Health and educational leaders are calling for urgent clarity over vaccine exemption certificates as the cut-off date looms for teachers to get vaccinated.
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The calls come as some principals are being presented with questionable exemption certificates, signed off by homeopaths and midwives.
The Post Primary Principals Association says principals have inadequate information, are under pressure and confused as to how to deal with staff who choose not be vaccinated.
The cut-off date is 15 November. Principals estimate several thousand teachers are resisting the government order to get vaccinated.
PPTA president Melanie Webber said principals needed clarity over the legitimacy of exemptions and how do deal with staff refusing to get vaccinated.
"They're worried about getting it wrong and getting a personal grievance against them," she told Nine to Noon.
"Principals are in a really tough situation because they are having to have really difficult conversations with people about their livelihood and it's with people that they care about and who they've known for a really long time and are having to try and sort out what to do.
"It's rough on principals and have on those people who are in this situation having to make these decisions.
"They should now have a clear direction as to how to manage the process. But what is not clear is the bit around exemptions. There are a lot of people who believe they are able to get exemptions who may not actually be able to."
She said the ministry had not presented a medical list as to who is an appropriate medical professional to give exemptions.
"We've got homeopaths and midwives giving exemptions, which is not an area they should be getting involved in necessarily. There needs to be real clarity. The advice at the moment to the principals is to put that in the drawer and reassess it once that advice is up there."
Anti-vax GPs were also giving exemptions. Some were being asked to pay $100 consultations for the certificates, she said.
The Ministry of Education expected only 100 people across the country to have been exempted, Webber added.
"We've had a shortage of teachers for a very long time and there hasn't been a lot done about it." - PPTA president, Melanie Webber
She said that advice was unlikely to come this week, meaning principals would have week to assess who had proper exemptions and what to do with staff.
Schools should at this point have a clear record of who is vaccinated and who hasn't been yet, with proof of vaccination.
"There's a requirement there to provide the information and if someone doesn't provide it the assumption is they are not vaccinated," she said.
Failure to get vaccinated and have a legitimate exemption could lead to ultimate dismissal from the job, creating further headaches for schools.
"I'm really worried about that. We've had a shortage of teachers for a very long time and there hasn't been a lot done about it," Webber said.
"We've had ongoing teacher shortages, but it comes down to a matter of health and it's going to be tricky... Ultimately we need to be keeping people safe."
Warning not to issue certificates
The College of GPs is warning members not to issue vaccine exemption certificates until health officials have closed an apparent loophole in the rules.
It says these include a reference to unspecified health issues, which could be exploited.
College president Dr Samantha Murton said they too were waiting on the Ministry of Health's finalised view on exemption reasons.
"We have a duty of care to our patients and we know that the vaccine is safe, we know that the vaccine does its job" - College of GPs president Samantha Murton
Murton said at present reasons include an anaphylactic reaction to the vaccine, a severe allergy to some part of the vaccine, or some significant heart condition.
Those conditions may mean a person cannot have the vaccine, or that it has to be administered in a different way or delayed.
"We're working with the ministry and the Immunisation Advisory Centre on clarifying and laying out exactly what those reasons are.
"The problem we have is that the law also says "and other health issues" and that's where we come unstuck.
"People come up with an enormous variety of reasons why for their health they don't want a vaccination."
Exemptions signed now will not necessarily be valid once the criteria are finally set out, she said, and clarity was "needed urgently" so patients knew what they were able to get and practitioners had a "clear line in the sand" on valid reasons.
The College had recommended to its members not to sign any certificates until that process was formalised.
Murton pointed out the law appeared to permit any health practitioner registered under the Health Practitioners Competence Assurance Act to provide an exemption certificate. That would include in GPs, dentists, podiatrists and midwives and others.
"To my mind, and from the College's perspective, we'd expect someone who is signing off one of these certificates would know about the health of that particular person, would have a generalist knowledge of healthcare and also be very aware of how the vaccine works and what the issues are with the vaccines."
That would be someone who had a wide knowledge of vaccination and the patient, and not a health professional who works on a part of the body rather than the whole person, she said.