Australia’s mandatory vaccination policies have historically allowed for non-medical exemptions (NMEs), but this changed in 2016 when the Federal Government discontinued NMEs for childhood vaccination requirements. Australian states introduced further mandatory vaccination policies during the COVID-19 pandemic for a range of occupations including healthcare workers (HCWs). There is global evidence to suggest that medical exemptions (MEs) increase following the discontinuation of NMEs; the new swathe of COVID-19 mandatory vaccination policies likely also placed further pressure on ME systems in many jurisdictions. This paper examines the state of play of mandatory vaccination and ME policies in Australia by outlining the structure and operation of these policies for childhood vaccines, then for COVID-19, with a case study of HCW mandates. Next, the paper explores HCWs’ experiences in providing vaccine exemptions to patients (and MEs in particular). Finally, the paper synthesizes existing literature and reflects on the challenges of MEs as a pressure point for people who do not want to vaccinate and for the clinicians who care for them, proposing areas for future research and action.

澳大利亚的强制疫苗接种政策历来允许非医疗豁免 (NME)，但这种情况在 2016 年发生了变化，联邦政府根据儿童疫苗接种要求停止了 NME。在 COVID-19 大流行期间，澳大利亚各州针对包括医护人员 (HCW) 在内的一系列职业推出了进一步的强制性疫苗接种政策。全球证据表明，随着 NME 的终止，医疗豁免 (ME) 有所增加；新的 COVID-19 强制疫苗接种政策可能也给许多司法管辖区的 ME 系统带来了进一步的压力。本文通过概述儿童疫苗政策的结构和运作，然后概述针对 COVID-19 的政策的结构和运作，并结合医护人员强制要求的案例研究，探讨了澳大利亚强制疫苗接种和 ME 政策的现状。接下来，本文探讨了医护人员在向患者（特别是 ME）提供疫苗豁免的经验。最后，本文综合了现有文献，并反思了 ME 所面临的挑战，作为不想接种疫苗的人和照顾他们的临床医生的压力点，提出了未来研究和行动的领域。