Vaccines: physicians rights and responsibilities

UPDATE: Ministry expands RSV vaccine eligibility

Ontario’s publicly funded RSV vaccination program is being expanded to cover additional high-risk groups. Groups now eligible for the vaccine include people who are 60 years of age and older AND who are:

Living in long-term care homes
Living in elder care lodges
Residents of retirement homes licensed to provide dementia care
Patients in hospital receiving alternate levels of care
Patients receiving hemodialysis or peritoneal dialysis
Recipients of solid organ or hematopoietic stem cell transplants
Individuals experiencing homelessness
Individuals who identify as First Nations, Inuit or Métis

Vaccines will be administered through long-term care homes, elder care lodges, retirement homes, hospitals, public health units and Indigenous care organizations.

Download the RSV fact sheet for health-care providers.

Physician rights and responsibilities

This summary was developed in consultation with the Canadian Medical Protective Association (CMPA) and the College of Physicians and Surgeons of Ontario (CPSO). These considerations apply to all patients and their legal guardians.

Summary of physician responsibilities and vaccines

Physician advice is the most important source of vaccine information for patients and families.

The advice you give to your patients or their guardians will have a significant influence on their decision-making.

Be prepared to address questions or concerns about vaccines, the diseases they protect against and the vaccination schedule.

When discussing vaccines or obtaining informed consent from your patients/guardians, the CMPA recommends that you address the following topics:

Benefits of the vaccine
Risks of the vaccine (including uncommon risks with serious consequences)
Risks and complications of the vaccine-preventable disease
Possible consequences of refusing the vaccine
Relevant legislation (like Ontario’s Immunization of School Pupils Act) or recommendations from groups like Public Health Agency of Canada, National Advisory Committee on Immunization, Canadian Pediatric Society, and others
Need for follow-up for subsequent doses
Cost of the vaccine, if not covered by OHIP

You may want to talk about mitigating pain and related symptoms (e.g. fear, fainting).

You may want to talk about reporting adverse events after immunization to a health-care provider or a local public health agency.

You may want to talk about the concept of community immunity and its role in the protection of individuals who cannot be protected through vaccination (particularly during times when a vaccine-preventable disease is circulating).

The CMPA recommends that you talk to patients/guardians about vaccines that are considered to be the standard of care for the patient’s circumstances.

Stay informed of standards published in reputable sources, common practice for physicians in your community, and recommendations from professional bodies or health organizations.

For physicians in Ontario, this can include staying up to date on Ontario’s Publicly Funded Immunization Schedule and information provided by the Medical Officer of Health and Ministry of Health.

Consider how outbreaks, vaccine requirements (for example, school entry, travel, etc.) or other environmental factors may affect the standard of care related to vaccines.

It’s important to record vaccine-related communications and events. The CMPA and the Public Health Agency of Canada’s Canadian Immunization Guide recommend that you document the following details in the patient’s medical record:

Conversations you have with the patient/guardian about vaccines and/or Ontario’s routine immunization schedule, including any hesitancy or concerns
The patient’s/guardian’s informed consent or refusal
Vaccines administered, including vaccination site, lot number and expiry date
Instructions you provide to the patient for reporting adverse events following immunization
Attempts to contact or remind the patient/guardian about vaccines or vaccine-related appointments

Remember to:

Record patient reactions (e.g. fainting, pain) and interventions used (so that these experiences can inform future practice)
Document any vaccines you administer in the immunization record held by the patient/guardian
Remind guardians that it is the guardian’s responsibility to report the vaccines received by school-aged children to their local health department

Responsibilities to patients who are vaccine-hesitant or refuse to vaccinate

These considerations apply when patients or their legal guardians are unsure about vaccines or refuse to vaccinate altogether.

Some patients/guardians may try to delay the vaccination schedule or refuse to vaccinate even after you’ve discussed vaccines and provided appropriate resources. As a physician, you must respect your patients’ autonomous decisions about vaccination.Chart your patient’s concerns related to vaccination so you can monitor potential changing views and decisions.

Keep the lines of communication open for future conversations with these patients. Do not end the physician-patient relationship solely because your patient refuses to vaccinate.

The CMPA also recommends that you consider implementing a system to identify and follow up with patients/guardians who are behind on the vaccination schedule.

It may be necessary to contact your local Children’s Aid Society (CAS) in exceptional circumstances where a guardian refuses a vaccine that is required to prevent imminent risk of harm or death.

OMA legal services notes that unless there is an imminent risk of harm, it’s unlikely that the CAS will get involved and reporting non-imminent cases could damage your relationship with the guardian.

If you are thinking about reporting a case to the CAS, consider contacting the CMPA for advice first.

Unvaccinated patients could potentially expose vulnerable patients to pathogens while in your office.

The CMPA suggests that you:

Encourage your patients or guardians to inform you if they are not fully immunized
Adopt scheduling practices to help avoid contact between unvaccinated patients and your most vulnerable patients

If you are considering other risk management strategies and have questions about their appropriateness, contact the CMPA for advice.