Commentary: How did Novak Djokovic get a medical exemption from Australia in the first place?
A panel assesses such requests through a "blind" process but the public outrage against the initial decision to grant Djokovic a medical exemption was palpable, says a sports researcher.
SYDNEY: Novak Djokovic, nine times Australian Open tennis champion, had earlier announced on social media – after much speculation – that he would compete in the 2022 tournament.
The sticking point for him was the Victorian government’s requirement that all players be vaccinated, in the interests of reducing public transmission of COVID-19.
A noted anti-vaxxer, Djokovic submitted a request for a medical exemption to the vaccine mandate, which was earlier approved.
Yet now he's been denied entry. Australian prime minister Scott Morrison said Djokovic could not prove his medical exemption to enter Australia.
DJOKOVIC'S ROCKY HISTORY WITH COVID-19
In June 2020, Djokovic contrived a tournament, the Adria Tour, in the Balkans, as a response to the cancellation of many tennis events during the pandemic. It was organised by the Novak Djokovic Foundation, as a “charity tour to help the coronavirus victims”.
However, players and officials did not wear masks or socially distance – instead, there was a party atmosphere. No surprise, then, that COVID-19 broke out among attendees.
Djokovic and his wife Jelena were among those infected, with the tournament abandoned before it reached the finals. Being young and healthy, Djokovic’s body handled the virus in a way that others – the elderly and immune-compromised – often do not.
Six months later, he competed at the 2021 Australian Open, although he was annoyed at having to follow quarantine protocols. The imposition did not impede the Serb’s on-court performance, for he left Melbourne with yet another major singles title.
For the 2022 tournament, a lengthy quarantine is not required for fully vaccinated players and officials. Yet, for Djokovic, the requirement to be vaccinated – as a condition of entry – was something he objected to.
His father, speaking to Serbian media, described the rule as tantamount to “blackmail”.
Given that Djokovic has had COVID-19, what is the case for requiring him (and others) to be vaccinated?
In general, antibodies produced naturally to fight COVID-19 are effective in healthy patients, but their longevity is uncertain. By contrast, the antibody responses through vaccinations – with boosters – are better understood.
The dual goal, of course, is to optimise personal protection and reduce the risk of transmission. So, this is about the health of the wider community, with individuals expected to commit to a greater good.
After all, an unvaccinated person is “roughly 20 times more likely to give you COVID” than someone who has been fully jabbed.
HOW ARE MEDICAL EXEMPTIONS ASSESSED?
So, what is the process for assessing a medical exemption for a COVID-19 vaccine? Applications are first assessed by “an expert panel of doctors specialising in immunology, infectious diseases and general practice”.
Assuming they see merit in the submission, a second review is conducted by a government-appointed expert panel, known as the independent Medical Exemption Review Panel (IMERP).
This panel’s job is to establish that the application meets the Australian Technical Advisory Group on Immunisation (ATAGI) guidelines on medical exemptions to vaccination.
ATAGI has two guideline categories:
Acute major medical conditions that warrant a temporary medical exemption
A permanent exemption arising from “a medication contraindication to all COVID-19 vaccines available for use in Australia”.
The first of these speaks to an individual having experienced a significant medical challenge, such as serious illness or surgery, that is likely to be temporary and can be reviewed six months later.
The second speaks to “medication contraindications” to “a component” of one of more of the three vaccines available in Australia, leading either to “anaphylaxis” or a “serious adverse event”.
Those seeking an exemption for either of these scenarios need to “produce evidence provided by a medical practitioner”.
SHROUDED IN SECRECY
So, how is it that one of the world’s fittest athletes was initially granted a COVID-19 vaccine medical exemption? By design, the public cannot know.
Nor, it seems, can those who adjudicated on the medical merits of Djokovic’s case. That is because exemption submissions were “blinded”, which means those evaluating the application (should) have no idea whom they were assessing, and thus could be medically objective.
Tennis Australia’s chief executive Craig Tiley revealed 26 athletes had applied for exemptions for the Australian Open this year, “and a handful of those have been granted”.
The decision was initially supported by the Victorian Department of Health as it was confirmed those given exemptions have a “genuine medical condition”.
Of course, the public cannot automatically know who these individuals are because that information is protected by privacy conventions and laws around personal health data.
In Djokovic’s case, though, he has indirectly revealed he is unvaccinated, given he has a medical exemption that permits him to travel to Australia and play at the open. This means Djokovic would have had the same quarantine status as someone who is fully vaccinated.
All that was required of him was a COVID-19 test within 24 hours of arriving in Australia and isolating at his hotel until receipt of a negative result. He would then have had to repeat that process five to seven days after entering the country.
But the medical exemption sat with the Australian public poorly. Many were infuriated by what they see as Djokovic’s hubris in seeking an exemption and, given his power and celebrity status in tennis, their lack of confidence that the correct medical decision was made.
Djokovic could, of course, choose to be candid with the Australian public, explaining to them the medical calamity that allows him to meet the exemption guidelines. But that would invite debate about the scientific merits of his case.
As ever, Djokovic has positioned himself as a maverick, a sceptic of medicine and science while an advocate of alternative therapies, such as his belief in the transformative power of celery juice and the capacity of water to “react with human emotions”.
Daryl Adair is an Associate Professor of Sport Management at the University of Technology Sydney. This commentary first appeared on The Conversation.