If you’re looking for the long list of conditions that might entitle you to a medical exemption from mandatory COVID-19 vaccine policies, you can stop looking now.
It turns out the list of conditions valid for a medical exemption from vaccines in Canada is extremely limited, and even narrower than for masks. The only valid exemptions are for people allergic to ingredients in the vaccine, or those who experienced severe allergic reactions or heart inflammation after their first dose.
This has implications for health-care providers and citizens nationwide, as provinces including Quebec and B.C. introduce or plan to introduce vaccine passports, and organizations such as the Toronto Police Service and Air Canada announce mandatory policies for employees.
“The whole discussion of medical exemptions to COVID vaccine is a pretty straightforward one because the bottom line is there aren’t many,” said Dr. Barry Pakes, a physician and program director of the Public Health and Preventive Medicine residency program at the University of Toronto’s Dalla Lana School of Public Health.
“And we’re encouraging physicians to not give medical exemptions for invalid reasons, and despite the fact that their patients are pleading with them … it is really important to just help them understand that those aren’t genuine reasons not to get the vaccine,” he added.
The primary ingredient that has been identified as an allergen of concern is a chemical compound called polyethylene glycol, which has been linked to serious reactions. But even allergies to that are quite rare, Pakes said.
Previously, Pakes said the rare blood clot issue seen in some people who got a shot of the AstraZeneca vaccine was a matter of concern for people who take blood thinners or with pre-existing clotting conditions, but that doesn’t apply to mRNA vaccines.
Pakes said he frequently consults with patients who have conditions such as Lyme disease, which make them immunocompromised, who express concerns about receiving the vaccines.
In fact, people who are immunocompromised are the ones who should be most eagerly rolling up their sleeves and even considering a third dose when it’s made available, Pakes said.
Omar F. Khan, a vaccine expert and assistant professor at U of T’s department of immunology, agrees.
“Those very same pre-existing conditions are what make you more vulnerable to actual natural infection,” Khan said. “So your options are I can get naturally infected, and my immune system will fight and overcome it … or taking the shortcut, where the vaccine just helps you get your antibodies quicker and then that saves you a lot of burden on your immune system and doesn’t tax in you the same way.”
If people believe they might be allergic to an ingredient in any of the currently available vaccines, they must consult a family physician, Khan said.
“If you need to get that medical exemption you actually need to talk to someone who knows your medical history,” he said. “That’s the key part of this.
“A lot of people have been doing their research online and kind of making their own decisions, but this is not a decision you should be making with internet research.”
Pakes said he expects some patients will try to pressure their doctor or pay them to receive a doctor’s note listing a medical exemption, and he hopes it won’t be widespread.
“The real challenge is when you have some doctors writing letters of exemption charging $50, $100, whatever they might do. And that undermines the stand of the 99 per cent of doctors or health-care practitioners who are not doing that.”
The College of Physicians and Surgeons of Ontario’s website says health-care providers must be “comprehensive, accurate and objective” when providing notes, and if a patient does not have a valid reason for a medical exemption, they must still write a note and “state the accurate clinical information (e.g., patient doesn’t have any medical conditions/risks to their health).”
Pakes said mental health challenges such as anxiety or needle phobia are a worthy consideration but “not a reason to get a medical exemption,” noting there are clinics that cater to people with needle phobia.
The only contraindications, or a reason for why someone should avoid a specific treatment, listed on Health Canada’s website for mRNA vaccines is for people who experienced anaphylaxis, a severe allergic reaction, after receiving a previous shot, or who are allergic to an ingredient.
The list of precautions is longer. It includes acute illness (people who are sick should wait until those symptoms resolve, to avoid attributing complications from possible COVID infection to immunization); hematologic (people with bleeding disorders should manage their condition before getting the shot so minimize risk of bleeding); and myocarditis and/or pericarditis, which is inflammation of the heart muscle/heart lining.
Health Canada says there have been no drug interaction studies performed yet.
The Ontario Medical Association’s position is that there are “few legitimate reasons for exemptions validated by the Ontario Chief Medical Officer of Health,” listing allergies to ingredients, a previous severe reaction or having previously experienced myocarditis or pericarditis after a first dose as reasons for exemption.
For people with allergies, the OMA says “most of these patients may still receive the vaccine in controlled conditions after being assessed by an allergist or immunologist.”
It’s unclear what employers will ask for specifically when it comes to doctors’ notes providing a medical exemption. In a statement, the Toronto Police Service said its policy is still being developed.
Andrew Caldwell, human relations advisory team lead with Peninsula Canada, said employers won’t need to know the medical condition is, they just need to know it’s been validated by a health-care provider.
“From a business perspective, they shouldn’t just be accepting self-declarants because you can’t validate that … you want to actually get something valid because the onus is on the employer for the employee’s safety, and the other employees’ safety and their customers’ safety,” he said.
Religious objections could also emerge as a reason for an exemption, but Pakes said he doesn’t believe they will hold water.
“The impact of religious exemptions is very, very limited and in fact, for most of the people who seek exemptions (on those grounds) it’s for reasons of conscience … Despite religious convictions, there are certainly justifications where the public good would trump that.”