Disclosing your COVID-19 vaccination status

The College has received the first of what it anticipates will be many inquiries about disclosure by a Registrant of their vaccination status. While the initial inquiry related to whether the College would allow a Registrant to disclose their status on social media, other questions and concerns will likely arise about whether a Registrant is required to disclose it to an employer or a patient.

I will preface our response with two important caveats.

The first caveat is that this post is based on an extensive review of case law and legislative requirements and drawing parallels to COVID-19 as there is no specific law governing these questions and no court matters on it specifically. This work was conducted by one of Ontario’s foremost authorities in administrative law.

The second is that the College does not and cannot offer legal advice to Registrants. We are providing the following information as guidance only. Legal counsel should be sought for specific issues if they arise. This is broadly true and particularly true in situations involving your employer.

The first issue is whether a Registrant can promote on social media that they have been vaccinated against COVID-19. Registrants need to be guided by the College’s Standard of Practice on Advertising as well as the Standard of Practice on the Scope of Practice and the College’s Vaccination Policy. Fundamentally, disclosing your immunization status for COVID-19 is a personal decision as it is your personal health information.

If you decide to disclose your status via social media, you will want to exercise extreme caution. As COVID-19 is not something that an ND can adequately diagnose or treat, and would be considered outside of the scope of practice. Therefore, any commentary beyond your own status, such as recommending that others do or do not get vaccinated or encouraging a COVID-19-related discussion in the comments would likely be inappropriate. You will also want to be careful to ensure that your message is accurate, true, verifiable, professional, comprehensible, not misleading and is in good taste. It should also not be used as a comparative to other NDs or professions.[1]

If you choose to tell patients you are vaccinated for COVID-19, what will you do if they ask you to prove that it is true? Are you required to disclose your vaccination status to a patient if they ask? While you may not have to disclose it, you may elect to tell a patient to reassure them that the risks of receiving treatment are lowered.

There is no absolute answer to whether you need to disclose your COVID-19 immunization status, either proactively or in response to a direct question. As I earlier said, your status is your personal health information, and it is private.

However, keep in mind that if you choose not to disclose your status, certain situations and scenarios may still arise where you have a professional obligation to make a disclosure in the interest of patient and public safety. Some examples include:

• Whether you have any symptoms of COVID. If you have symptoms, you should not be seeing patients in person until it is safe to do so.
• The likelihood of you having been exposed where you may be contagious yet still asymptomatic. For instance, you may have family and close friends who have attended large public gatherings.
• The current information that is available about the prevalence of asymptomatic transmission in your region.
• The best available current information about the likelihood of transmission of COVID (e.g., whether you may have been exposed to a variant) during your proposed intervention based on the nature of the intervention (e.g., how long and how close are you to the patient) and the location of the treatment (e.g., indoor, low circulation etc.)
• Information about the severity of the effects of COVID-19 if you were to transmit it to the patient. This includes an assessment of the patient’s vulnerabilities (e.g. age, comorbidities) as well as your own COVID status.
• The effectiveness of prevention techniques you employ, such as using PPE, physical distancing, and point of care testing.
• Current information about the effectiveness of the COVID-19 vaccinations.
• The likelihood that a patient would assume you are vaccinated given the degree of the roll out in Ontario.

If there is a realistic possibility of COVID-19 transmission to the patient that would be mitigated if you were vaccinated—such that significant consequences are likely for the patient—there may be a duty to proactively notify the patient of your immunization status. Currently, there is not enough evidence to support that a vaccination will prevent an individual from contracting COVID-19 and potentially spreading it to others.

You are, as a regulated professional, required to be honest in response to a question from a patient. From the College’s perspective there is no need to provide proof of vaccination to a patient if you choose to disclose your vaccination status or are required to disclose your vaccination status. Your honest answer should be sufficient. Different considerations may apply in respect of your employer who has a legal obligation to maintain a safe workplace.

If a patient wishes to have their care transferred either because you decline to disclose your immunization status or because you disclose that you have not received a vaccination for COVID-19, you should make an effective, courteous, and prompt referral to another practitioner and provide any and all necessary assistance[2].

Respect the patient’s choice as you would want them to respect your own.

The above approach balances your own human rights as an individual against the safety considerations of your patient. It would also be rare for you to have to provide a reason why you are not vaccinated (e.g., you have a health condition that contraindicates vaccination, religious or conscientious belief) even if you have to disclose your immunization status.

Currently the College is not requesting or expecting disclosure to the College of your COVID-19 status or your immunization status. This would likely only change if directed by the Government or the Chief Medical Officer of Health. The College anticipates that you will exercise reasonable professional judgment without direct assistance from the College.

The College expresses its deepest thanks to Richard Steinecke, Partner, Steinecke Maciura LeBlanc for his in-depth analysis of this issue and his guidance to the College and to the profession.

Andrew Parr, CAE

Chief Executive Officer

[1] Performance indicators as set out in the Advertising Standard.

[2] Registrants should refer to the Referrals and Consultations Guideline for a specific list of the minimum requirements when referring a patient to another practitioner.