Ontario's crackdown on COVID-19 vaccine medical exemptions seems to be working

Ontario's new rules requiring a review of medical exemptions for COVID-19 vaccines seem to be reining in the number of people being granted a waiver from vaccination mandates. 

Research by CBC News reveals that 209 medical exemptions have been approved provincewide since a new requirement that they be checked by public health units came into effect earlier this month. 

That figure indicates that fewer than one in 50,000 Ontario adults has a valid medical exemption. 

Some employers in the province have said far-higher proportions of their staff sought medical exemptions from their workplace vaccine mandates, a trend that raised alarm bells among Ontario's health leadership. 

The ministry did not provide a requested breakdown of how many exemptions were submitted to and approved by each public health unit. However, three of the province's largest public health units provided their own figures to CBC News:

• Toronto: 65 requests for medical exemptions submitted; 40 accepted.
• York Region: 22 requests; 15 accepted.
• Ottawa: 18 requests; four accepted.

Ottawa Public Health said it has denied 11 requests, and three are still pending. The other public health units did not indicate the status of the unapproved requests. 

The relatively small number of approvals suggests that the province's new verification process is having an impact on weeding out illegitimate medical exemptions.

"Those numbers are very reassuring," said Dr. Fahad Razak, an internal medicine physician at St. Michael's Hospital in Toronto and a member of Ontario's COVID-19 science advisory table. 

"The real worry was exemptions were being given out for reasons that were not medically indicated pretty widely across the province prior to this step."

QR code needed

A doctor's note claiming an exemption is no longer enough to get into locations where Ontario requires proof of vaccination. Instead, people with medical exemptions must now show a digital QR code that can be scanned by the Verify Ontario app. 

The measure was announced in December and came into effect Jan. 4 as part of Ontario's response to the rapid spread of the Omicron variant of the novel coronavirus.

However, enforcement will really begin only next Monday when restaurants and bars reopen for limited-capacity indoor service, along with gyms, cinemas and other venues, following nearly four weeks of closures.

To obtain a QR code, each person who wants a medical exemption must ask their physician to submit documentation to local public health units for review. If the exemption request is accepted, the public health unit enters the information into the province's COVaxON database. The person can then download the QR code from Ontario's proof of vaccination website.

Officials with the Ministry of Health told CBC News that 209 medical exemptions have been entered in the database.

'The process is working'

"We're very pleased that given the limited number of valid medical exemptions issued to date, the process is working," said Alexandra Hilkene, a spokesperson for Health Minister Christine Elliott, in an email. 

The verifications are providing a check on the legitimacy of medical exemptions, said Dr. David Fisman, a physician and epidemiologist with the University of Toronto's Dalla Lana School of Public Health.     

"It sounds like this is working out really well," said Fisman in an interview.

He said physicians are likely to be especially careful about issuing an exemption knowing that it is subject to review by public health officials.   

"Once [doctors] actually have to bounce this off a third party, it's fascinating that the numbers plummet the way they do," Fisman said.  

Last fall, Ontario's chief medical officer of health, Dr. Kieran Moore, expressed concern that medical exemptions were being claimed far more frequently than warranted, by as much as two per cent of staff in some workplaces. 

Moore said no more than one in 20,000 people would have one of the rare conditions that would qualify someone for a medical exemption under Ontario's rules. 

"There are very few actual contraindications to Health Canada-authorized COVID-19 vaccines that would qualify as medical exemptions," says the province's official guidance to physicians, updated on Jan. 12.

Reporting by the Toronto Star last October showed about one in 475 staff at school boards around the province claimed medical reasons for not complying with mandatory vaccination policies.   

In mid-January, a freedom of information request by CBC News revealed that the City of London granted medical exemptions to 14 of its municipal workers, which works out to about one out of every 200 city employees. The municipality also granted more than 100 exemptions on what it called human rights grounds. 

Doctors warned against issuing illegitimate exemptions

While people with medical exemptions will have to present their QR codes to gain entry into such locations as bars and restaurants in Ontario, the government has so far not told employers who are subject to vaccination mandates that their employees will have to do the same.

The agency that regulates doctors in the province warned its members against issuing illegitimate medical exemptions.

"If you are asked by your patient to provide information supporting a medical exemption from receiving a COVID-19 vaccine, your patient must have a legitimate medical condition that would warrant an exemption," said the College of Physicians and Surgeons of Ontario in a list of pandemic FAQs on its website. 

Ontario's vaccine passport system is currently in place for an indefinite period of time.

When Premier Doug Ford announced the province's six-week timeline for easing the current round of public health restrictions, he did not indicate when proof of vaccination rules would end. In October, he had set Jan. 17 as the date for lifting the measure.