Doesn’t it feel like employers have already run a marathon through the Rockies in the past year and a half? And the Rockies is the right image for the climbing and descending covid case counts, colour codes, and lockdowns throughout Ontario as we slowly edge our way up what we hope is not the fourth mountain. If you are either contemplating or dreading the implementation of a mandatory vaccine policy or vaccine passport system at your workplace, we understand your concerns. You do know this note is coming. As an employer, no doubt some of you have already had to manage a very similar situation when employees brought in medical notes exempting them from wearing masks. The medical note might say, “this patient has a complicated medical history and cannot get the covid-19 vaccine” or “for health reasons this patient cannot get the covid-19 vaccine.” Firstly, these notes belong on the medical notes wall of shame. They are not sufficient in most if not all jurisdictions. And your knowledge of the employee may well be an indicator that this employee has regrettably gotten a physician to write them a note that is aimed at accomplishing their non-medical objectives and outcomes.
Two entire provinces in Canada, Manitoba, and British Columbia do not permit any exemptions as part of their vaccine passport policies. But this is not without controversy. The Canadian Constitution Foundation (CCF) has threatened to take B.C. and Manitoba to Court on this very issue and they do have an online petition circulating. There are small vocal protests occurring at hospitals and other workplaces throughout Ontario that have implemented vaccine mandates. On the other hand, the Medical Officer of Health for the Middlesex-London Health Unit issued a strong recommendation that employers follow the Province in implementing mandatory vaccine policies to prevent the fourth wave of Covid-19 from shutting down our economy and overloading our exhausted healthcare workers.
From a medical perspective, there are two frequently mentioned legitimate medical reasons for being exempted from the Covid-19 vaccine in some jurisdictions. Both, interestingly, require that the person already had a first covid-19 vaccine. These are:
1) anaphylaxis from a previous dose of Covid-19 vaccine or a documented allergy to any of its components (supported by allergist/immunologist confirmed documentation); or
2) a rare event (such as serious myocarditis/pericarditis) following the first vaccine of Covid-19 (supported by additional medical documentation). This should not be confused with a pre-existing heart condition. The Canadian Cardiovascular Society supports the broad vaccination of all eligible Canadians against Covid-19. Go here for more resources heartandstroke.ca (click on the link Covid-19 Vaccine & Heart Conditions, then scroll down to page 4 more resources).
Dr. Nancy Whitmore, the Chief Executive Officer of the College of Physicians and Surgeons Ontario has recently told Ontario’s doctors not to be handing out baseless medical exemptions. Thank you, Dr. Whitmore! Regrettably, we know that there were far too many family physicians writing mask exemptions for the past year and a half. Rightfully so, those were ignored. Even the Canadian Thoracic Society published that there was NO evidence that wearing a face mask would exacerbate an underlying lung condition.
Those who are truly allergic to a specific ingredient in the covid-19 vaccine and who are feeling limited or left out may want to discuss the possibility of a second shot under the medical supervision of their doctor or allergist. Some small-scale research has was conducted on people who had first-dose allergic reactions to the Covid-19 vaccine, including 19 individuals with first dose anaphylaxis to the Covid-19 vaccine. All individuals in this small study subsequently, safely had the second with the aid of antihistamines. This of course is only a decision to make between an individual and their doctor.
Some thoughts on what to keep in mind when implementing a mandatory vaccine policy:
- Receiving a Covid-19 vaccine is voluntary. And at the same time, the voluntary nature of the covid-19 vaccine does not take away an employer’s voluntary right and legal obligation to protect its staff, its customers, and its business in a global pandemic.
- We are in the context of a global public health emergency.
- This policy is a temporary infringement (put a time limit on it and then revisit).
- There is a reasonable hierarchy of rights, that puts health and safety above other rights (see section 2 (2) of the Occupational Health and Safety Act in Ontario…”Despite anything in any general or special Act, the provisions of this Act and the regulations shall prevail.” Health and Safety, therefore, IS the right bower. As a caution though, euchre players know that you should never use your bower when a much smaller trump card will get the trick.
- Use the free Provincial Antigen Testing Program as part of your screening tools.
- Ensure that there are no access, equity, or education issues that could be addressed.
- The Ontario Human Rights Commission’s position is that a singular belief or personal preference against vaccinations or masks is not a protected ground under the Code.
- As with everything else in the employment relationship, each case should be considered on a case-by-case basis with compassion, dignity, and respect. Tough choices should be made only after a thorough investigation and consideration of all options and the careful guidance of legal counsel.
We still have a LOT of work to do to keep our businesses operating, solvent, and profitable, our hospitals at functional capacity, and our communities safe from Covid-19. Refuse the invitation to turn this into a political or ethical issue about individual freedoms and personal beliefs. We are talking about the protection of the public in a global health crisis. It really is just about leadership. Rights are never granted unconditionally and without responsibilities. Ever.
For the many businesses implementing a vaccine passport or protocol, you will have to decide how to handle to the medical note / medical exemptions that you are presented with. This is especially challenging in public settings like restaurants. To maintain the dignity of the person being screened, ask them to step away from others for a brief private screening. Here is a sample screening protocol to implement:
- Oh please step aside as we have a brief private screening for our unvaccinated customers. Do you have a medical note? Have you had one vaccine or none? (one is far less risky than none)
- Record the date of the note, the doctors’ name, and the “reason” on a separate sheet in the event that your establishment has an outbreak associated with the timing of this person’s visit.
- Ask the person: When was the last time you had a negative covid test?
- Great, now was that a rapid antigen, or pharmacy test? On what date was that? Record the date.
- Since that last negative covid test, have you been in contact with any unvaccinated persons including children who attend school? Or have you been out of the country?
- If no, then the person can enter.
- If yes, you will have a difficult decision to make depending on your region, and the covid numbers.
Cézanne
