Doctors are seeing an uptick in medical exemption requests as vaccine mandates sweep across the country, but health officials warn that very few patients will qualify.
Instead, some doctors see it as an opportunity to address patients’ concerns with immunization and explain the benefits of getting their shots, says Dr. Katharine Smart, president of the Canadian Medical Association.
“At this point in the pandemic, all of us as physicians are trying to take any opportunity we can to share information with patients and help them with any hesitancy that might be preventing them from being vaccinated, and this is definitely an opportunity,” Dr. Smart says. “Many people with chronic health problems that may have perceived that as a reason not to be vaccinated are actually the very people we want to have vaccinated because they’re at much higher risk of a bad outcome from COVID.”
Several provinces, including B.C., Alberta, Quebec and Manitoba, have already introduced passports that require proof of vaccination to access non-essential services such as restaurants, movie theatres, sporting events and gyms. Ontario will roll out its vaccine-certificate program on Sept. 22.
There are very few conditions that meet the criteria for a medical exemption. Those include having known anaphylaxis to any of the ingredients in the vaccine confirmed by an allergist or immunologist; having had a significant allergic reaction to the first dose; or myocarditis, an inflammation of the heart muscle and a rare side effect of the three vaccines. Some provinces have added other conditions to that list. In Manitoba, for example, the province’s Vaccine Implementation Task Force has said that people who suffered Guillain-Barré syndrome as a result of the first dose, or are currently receiving treatment that prevents them from mounting an immune response, qualify for an exemption.
Given this list of reasons, it is highly unlikely that many people who inquire about an exemption will qualify for one, Dr. Smart says. “The reality is, valid medical exemptions for vaccination are very few so it is fairly straightforward.”
For example, in Canada there have only been 678 confirmed cases of myocarditis/pericarditis linked to the COVID-19 vaccines from the beginning of the vaccination campaign up to and including Sept. 3, according to data from the Public Health Agency of Canada.
The Ontario Medical Association has already seen a small rise in requests for medical exemptions, says Dr. Adam Kassam, president of the organization, but he adds “you’re going to start seeing that uptick grow” as time goes on.
Dr. Shane Barclay, a physician at Sun Peaks Community Health Centre, in Sun Peaks, B.C., has had approximately a dozen patients ask him for a medical exemption to the vaccine. Not one of them had a condition that would qualify them for an exemption, he says. One patient asked for an exemption because they only have one kidney. Another told him their lungs were bad.
“Then I would say, ‘All the more reason that you should be getting a COVID vaccine,’ ” Dr. Barclay says.
The demand for exemptions prompted Dr. Barclay to write a letter to patients saying that approving an exemption for a patient who doesn’t have a valid reason would amount to fraud. “It’s a bit of a strong statement, but I wanted for patients to realize that as a physician every time we sign our name, even on a sick note, that’s a medical, legal document,” Dr. Barclay says. “This is not some benign request that you’re asking your physician for.”
At least three people each day have asked Dr. Mukarram Zaidi for a vaccine exemption letter since Alberta’s “restrictions exemptions program” came in to effect on Monday. Not one of them has had a valid reason, the Calgary-based family physician says.
“Some said, ‘I know a few people who have had side effects,’ ” Dr. Zaidi says. “Today I had one [person] and she said after the first vaccine she has been feeling tired.” One man didn’t offer a reason, instead offering Dr. Zaidi $200 for an exemption letter, no questions asked.
“I said, ‘This discussion is over,’ ” Dr. Zaidi says. One couple asked for exemptions for themselves and their children, who are over 12 years of age and are therefore eligible for the vaccine. “I was very blunt with them. I told them, because of you people are suffering and dying,” Dr. Zaidi says. He told them his own children are vaccinated, and after more discussion, the family decided to vaccinate their kids, Dr. Zaidi says.
Like Dr. Smart, Dr. Kassam believes it is a chance to try to persuade more people to get the vaccine.
“If you’re seeking an exemption the assumption is that you’re probably not fully vaccinated. So perhaps that also offers the opportunity to have a conversation with that individual about getting the vaccine,” Dr. Kassam says.
In Ontario, in order to access non-essential services, people with medical exemptions will have to provide a written document, completed and supplied by a physician stating that the individual is exempt for a medical reason from being fully vaccinated against COVID-19 and the effective time-period for the medical reason, according to the Ministry of Health. The patron must also provide identification.
The province is working to develop a way for legitimate medical exemptions from COVID-19 vaccinations to be built into the QR code the verification application will read so people do not have to display their exemption form and businesses do not have to verify those forms.
In Alberta, Premier Jason Kenney says the province is exploring whether prior COVID-19 infection could offer exemption to proof of vaccination, given that people who have been infected get some degree of natural protection from the virus. But public-health guidance still recommends the vaccine if you have had COVID-19, says Dr. Susy Hota, medical director of infection prevention and control at the University Health Network in Toronto.
“I don’t think we have a full understanding of comparing natural immunity from having recovered from an infection to vaccine-induced immunity,” Dr. Hota says. How long ago someone had COVID-19, what variants were circulating at the time, how mild or severe the illness was could all affect a person’s ability to have protection from the virus, she says.
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