Ontario's COVID-19 forthcoming vaccine passport system is sparking a growing conversation on what counts as a medical exemption.
People who want to eat indoors at a restaurant or go to a gym, nightclub or movie will need to provide proof of vaccination or a medical exemption as of Sept. 22.
Until medical exemptions can be worked into the digital passport system, the province says a doctor's note will be sufficient to gain entry to these places.
The head of the College of Physicians and Surgeons of Ontario has already asked doctors in the province to be judicious when handing out exemptions.
Dr. Elizabeth Muggah, a family doctor with Bruyère Family Medicine Centre in Ottawa and the president of the Ontario College of Family Physicians, said she's seen a few requests for exemptions but not a "deluge."
"We're seeing this opportunity to answer those questions that people have maybe been holding on to for a very, very long time," she told CBC's Ottawa Morning.
Two main medical exemptions
At the moment, there are two main medical exemptions: being allergic to something in the vaccine, or having an adverse reaction to the first dose.
For an allergy to qualify, it would need to be a potentially life-threatening anaphylactic allergy, Muggah said, one that would cause trouble breathing and would be similar to a severe allergy to bees or nuts.
Having an anaphylactic allergy to something else, Muggah clarified, does not mean a person is more likely to be allergic to a component of the vaccine.
The vaccine ingredient most likely to cause a reaction is called polyethylene glycol (PEG), a common chemical found in cough syrups, some prescription medications and even skin care products, Muggah said.
It's in the mRNA vaccines — Pfizer-BioNTech and Moderna — to keep them functioning. Most people will already have come in contact with PEG at some point in their lives, she said.
The second exemption would be granted after someone who's had one dose of an approved vaccine develops inflammation in their heart or its lining, myocarditis or pericarditis respectively.
"We actually know that in some cases, those reactions may be mild enough that you can receive your second dose," Muggah said.
Anyone with reservations should reach out to their family doctor, pharmacist, or someone with knowledge of their medical history for advice, Muggah said.
She emphasized that vaccines are very safe for anyone who is eligible, including those who are pregnant or trying to get pregnant.
Being immunocompromised is not a reason for a medical exemption, she said, but instead a reason to get vaccinated as it puts people at elevated risk of contracting COVID-19 and developing a serious infection.