Ontario confirms there are only two valid medical exemptions from COVID-19 vaccines

When Ontario’s COVID-19 vaccine passport rolls out on Sept. 22, individuals with medical exceptions must show proof confirming why they can’t get the shot.

Ontario’s Ministry of Health told CTV News Toronto last week that there are only two valid medical exemptions from COVID-19 vaccinations.

The first would be an allergic reaction to a component of the vaccine within an individual, which must be confirmed by an allergist or immunologist.

According to the Ministry of Health, residents are encouraged to review the ingredient list of any vaccine they receive before administration, as polyethylene glycol (PEG), polysorbate 80 and/or tromethamine can sometimes cause allergic reactions, albeit rarely.

The second would be if an individual suffered myocarditis or pericarditis after the first dose of a vaccine.

Myocarditis and pericarditis are types of heart inflammation, which have been recently found in a small number of male adolescents and young adults within several days of receiving an mRNA vaccine. The Centre of Disease Control (CDC) called reports of these reactions “rare.”

“From a medical exception standpoint, you either had a bad reaction to the first dose, or you have an allergy to a component of the vaccine, or you have a greater risk of having a negative impact because you have an underlying heart condition,” Infectious Diseases Specialist Dr. Isaac Bogoch told CTV News Toronto on Friday. “That’s about it.”

Experts say that the challenge is that these medical exceptions are not set in stone.

“The medical side of these exceptions is evolving … that’s why you can’t nail it down,” Dr. Miriam Hanna, allergy section chair of the Ontario Medical Association, told CTV News Toronto Friday.

“To say you cannot get [a second] vaccine because you had a reaction to [the first] vaccine is really limiting,” she said.

For those who are allergic to a specific component of a vaccine, there are options, Hanna said.

“You can still choose to get vaccinated under a more observed environment or with more gradual doses.” Another alternative is getting an entirely different vaccine, she says.

With past vaccines, chronic conditions were, at points, reason enough for not getting vaccinated. But, that “doesn’t apply with mRNA vaccines,” Dr. Sumon Chakrabarti, an infectious disease specialist at Queensway Health Network, told CTV News Toronto.

He says this is because the composition of the vaccine is different than non-mRNA shots.

Since the mRNA COVID-19 vaccines do not actually carry the virus, unlike, for example, the flu shot, there are not a lot of potential side effects, Chakrabarti said.

Reacting to a component of the vaccine is “a very, very rare thing.”

“The COVID vaccine is a very different beast. There are very few exceptions in terms of getting a medical exception, “ he said.

As the province is set to roll out its vaccine passport program on Sept. 22, “there should be some standardization about what is an approved exemption to vaccination,” Bogoch said.

“We need standardization and we don’t have it.”

Hanna said public health units are working with the Ministry of Health to create an easy, accessible, unified document on medical exceptions.

“These questions are coming in, we are certainly seeing large volumes of them,” she said.

On average, Hanna said she and her colleagues see between 500 to 700 consults per week to discuss these kinds of issues.

“With these vaccine mandates, we’re just going to see more,” she said.

On Wednesday, the College of Physicians and Surgeons Ontario sent an internal memo saying the organization is seeing an uptick in requests for “unfounded” medical exemptions. 

With files from CTV Toronto's Abby Neufeld.