Are There Medical Exemptions From the COVID-19 Vaccine?

Medical exemptions to the COVID-19 vaccine have been a hot-button topic. And while plenty of people may claim they have a medical exemption from getting vaccinated, legitimate medical exemptions are "very uncommon," William Schaffner, MD, an infectious disease specialist and professor at the Vanderbilt University School of Medicine, told Health.

What conditions could cause someone to be medically exempted from the COVID-19 vaccine? The classification is actually pretty narrow. Here's a breakdown.

What Conditions Can Get You a Medical Exemption From the COVID-19 Vaccine?

The Centers for Disease Control and Prevention (CDC) breaks down the contraindications and precautions for people getting any of the COVID-19 vaccines. It mostly boils down to allergies and allergic reactions to vaccine ingredients, said Dr. Schaffner. A medical exemption is due to a patient having a contraindication to the vaccine, meaning getting it could be bad for their health.

Here's a list of the Comirnaty/Pfizer-BioNTech vaccine ingredients:

• mRNA
• Lipids ((4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate), 2 [(polyethylene glycol)-2000]-N,N-ditetradecylacetamide, 1,2-Distearoyl-sn-glycero-3- phosphocholine, and cholesterol)
• Potassium chloride
• Monobasic potassium phosphate
• Sodium chloride
• Dibasic sodium phosphate dehydrate
• Sucrose

While we're at it, here's a list of the ingredients in the Moderna COVID-19 vaccine:

• mRNA
• Lipids (SM-102, 1,2-dimyristoyl-rac-glycero3-methoxypolyethylene glycol-2000 [PEG2000-DMG], cholesterol, and 1,2-distearoyl-snglycero-3-phosphocholine [DSPC])
• Tromethamine
• Tromethamine hydrochloride
• Acetic acid
• Sodium acetate
• Sucrose

And the ingredients for the Johnson & Johnson COVID-19 vaccine:

• Recombinant, replication-incompetent adenovirus type 26 expressing the SARS-CoV-2 spike protein
• Citric acid monohydrate
• Trisodium citrate dihydrate
• Ethanol
• 2-hydroxypropyl-β-cyclodextrin (HBCD)
• Polysorbate-80
• Sodium chloride

For each vaccine, the contraindication is the same: You shouldn't get it if you have had a severe allergic reaction to one of the ingredients in the vaccine. However, this might not mean that you can't be vaccinated at all. If you're allergic to something in one of the vaccines, you might be able to get another one of the vaccine brands available, since some of the ingredients are different in each one.

"Because there is more than one type of vaccine available in the United States, I don't think that there are actual true medical exemptions to both mRNA vaccines and the adenovirus vectored vaccine," infectious disease expert Amesh A. Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, told Health.

"For example, if someone had a severe allergic reaction to dose one of the mRNA vaccines, they could complete their series with the Johnson & Johnson vaccine," said Dr. Adalja. "The same is true for those who have known allergies to the ingredients of one of the vaccines."

There may be at least one other situation where a doctor will write a medical exemption with legitimate intentions, Dr. Schaffner explained: If someone developed a serious health issue soon after getting their first dose of an mRNA vaccine. "There are some people who have received one dose of the vaccine and had a subsequent medical event close in time to the vaccine," said Dr. Schaffner.

For example, one such situation recognized by the CDC as a contraindication to getting a Johnson & Johnson booster vaccine is for those who experience thrombosis with thrombocytopenia syndrome (TTS) after their first J&J shot. This is a rare but severe condition that causes blood clots.

For people who experience this or another adverse event following a shot, the CDC encourages you to report it to the Vaccine Adverse Event Reporting System (VAERS).

What To Do if You Have an Allergy to a COVID-19 Vaccine

Dr. Schaffner recommended meeting with an allergist. They can give you allergy testing to see what, exactly, you're allergic to and then recommend the right COVID-19 vaccine for you based on the findings, said Dr. Schaffner.

If you do happen to qualify for a medical exemption, it will likely be in the form of a doctor's note, said Dr. Schaffner.

Still, if you happen to be allergic to any ingredient in one COVID-19 vaccine, experts recommend investigating to see if you can get another vaccine. "Getting vaccinated is important," said Dr. Schaffner.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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