TORONTO -- As the province's vaccine certificate program takes effect in non-essential businesses, doctors are warning that there are very few legitimate medical exemptions to the COVID-19 vaccine—and notes excusing Ontarians from receiving it should be "vanishingly rare."

“I think the expectation is that there might be an uptick in the request by individuals, of doctors, to grant those exemptions,” Dr. Adam Kassam, president of the Ontario Medical Association, told CTV News Toronto Wednesday.

“We know that those exemption criteria are very, very narrowly-defined.”

Guidance from Ontario’s Ministry of Health advises “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.”

The exceptions, according to the ministry, largely apply to anyone who experienced myocarditis or pericarditis, an inflammation of the heart muscle or membrane, following the first dose of an mRNA COVID-19 shot, or anyone aged 12-17 with either of those conditions prior to receiving a COVID-19 shot.

Anyone with a severe allergic reaction or anaphylaxis to a component of a COVID-19 vaccine could also be deemed exempt through the assessment of an allergist or immunologist.

“Allergists or immunologists may go an entire career without seeing an allergy to one of the key ingredients of this vaccine,” Dr. Kassam said.

Anyone who experienced a serious adverse event following the first dose of COVID-19 vaccine should be referred to an allergist or immunologist, according to the Ministry of Health, which stated that in many cases the second dose could still be administered safely under the management of that specialist.

Ontario family physician Dr. Nili Kaplan-Myrth has never had a patient in her practice with a true medical exemption to the COVID-19 vaccine, and stresses that doctors’ notes excusing patients from getting immunized should not be common practice. 

“It [would] be very disconcerting to see people parading around with exemptions and trying to skirt the rules.” said Dr. Kaplan-Myrth. “That is dangerous.”

The College of Physicians and Surgeons of Ontario has already warned doctors to be judicious about handing out notes to people who don’t want to get immunized.

Dr. Kaplan-Myrth stressed that discussions with patients present an opportunity to clarify misinformation about vaccine safety.

“The most important thing is not assuming they are anti-vaccine,” echoed Trillium Health Partners infectious diseases physician Dr. Sumon Chakrabarti. “Many just have questions, which I think is very reasonable, and I’ve had many of these conversations and have provided reassurance to help people vaccinated.”

Any valid medical exemption used to access to a non-essential business in Ontario must include the name and contact information of the doctor or nurse who provided it, the reason for the exemption, and the time period for which it is valid.