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Ontario Publishes Guidance on Medical Exemptions to COVID-19 Vaccination Rules

On September 14, 2021, the Ontario Ministry of Health published guidance on Medical Exemptions to the COVID-19 Vaccination (“Guidance”). While the Guidance is intended “to assist physicians/ specialists and nurse practitioners in evaluating contraindications or precautions to COVID-19 vaccination that may warrant a medical exemption”, it is useful for employers and service providers evaluating requests for accommodation under a mandatory vaccination policy.

Per the Ministry Guidance, “there are very few actual contraindications to available COVID-19 vaccines that would qualify as medical exemptions and most individuals can safely receive COVID-19 vaccines.”

In particular, the Ministry has restricted the list of possible exemptions to the following, all of which are subject to qualifying conditions set out in the Guidance:

i. Pre-Existing Conditions, including (a) a severe allergic reaction or anaphylaxis to a component of a COVID-19 vaccine (provided it meets the qualifying conditions), or (b) myocarditis prior to initiating a mRNA COVID-19 vaccine series in individuals aged 12-17 years old (again, provided it meets the qualifying conditions);

ii. Contraindications to the AstraZeneca/COVISHIELD Vaccine, in which case the vaccination series should be completed with an mRNA vaccine and exemption will only be available if the individual also has a medical exemption to an mRNA vaccine;

iii. Adverse Events following COVID-19 Immunization, including (a) a severe allergic reaction or anaphylaxis, (b) thrombosis with TTS/VITT following the AstraZeneca/COVISHIELD vaccine, (c) myocarditis or pericarditis following a mRNA COVID-19 vaccine, or (d) another series adverse event following COVID-19 immunization; or

iv. Actively receiving monoclonal antibody therapy or convalescent plasma therapy for the treatment or prevention of COVID-19, which will be a time-limited exemption only while therapy is active.

The Guidance goes on to state: “In many instances, safe administration of subsequent doses of COVID-19 vaccine is possible under the management of an allergist/ immunologist. True medical exemptions are expected to be infrequent and should be supported by expert consultation.” In fact, in most of the exemption categories noted above, there are conditions and alternatives that must be considered and satisfied before an exemption might be granted.

Finally, the Guidance outlines the minimum required documentation, to secure an exemption:

Documentation of a medical exemption must be provided by either a physician or a nurse practitioner (note: A nurse practitioner is a registered nurse who holds an extended certificate of registration under the Nursing Act, 1991). The exemption must clearly indicate the reason why the individual cannot be vaccinated against COVID-19 (i.e., clear medical information that supports the exemption).

The physician’s or registered nurse in the extended class’s information is complete by including:

  • Name and contact information of the physician or registered nurse in the extended class;

  • Logo or letterhead identifying the physician or registered nurse in the extended class;

  • Statement that there is a medical reason for the individual’s exemption from being fully vaccinated against COVID-19; and

  • Any effective time-period for the medical reason which includes the date the patron is seeking access to the business or organization.

If you have not yet developed or implemented a vaccination policy and require assistance, please contact any member of our Labour and Employment team. Vaccination policies require thoughtful drafting and implementation and our expert team is ready to help.




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