COVID vaccine exemptions.

Initially (i.e. when the vaccines first came out) our government guidance for exemptions were vague. There wasn't much pressure on the 'urgency' of getting our population vaccinated, so, probably in an attempt to avoid complaints and litigation, they advised for all pre-existing medical conditions to be 'reasonably controlled' before proceeding with the COVID vaccine. Which is a very loose definition, because what is 'reasonable control'? A patient with a blood pressure of 135/80 strictly speaking isn't 'well-controlled' but that's almost all of our medical cases, so should none of them be vaccinated yet? Most patients with moderate or severe medical conditions (i.e. diabetics with kidney disease, stroke patients, elderly patients) generally don't have perfect control of their blood pressure or diabetic control, but they are the ones who will die first if they get COVID.

So eventually, because the pandemic worsened and the vaccine uptake was so abysmal, the guidelines tightened to 'almost nobody can be exempted unless they have these specific conditions related to previous COVID vaccines' and a number of restrictions in place if you don't get vaccinated, such as not being allowed in shopping centres, restaurants, doctors' clinics (let the ridiculousness of this restriction simmer for a bit) or going to work. But patients aren't told the guidelines for exemption have changed, so the ones who were told six months ago that their blood pressure isn't perfect yet so they should get it better controlled before they get the vaccine, are now being told they have no reason to not get it even though their medical condition hasn't changed.

Don't get me wrong. I think everyone who can be vaccinated (including those with suboptimal diabetic or blood pressure control) should be vaccinated. And a fair few patients we see have pre-existing problems that they have little motivation to change (such as the high cholesterol patient refusing medication, the high blood pressure patient refusing to lose excess weight) so their physical condition literally will not 'get better' enough to fulfill the initial vaccine guideline. But this puts me in a difficult situation when there is already vaccine hesitancy in place (see Chapter 144).

But something else I don't get is, when we have had about 10k deaths from COVID in Hong Kong in a city of 7 million (that is, 1 in 700 people have died), why are folks still seeking vaccine exemptions?

I've had patients who said they got a headache or muscle pain or muscle twitching or joint pains or another bout of chest pain (on top of their year-long history of chest pain even before this) since they got their first dose vaccine tell me they don't intend to get the subsequent jabs. Whilst I have no right to force them, the logic is baffling to me.

Here is a very contagious, potentially deadly virus wreaking havoc and you actually want to be told you can't get one of the most effective defenses for it? Like you want to be told you can't wear armour when someone is shooting a gun at you? And by you not wearing armour, this also kills your grandmother at home too? And you think having some knee pain after a vaccine is worse than literally dying or having your lungs destroyed by COVID and killing your elderly relatives?

And this is putting aside how living in a society requires you to have a certain responsibility to do your part to care for the community, such as not being a deadly vector of disease (by being vaccinated against other transmissible and deadly diseases like measles and tuberculosis here) or not driving whilst intoxicated or not littering and it's being wholly selfish to deliberately choose not be vaccinated and whilst banking on others being vaccinated to protect you. Plus, your own selfish action (or inaction) can literally kill hundreds or thousands of others.

And also putting aside how your selfishness also literally increases my workload unnecessarily because I still have the obligation to treat you when you inevitably get COVID (not to mention however many tens / hundreds / thousands you infect along the way).

You can choose not to be vaccinated, but I'm sorry but I won't indulge in or endorse your selfishness.