For the fully vaccinated, life in NSW is – thankfully – returning to some sort of new normality. But for those who are hesitant or opposed to vaccination and haven’t yet had a double dose, many restrictions will still apply.
As restrictions ease for fully vaccinated NSW residents, doctors are increasingly facing pressure from these patients to issue certificates exempting them from COVID-19 vaccination.
As a doctor, when faced with this situation it is important to remember the criteria for vaccination exemption are limited to a very specific set of medical contraindications.
Having a good understanding of these criteria – and being prepared for some difficult patient consults – is the key to successfully managing this challenge.
Temporary medical contraindication
Vaccinations may be temporarily deferred for individuals with some acute major medical conditions for a maximum of 6 months.
These acute major medical conditions can include:
- acute major illness,
- significant immunocompromise of short duration, or
- past confirmed infection with SARS-CoV-2 within the last 6 months.
If a patient requests a temporary vaccination exemption on the grounds of a past COVID-19 infection, Dr Martine Walker, medical advisor at the Medical Council, suggests asking for the patient’s consent to contact the relevant lab or testing centre to get evidence of the infection. Asking to see documentation that proves their diagnosis would also be reasonable in the circumstances. Alternatively, doctors could simply ask the patient to do a COVID-19 antibody blood test, although this may not be accurate after a certain period of time.
COVID-19 vaccine medical contraindication
For all three COVID-19 vaccines available for use in Australia (Pfizer, Moderna, and AstraZeneca), a patient who has had a serious adverse reaction to the first dose has a medical contraindication to receiving a second dose of the same brand.
In a limited number of cases, a history of anaphylaxis to a component within one of the three available brands of COVID-19 vaccine may qualify as a medical contraindication to receiving that brand.
Who can be exempted from COVID-19 vaccination?
In order to be exempted from having a COVID-19 vaccination, a patient must have medical contraindications to all three available brands of the vaccine.
If a patient has a medical contraindication to one brand of COVID-19 vaccine, they will most likely be able to receive an alternate brand. For this reason, medical exemptions from COVID-19 vaccination are extremely rare.
‘Allergy and anaphylaxis have been confused in the public health messages,’ says Graeme Stewart, clinical immunologist at the Westmead Institute for Medical Research and Clinical Professor of Medicine at the University of Sydney.
‘Twenty percent of Australians suffer from an allergy of some sort… [but] are not at risk of anaphylaxis or severe allergic reaction to these vaccines.’
For the smaller percentage of Australians who have a history of anaphylaxis, they are still likely to be able to receive a COVID-19 vaccine safely after being assessed.
Change the conversation
Some patients may seek an exemption from you without medical grounds. These conversations can be quite confronting.
Dr Karen Price, President of the Royal Australian College of General Practitioners (RACGP) says ‘In these instances, it’s important to have a discussion with the patient and try to get to the bottom of their concerns and explain the benefits of vaccination for them and their unique situation. While it may be a challenging process, GPs are in a great position to support patients who are vaccine hesitant and encourage vaccine uptake.’
If a patient comes to you aggressively demanding a vaccination exemption without fulfilling the medical criteria for it, try to deescalate their aggressive behaviours.
You can do this by:
- listening to the patient attentively,
- making the interaction patient-centred,
- explaining that you can’t give exemptions without evidence of genuine medical contraindications, and
- using the NSW Government’s Contraindication Form as a tool to demonstrate that the patient does not have the medical grounds for exemption.
The NSW Government’s Covid-19 Vaccine Contraindication Form specifically lists the medical contraindications relevant to each vaccine, and by going through the list with the patient, it can be easier to tell them they don’t qualify for an exemption.
Talking through the patient’s fears and anxieties about the COVID-19 vaccines can give you an opportunity to correct any misinformation that is influencing their vaccine hesitancy.
By certifying medical contraindications responsibly, you are protecting the wellbeing of your patients and the community at large.
- COVID-19 vaccination: Information for clinicians in NSW - Vaccination
- Clinical guidance on use of COVID-19 vaccine in Australia in 2021 (health.gov.au)
- ATAGI Expanded guidance on temporary medical exemptions for COVID-19 vaccines (health.gov.au)
- Medical exemptions for COVID-19 vaccines 'very rare' - PM - ABC Radio
- Covid-19 Vaccine Contraindication Form (nsw.gov.au)