MEMO: COVID-19 Vaccine Contraindications and Medical Exemptions

TO: Health Care Professionals in the Niagara region

FROM: Pandemic Response Division, Niagara Region Public Health

REFERENCE: COVID-19 Vaccine Contraindications and Medical Exemptions

DATE: August 27, 2021

With the August 17, 2021 provincial announcement outlining COVID-19 vaccination policies are mandatory in high-risk settings, primary care may have some patients reach out requesting a medical exemption.

Directive #6 for COVID-19 Vaccination Policy in Health Settings specifies that employees, staff, contractors, volunteers and students in high-risk settings that have a medical reason prohibiting being fully vaccinated must provide written proof from a physician or nurse practitioner.

Medical Exemptions to Directive #6

There are two contraindications that would qualify patients for a medical exemption

[1] Allergy to a component of the vaccine as confirmed by an allergist/immunologist

Potential allergens include:
- Moderna and Pfizer-BioNTech – polyethylene glycol
- Moderna – tromethamine
- AstraZeneca - polysorbate-80
- Janssen - polysorbate-80
- Please consult the product leaflet or information contained within the product monograph available through Health Canada’s Drug Product Database

[2] Myocarditis/pericarditis after a first dose of an mRNA vaccine

As a precautionary measure, the second dose in the mRNA COVID-19 vaccination series should be deferred in individuals who experience myocarditis or pericarditis following the first dose of an mRNA COVID-19 vaccine until more information is available. NACI will continue to monitor the evidence and update recommendations as needed.

Since contraindications to mRNA vaccines (Moderna and Pfizer-BioNTech) are different to those for viral vector vaccines (AstraZeneca and Janssen), most clients with a contraindication to one platform of vaccines should still be eligible for other, and should be offered vaccine accordingly. (I.e., individuals with anaphylaxis post mRNA vaccine may be offered a viral vector vaccine (e.g. AstraZeneca vaccine) and individuals with anaphylaxis post viral vector vaccine may be offered an mRNA vaccine).

Written Proof of a Medical Reason

Currently there are no COVID-19 vaccination exemption affidavits for adults
In the absence of an existing medical exemption form for COVID-19 vaccine, please write an official note from your clinic for patients that meet a medical reason for not being fully vaccinated against COVID-19 that includes:
- The medical reason for not being fully vaccinated against COVID-19, and
- The effective time-period for the medical reason

Policy and Procedures for Patients with a Medical Exemption

As per Directive #6, individuals who are not fully vaccinated must undertake regular point of care rapid antigen tests and demonstrate negative results in a manner consistent with the organization covered under the directive’s vaccination policy at a minimum once every seven days.
For patients that meet a medical reason for not being fully vaccinated against COVID-19, Directive #6 requires they will need to submit to regular antigen point of care testing for COVID-19 and provide verification of the negative test result to the covered organization/high-risk setting. Testing must be a minimum once every seven days.
Patients will need to follow the policy and procedures for testing as outlined by the covered organization/ high-risk setting. Patients should contact their employer or post-secondary institution directly for any questions, not Public Health.

Patients Asking for a Medical Exemption Due to Precautions

Some patients may ask for a medical exemption if they have a precaution to getting a COVID-19 vaccine (e.g. hypersensitivity and allergies, acute illness, hematologic). These patients are still able to be vaccinated safely and therefore don’t qualify for a medical exemption. Guidance to counsel these patients can be found at:

NACI: Recommendations on the use of COVID-19 vaccines. See contraindications and precautions.
Ministry of Health: COVID-19 Vaccination Recommendations for Special Populations
Niagara Region Public Health: Frequently Asked Questions on Novel Coronavirus (COVID-19)

Non-Medical Exemptions

If you have patients that wish to decline vaccination for a non-medical reason, address their vaccine questions and hesitancy using the resources on the vaccine site onboarding webpage.

Currently there are no COVID-19 vaccine exemption affidavits for adults. Patients can monitor the province’s vaccination website.

More Information

As more information becomes available, we will be sure to communicate this with you.