Few legitimate reasons for vaccine exemption, says disease specialist

Few qualify for exemption

The only medical reason for not having a COVID vaccine is serious allergic reaction to ­components of the vaccines, says ­infectious disease specialist Dr. David Forrest.

“There is so much misinformation out there it’s astonishing,” said Forrest, who is based in Nanaimo.

Island Health estimates that only 0.01 per cent of the eligible population age 12 and older may qualify for medical exemption, according to guidance in a provincial health officer order.

Being pregnant, breastfeeding, having already had COVID, and infertility concerns are reasons to get the vaccine, not to be exempted, provincial health officer Dr. Bonnie Henry and Canada’s National Advisory Committee on Immunization have said. COVID can cause serious ­illness for these groups.

While Forrest said he has heard people say on more than one occasion “I couldn’t get the vaccine because I’m immuno-compromised,” being clinically extremely vulnerable — having blood cancers or an organ transplant or taking medications that suppress the immune system — are reasons to be vaccinated and also to get a third booster shot, a program that is underway in B.C.

Most people with other serious health conditions have a higher risk of becoming seriously ill or dying from COVID and are advised by the National Advisory Committee on Immunizations to be vaccinated.

“The only contraindication to receiving the COVID vaccine is having had an anaphylactic reaction to the vaccine,” said ­Forrest. Even when there’s been an anaphylactic reaction or significant allergic response, a second dose can be given with a different vaccine — for ­example, you can get the AstraZeneca vaccine if you originally had an mRNA vaccine such as Pfizer or Moderna, he said.

The mRNA vaccines are very unlikely to produce anaphylaxis because they don’t contain proteins, said Forrest. People can be allergic to components of vaccines such as PEG or polyethylene glycol or polysorbate 80.

Island Health said immunologists can perform skin testing to see if people are allergic to the components in either COVID vaccine.

There is concern, said Forrest, about people who develop very serious reactions to first doses — such as thrombosis and low platelets, myocarditis or pericarditis (heart muscle inflammation), and Guillam Barre neurological condition.

In Island Health, 30 of more than 640,000 people who have received one dose had a serious adverse event — mainly cases of myocarditis or pericarditis after mRNA vaccination, of which the majority are mild and completely resolved, said Island Health. “But we do not know yet what the risks of subsequent vaccination are.”

The office of the provincial health officer does suggest deferrals — until the person is fully recovered and 90 days after diagnosis or until further notice — for people who have had serious physician-diagnosed reactions, such as multisystem inflammatory syndrome or heart inflammation following a first dose of AstraZeneca.

The B.C. Centre for Disease Control’s adverse events following immunization report says heart inflammation after mRNA vaccines is being investigated, with an association seen in several countries, especially in adolescent and young adult males.

The rate of serious adverse events recorded between Dec. 13, 2020 and Sept. 11, 2021 was 3.2 per 100,000 doses administered.

Of 241 serious adverse events during this period, 226 patients were admitted to hospital, almost half for circulatory system problems including stroke.

Forrest said a reaction to the influenza vaccine does not mean a person would have a reaction to a COVID vaccine.

A person can consult with an allergist prior or during immunization. An anaphylactic reaction usually occurs within 15 minutes and is treated with epinephrine, sold under the name EpiPen.

People on life-saving treatment drugs for an organ transplant or cancer can talk to their specialists, said Forrest.

Generally, while there may be some risk in withholding immunosuppressive medications while getting a COVID vaccine, “that risk is well outweighed by the risk of getting COVID,” said Forrest.

Seriously immune-compromised people typically don’t develop as strong an immunity from COVID vaccines as do healthy individuals with no underlying health conditions.

Forrest said his colleagues have been frustrated by patients who ask for unwarranted medical exemptions.

B.C.’s Vaccine Card, required to visit non-essential businesses and venues such as restaurants and gyms, does not allow for exemptions.

In B.C., all health care ­workers in long-term care and assisted living, about 49,000 workers, must be double-vaccinated by Oct. 12. Health care workers in hospitals and health authority clinics, including doctors, nurses and care aides, must be vaccinated by Oct. 26.

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