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Aside from allergic reactions, is there any other medical reason for an adult to not get vaccinated?

Question: Aside from an allergy to an ingredient in the vaccine, is there any other valid medical reason for an adult to not get vaccinated? The back story: My son’s occupational therapist is unvaccinated – her only explanation is that she’s “unable to get vaccinated” – and I’m wondering why that would be. Where we live the Governor passed a law that all healthcare workers must be vaccinated to interface with patients, so she is about to lose most of her in-person patients. We adore her, she’s highly educated and seems very well-versed in science, so I can’t imagine she’d be making the decision to remain unvaccinated due to a political belief, but if she were allergic to the vaccine I don’t know why she wouldn’t just say so – so I’m wondering what else it could be. 

Answer: CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines is online and updated regularly, as is the relevant summary document.  The only contraindications (e.g. “do not use” conditions) are related to allergies.  Contraindications include:

  • Severe allergic reaction (e.g. anaphylaxis) from a previous dose of the COVID-19 vaccine;
  • Severe allergic reaction a component of the COVID-19 vaccine; 
  • Immediate (within four hours of exposure) allergic reaction of any severity to a previous dose;
  • Diagnosed allergy to a component of the COVID-19 vaccine. 

There are a few conditions that would suggest deferral of vaccination.  Specifically, if a person received monoclonal antibodies or convalescent plasma to treat COVID, they should defer vaccination for at least 90 days; and if a person has been exposed to COVID-19 and they do not live in a congregant setting, they should wait for vaccination until their quarantine period has ended. (Table)  

Finally, I know a lot of folks who are pregnant or trying to become pregnant are concerned about vaccine safety.  On that front, data continues to accumulate indicating that COVID-19 vaccination is safe for pregnant women, with no known adverse maternal or fetal outcomes.  For example, just last week a case-control study was published in JAMA that showed COVID-19 vaccination was *no* associated with increased risk of miscarriage.

Table. Summary of CDC Clinical Considerations (from CDC)