Here’s where we need to separate the public health perspective from the individual patient one. From a population health standpoint, I think fourth doses won’t change the trajectory of BA.2 in the United States. About half of those eligible for the third dose have not yet received them, including 1 in 3 adults 65 and older. And of course, there are those who remain totally unvaccinated. Getting vaccines to these groups should remain the priority of health officials.

A permissive allowance is therefore the best policy. Individuals aren’t required to get the extra vaccine, but they can if they wish. In a sense, the decision for an additional booster becomes similar to continued masking or rapid tests before indoor gatherings. There are many Americans who are no longer concerned about covid-19. Those who are vaccinated and boosted might not opt for an extra booster at this time, just as they could choose not to mask or regularly test. This is especially true if they recently recovered from omicron.

There are others who remain worried about coronavirus infection. For the elderly and for the medically frail who would end up in the hospital with any respiratory infection, I understand the rationale for choosing the additional shot.