000 children (median 5.2 per 10,000), while prevalence of autistic spectrum disorder is estimated to be 1 to 6 per 1,000.

Eleven epidemiological studies (including ecologic, case control, case-crossover, and cohort studies) were reviewed in detail, including study design and limitations. The review concluded that existing studies do not show evidence of an association between the risk of autism or autistic disorders and MMR vaccine.

Three laboratory studies were also reviewed. It was concluded that the alleged persistence of measles vaccine virus in the gastrointestinal tract of children with autism and inflammatory bowel disease required further investigation through independent studies before published laboratory findings, which had serious limitations, could be considered confirmed.

Based on the extensive review presented, GACVS concluded that no evidence exists of a causal association between MMR vaccine and autism or autistic disorders. The Committee also concluded there was no evidence to support routine use of monovalent measles, mumps and rubella vaccines over the combined vaccine, as this strategy could increase the risk of incomplete immunization. GACVS recommended no change in current vaccination practices with MMR.

(When publishing, you can link to the WHO report as an outbound authority source.)

In Costa Rica, the Ministry of Health has not specifically addressed autism in relation to vaccinations as a public policy issue. Currently, there are no national statistics included here on that point. The Costa Rican Association of Parents and Friends of Autistic Persons has sought government assistance, including legislation acknowledging the issue, without success.

MY PERSONAL DECISION

I like the quote by Ortega y Gasset: “I am myself plus my circumstances.” I tend to make decisions based on circumstances, experience, and risk.

I lost my daughter last year. As a parent, it is difficult to describe the sense of helplessness that can come with trying to do everything possible and still being unable to prevent loss. My wife and I are trying to have another child, and we will do everything in our power to protect our children’s lives.

For that reason, at a personal level, we will vaccinate.

At a broader level, the public-health risk is not theoretical. According to WHO estimates included in the original discussion, measles continues to cause significant mortality globally. Not vaccinating children increases risk not only for them, but also for other children and vulnerable members of the community.

I also recognize that parents who choose not to vaccinate often make that decision with sincere concern for their children. I remember having a conversation with a friend from Europe who weighed perceived risks and benefits and decided not to vaccinate their children. I do not blame him for that decision, and I would hope for the same mutual respect regarding my decision to vaccinate.

The key point from a Costa Rican legal perspective, however, remains unchanged:

Vaccinations are mandatory by law, and Costa Rica’s system prioritizes public health over individual preference in this area.