Who is actually eligible for a COVID-19 vaccine exemption?

Anastasia Tsirtsakis

29/10/2021 4:09:22 PM

UPDATED: With different vaccine mandates now in effect across Australia, newsGP explores the criteria and processes for exemptions in each state and territory.

People standing in the formation of Australia.
Patients have been pressuring GPs and other practitioners for unlawful vaccine exemptions.

UPDATED at 5.30 pm Tuesday 25 January to reflect changes to ATAGI's recommendations on vaccine deferral. 

Threats. Abuse. Bribes.
This is the reality for some GPs who are being targeted by people seeking unlawful COVID-19 vaccine exemptions, as public health orders mandating vaccination for various sectors come into effect.
RACGP President Dr Karen Price says it has become a significant issue and believes persistent misinformation about the vaccines is the driving force.
‘It’s affecting GPs and practice teams across the country,’ she told Guardian Australia.
‘Some patients are aggressive and abusive, demanding an exemption when not fitting the clear criteria.
‘It is not just GPs, but our hard-working receptionists and other practice team members who’ve bore the brunt of this, and it does add to our stress levels.’
A vocal anti-vax group has recently been attempting to manipulate the Australian Technical Advisory Group on Immunisation’s (ATAGI) Expanded Guidance on vaccine exemptions by advising people who are hesitant to seek an exemption on the grounds of ‘acute major anxiety caused by the threat of a mandatory medical procedure’.
The ATAGI guidance does list ‘acute major illness’ as a reason for temporary exemption, but anxiety is not listed as a contraindication.
Dr Price said that while GPs take anxiety ‘extremely seriously’, the ploy will not be successful.
‘GPs and general practice teams have a lot on their plate at the minute – the last thing we need is groups of people emerging from the woodwork demanding a vaccine exemption because of information they have sourced from an anti-vaxxer group,’ she said.
Rather, Dr Price said people with anxiety will be better off talking to their GP to allay any fears. But the Melbourne GP made clear that despite vaccine mandates, which pose restrictions for employment, consent remains key.
‘We are experts in providing evidence-based information, GPs do this every day for other vaccinations and it’s a key part of our day-to-day job,’ she said.
‘But no individual will ever be forcibly vaccinated. GPs live by the Hippocratic Oath and will not administer any medical care or treatment without patient consent.’
To issue a permanent or temporary exemption, doctors in all states and territories are required to ensure a patient meets specific criteria outlined in the ATAGI’s latest clinical guidance, which contains very few contraindications.
In most states and territories, an exemption issued and signed by a registered medical practitioner is legally valid, with Victoria and South Australia the outliers.
Up to now, Victorian GPs have only been required to register an exemption through the Australian Immunisation Register (AIR) and issue patients with a medical letter or certificate as proof of their exemption.
But as of 6.00 pm on Friday 29 October, Victorians who are exempt will need a certificate from the AIR.
That means anyone who has received an exemption letter, will need to return to their GP by 12 November 2021 to have a form submitted to the AIR to obtain a formal certificate that will be available via the myGov website or app.
The Victorian Government also has plans to issue GPs with a guidance form, clearly outlining valid contraindications for an exemption.
The state’s Acting Chief Health Officer, Professor Ben Cowie, said the move is not about controlling people’s behaviour, but keeping everybody safe.
‘We feel the combination of the Victorian guidance form and the Commonwealth’s medical exemption form will provide GPs with a really tight and clear process that they can work through with their patients,’ he said.
Meanwhile in South Australia, GPs are required to have each exemption submitted to the AIR formally approved by Chief Public Health Officer, Professor Nicola Spurrier, or one of her deputies.
RACGP SA&NT Chair Dr Daniel Byrne told newsGP he supports the new process. Having had been approached for vaccine exemptions by people who are not eligible, he believes it will relieve GPs of pressure being placed by patients.
‘It just makes it crystal clear that you need your GP to sign it and you need the Chief Public Health Officer to sign it because if it’s genuinely valid, it’ll be signed,’ he said.
‘We won’t get the arguments and the pushback that seem to be happening interstate.’
At present, COVID-19 vaccination is mandated in South Australia in healthcare settings and by various private companies. For exemptions to be legally binding, GPs in South Australia are required to submit a form to SA Health for approval.
The introduction of SA Health’s public health order follows reports of patients queuing up at a practice in rural Victoria amid rumours a GP had been handing out vaccine exemptions.
Dr Byrne suspects this may have led to SA Health’s decision. Since the public health order was introduced, he says anecdotally that just one of the 10 exemptions submitted to the Chief Public Health Officer have so far been approved.
‘I just want the GPs in South Australia to actually know that this is law – this is not optional, this is a public health order, which trumps anything you might think personally,’ he said.
‘It also gives us as GPs the power to say to the patient, “Look, it’s not up to me; it’s up to Professor Spurrier. You don’t meet the criteria and she’s not going to sign it”.
‘It helps us have a more honest conversation.’

