Ask a McMaster expert: Medical conditions and COVID-19 vaccine exemptions

With organizations and governments around the country implementing vaccination policies, you may be wondering what medical conditions could qualify for exemptions. We spoke with Dr. Zain Chagla, M.D., associate professor of Medicine and co-medical director of infection control at St. Joseph’s Healthcare Hamilton to answer questions about the rare cases where there may be a medical exemption, and how vaccines are proven to be safe and effective.  

What are the potential reasons why someone may be medically exempt from receiving the COVID-19 vaccine? 

While there may seem like many vaccine exemptions, in reality there are very few. 

Allergy to a component of the vaccine or allergy to the first dose of vaccine, while considered an exemption, can often be mitigated with the help of an allergist or immunologist. 

Individuals who develop myocarditis (inflammation of the heart), Guillain-Barre Syndrome or Bell’s Palsy (inflammation of the nerves) after the first dose should not receive a second dose until better data becomes available. These are all incredibly rare side effects and are very unlikely to happen to the average individual. 

While individuals may have concerns about fertility and pregnancy, the COVID-19 vaccines approved by Health Canada have shown a record of safety, without any adverse effects on fertility for males or females, or any adverse effects in pregnancy or the fetus. They are considered safe in these groups. 

Are those who are immunocompromised ineligible, or should they endeavour to receive the vaccine and why? 

Immunocompromised individuals should absolutely get the vaccine. Vaccines have not been shown to worsen autoimmune disease but contracting COVID-19 can cause serious illness and death in those with immunocompromising states. The vast majority of immunocompromised individuals will have a good response to the vaccines. 

Where should individuals turn if they have questions about their medical history and how it may interact with the COVID-19 vaccine?  

Asking their primary care provider is a great start, and many family doctors, nurses, pharmacists, and nurse practitioners been doing counselling for their individual patients. The person administering the vaccine, or individual medical providers in clinic, also have insight into contraindications.

Vaccines have been administered to some of the most medically fragile members of our society (for example, those with transplants, the elderly in long term care, and those with cancer) and have had significant benefits in those populations with a record of safety. Most medical practitioners are happy to have one-on-one conversations if you have any questions.