Required vs recommended

Lots of people get stuck on these two terms in travel medicine. Required means just that - you HAVE to have the immunization to enter a country. There are only 2 REQUIRED immunizations (that is - required by international rules) available. Those are yellow fever and meningitis. The ONLY REQUIRED use of meningitis vaccine is for travelers to the Hajj pilgrimage to Mecca. . Otherwise, the only required vaccine is yellow fever. A big BUT... the organization you might be traveling with (as with a mission organization, etc) may have their own imposed requirements - and those must be met if you plan to accompany that organization to the destination. In that event, the organization is trying to cover their bases on liability as well as trying to keep the travelers under their watch healthy.

The only way you can travel to a country REQUIRING the yellow fever vaccine without one is to have a vaccine waiver. Those waivers must originate from a certified yellow fever site and must be due to a medical reason (severe allergy to vaccine component, age, immunosupressed condition, and some medical situations).

One the other hand, RECOMMENDED vaccines are those that have been deemed by the Centers for Disease Control (CDC), and the World Health Organization (WHO) that will help protect the traveler in an area endemic for that disease. It truly is in the traveler's best health interest to heed these recommendations. Granted, there are some itineraries that put the traveler at a very low risk of contracting a disease that is endemic to that area - but that should be evaluated on a person-by-person, step-by-step itinerary.

Recommendations also apply to malaria medications (prophylaxis). Malaria kills. There are various medications - specific to location - that are available and should always be used in those areas highlighted by the CDC and WHO.