RACGP SA&NT Chair, Dr Daniel Byrne believes SA Health's new policy will take the pressure off GPs.

A spokesperson for the Australian Health Practitioner Regulation Agency (AHPRA) told newsGP that advising against vaccination, unless there are evidence-based medical reasons, ‘undermines the national immunisation campaign’ and is not supported by the Medical Board.
‘Public protection is our number one priority,’ the spokesperson said.
‘We urge any practitioner being asked to supply exemption certificates to know and understand the advice provided by ATAGI.
‘You could also speak with your professional indemnity provider, who have also published clear advice to practitioners about when, why and how exemptions can be granted.’
If an exemption is found to be unwarranted, AHPRA said the consequences could be ‘significant’.
‘If a notification is made to us that a practitioner is providing exemptions in circumstances other than those described in the ATAGI advice, we will investigate,’ the spokesperson said.
‘We will consider each case on its individual facts, but an investigation could lead to restrictions on a practitioner’s registration. This could affect their ability to continue to provide exemptions, to manage patients in relation to COVID-19, or where there is significant continuing risk or it is in the public interest, could result in a suspension of registration.’
Who is eligible for a temporary exemption?
According to ATAGI’s Expanded Guidance, patients with some acute major medical conditions, and those who are undergoing major surgery or hospital admission for a serious illness, may be eligible for a temporary exemption for up to six months.
Conditions that warrant a temporary exemption for Pfizer and Moderna mRNA vaccines include inflammatory cardiac illness within the past three months, for example:

  • myocarditis or pericarditis
  • acute rheumatic fever or acute rheumatic heart disease (ie with active myocardial inflammation)
  • acute decompensated heart failure.
Patients are also eligible for a temporary exemption from all available vaccines if they have:
  • had SARS-CoV-2 infection confirmed with a PCR test, vaccination can be deferred for up to four months after infection
  • experienced a serious adverse event attributed to a previous dose of a COVID-19 vaccine and without another cause identified.
Examples of serious adverse events include:
  • thrombosis with thrombocytopenia (TTS) following AstraZeneca
  • medically significant illness (eg immune thrombocytopenia purpura, myocarditis)
  • potentially life-threatening events (eg anaphylaxis)
  • persistent or significant disability (eg Guillain-Barré Syndrome).
According to the ATAGI, an adverse event that is deemed serious must have been reported to a state or territory adverse event surveillance system, and/or the Therapeutic Goods Administration (TGA) and determined to be a risk if another dose is administered.

If a patient has tested positive to COVID-19 and received antiSARS-CoV-2 monoclonal antibody or convalescent plasma therapy, ATAGI reccomends that vaccination should be deferred for 90 days.

