Most institutions require a clinician to attest to the medical reason for the contraindication. Food and Drug Administration under emergency use authorizations, there remain those who will pursue medical exemptions for reasons outside of the absolute contraindications to the vaccine. However, given that the vaccines are new and currently authorized by the U.S. Previous allergic reaction to Polysorbate Previous allergic reaction to Polyethylene Glycol (PEG) History of an immediate allergic reaction to any other vaccine or injectable therapy (i.e., intramuscular, intravenous, or subcutaneous vaccines or therapies Severe immediate allergic reaction to a previous dose of the COVID-19 vaccine
Table 1- Contraindications to COVID-19 vaccination Absolute contraindicationsĬonditions that necessitate a vaccine precaution (not a contraindication- 30 minute post-vaccine observation period) In an ideal world, medical exemptions would be limited to absolute contraindications. Licensees have also been prosecuted by the Federal government for falsifying proof of vaccination documents.Ĭurrently there are very few absolute contraindications to SARS-CoV-2 vaccination (listed in Table 1). For example, the California Medical Board recently sent notice to its licensees raising concern about some physicians’ conduct related to writing mask mandate exemptions. Likewise, some health care licensees may be willing to support COVID-19-related medical exemptions to vaccination mandates based on specious or nonexistent grounds.Īlready, we have seen during the pandemic willingness among some licensed health care providers not only to spread questionable COVID-related information, but also to fulfill requests to circumvent COVID-related prevention measures. Several California physicians have been disciplined by the California medical board for such practices, including one San Diego, California-area physician who was placed in 2020 on three years’ probation for writing over 1,000 medical exemptions for families seeking to avoid the state’s school vaccine requirements. For example, efforts by families to circumvent childhood school vaccination mandates have led some physicians to violate practice standards in how they write medical exemptions.
The process for a medical exemption is dependent on the policies of the institution requiring vaccination but for most, the procedure includes the employee submitting an affidavit supported by a statement by a licensed health care provider that outlines the medical reason for the exemption. Under federal law, individuals who work in an environment where a vaccine is mandated may request a reasonable accommodation that would exempt them from the vaccination requirement due to having a disability that places them at such a risk. Vaccination mandates generally include a process through which individuals may request a medical exemption based on concerns that the vaccine itself may pose a particularly significant health risk. Medical Exemptions and SARS-CoV-2 Vaccine Contraindications
These safeguards also can decrease the temptation for licensed health professionals to recklessly undermine critical, lawful, evidence-driven public health efforts. That history also shows there is a possibility some health care licensees may be willing to support individuals seeking to circumvent COVID-19-related requirements through offering questionable medical exemptions.Įntities imposing COVID-19 vaccination mandates, and state health care licensure boards, can take several simple but significant steps to counter misuse of medical exemptions and better protect communities from COVID-19. Recent history with childhood immunization programs shows less rigorously-structured and -enforced vaccination exemption policies are vulnerable to increased usage, relative to narrower or more stringently-monitored programs. Most entities requiring vaccination mandates or proof of vaccination upon entry may offer limited grounds upon which an individual may request an exemption, usually based upon religious beliefs or medical reasons. BossletĪs COVID-19 vaccination mandates become increasingly common, we can expect exemption requests (and misuse) to become increasingly widespread, too.