If a temporary exemption is issued, it is advised that it does not exceed six months and that the patient be reviewed once recovered.
‘This time limitation will allow individuals who can safely be vaccinated to be protected against COVID-19 in a timely way,’ the ATAGI guidance states.
What about a permanent vaccine exemption?
To be eligible for a permanent exemption, a patient must have a contraindication to all three vaccines currently available in Australia.
This includes:
  • a patient that has had anaphylaxis after a previous dose of a vaccine
  • a patient that has had anaphylaxis after a dose of any component of a vaccine.
What are the processes for GPs to follow?
If a patient is deemed eligible for an exemption, GPs must use their Medicare provider number to input the exemption through the AIR using the Immunisation medical exemption form (IM011).
Aside from Queensland and Western Australia, each state and territory, in line with public health orders, has different requirements for documenting exemptions.
In addition to completing the AIR exemption form, GPs in Victoria have been required to provide the patient with a medical certificate or letter as proof of their exemption.
But as of 29 October, GPs will need to submit a form to the AIR on behalf of the patient to confirm they meet one of ATAGI’s contraindications and have  an exemption certificate issued via the myGov website or app. Patients who already have an exemption letter will need to return to their GP by 12 November to have a form submitted on their behalf.
New South Wales
GPs in NSW can either choose to complete the AIR’s exemption form or to complete NSW Health’s COVID-19 vaccine medical contraindication form.
If the clinician opts to complete the state government’s form, a copy should be given to the patient as proof of exemption.
Australian Capital Territory       
GPs issuing an exemption in the ACT are also required to complete the state government’s COVID-19 vaccine medical contraindication or temporary exemption form.
The completed form should then be given to the patient as proof of their exemption.
South Australia
GPs in South Australia are required to complete both the AIR’s exemption form and SA Health’s Immunisation exemption application form, which is specific to the healthcare worker mandate.
For the exemption to be legally valid, the Chief Public Health Officer or one of her deputies must give their approval.
Northern Territory          
GPs in the NT have the choice to either complete the AIR’s exemption form or issue a medical certificate stating the patient has a contraindication to all available COVID-19 vaccines as per ATAGI’s guidelines.
Tasmanian GPs issuing an exemption are required to complete the AIR exemption form, as well as the state government’s COVID-19 Vaccine Medical Contraindication form.
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Dr D   30/10/2021 4:24:09 PM

Did Dr Price really say "GPs live by the Hippocratic Oath..."?

I know members of the public often hold this view, but I have never heard it said by a doctor. I am a GP and have never taken the Hippocratic oath, and have no intention of doing so. I mean, it starts by swearing by an assortment of Greek gods, and includes a prohibition against surgery, amongst other archaic statements.

Dr Alan Graham MacKenzie   13/11/2021 1:14:06 PM

Interesting that in Medical Publications and lay press the Mental Health aspects of the Covid Pandemic are being emphasised ad nauseam
However the Mental Health effects of mandated vaccination and consequent employment termination are being trivialised
Hypocritical or Hippocratic

Dr Andrew Carr   7/12/2021 11:27:21 AM

First, perhaps the phrase "emerging from the woodwork" was inflammatory here and I would publicly distance myself from that comment.
Second, to my colleagues citing trivialization of the effects of mandated vaccination on mental health. I acknowledge that misinformation with respect to vaccine outcomes and misreporting of science has led to overwhelming anxiety in the community with respect to vaccines and as a member of this collage, we need to accept collective responsibility for failing to educate public about this. It is not the media's job. Their job is to create fear and sell clicks.
We need to acknowledge our model of care of doctor to impart 'wisdom' on to patients in a 1 on 1 clinical setting is limited in 2021.
Further to the issue of mental health, respectfully, is my colleague proposing that
a) a better outcome is continued lockdowns, closure of businesses, and long term travel restrictions?
b) Covid is a threat but we should just accept it ?OR
c) Covid is not a threat?

Dr Maher Luka   22/01/2022 10:12:12 AM

We are now receiving large numbers of patients who never had the vaccine for the last 9 months. Typically they notified the Health Deoartment of positive RATS.
They receive a message back from the department that they are COVID positive .
They use the formal message from the department as grounds to ask for an exemption.
I have lots of doubts on this scenario as there can be false reporting of positive RATS to give grounds for an exemption.

We need regulation in place to stop this wave of people gaining illegitimate exemptions