To boost or not to boost

Touchy subject I know, but I’m just interested in the medical advice and not the politics. I come here because I watch/read a lot of your stuff and trust your guy’s advice over the kinds of people we hear from in the regular media.

36/m in seemingly fine health, double jabbed since summer but now my country is pushing everyone to get a 3rd and then who knows how many others. I ended up getting Covid last week and the only symptom was a loss of smell, nothing else whatsoever. I guess my question is why bother getting boosted when we now know it doesn’t do much to limit transmission and the disease was so mild for me personally? And if I should, is that just it now every 6 months, a lifetime subscription to Pfizer?

Just looking for guidance. Obviously I know the risk of vaccine is incredibly low, but then I don’t want to just keep taking it mindlessly either.

I guess my question is why bother getting boosted when we now know it doesn’t do much to limit transmission and the disease was so mild for me personally?

Good question.

Just because it is still technically possible to have a breakthrough infection and/or to transmit, does not mean that the vaccine “doesn’t do much” to limit transmission.

It is both puzzling and frustrating that this is how the headlines and general public perception have become twisted (I am not coming at you for having this idea, but rather commenting on it more generally). It seems that the general public has come to expect that if a vaccine does not confer 100% protection against any symptomatic infection at all, then it is completely ineffective. There has literally never been a vaccine with this level of efficacy, ever. Believe it or not, the majority of cases of polio were benign and minimally symptomatic, with incrementally smaller fractions of people progressing to respiratory failure, hospitalization, paralysis, or death …

Now, for covid:

Being fully vaccinated (and now, in the setting of the newest variant, boosted with an mRNA option) substantially reduces the risk of infection.

If an individual should find themselves in the fraction of people who still experience a breakthrough infection, being fully immunized substantially reduces the risk of severe symptoms. (<— This was you)

If an individual should then find themselves in the sub-fraction of symptomatic people who experience severe symptoms, being fully immunized substantially reduces the risk of hospitalization.

If an individual should then find themselves in the sub-sub-fraction of unfortunate people with severe enough symptoms to require hospitalization, being fully immunized substantially reduces the risk of death.

And if I should, is that just it now every 6 months, a lifetime subscription to Pfizer?

I am not going to make confident predictions about the future. Rather, I am going to base recommendations on the evidence we have currently.

If you were vaccinated with an mRNA option x 2, and then experienced a breakthrough infection, you were effectively “boosted” from that infection and should be in good shape.

With that said, if you wanted to maximize protection even further, it would still be safe to get boosted – but double-vaccination-plus-infection (or vice versa) both seem to generate quite good immunity.

If you had not experienced a breakthrough infection but had been double-vaccinated several months ago, I would more strongly recommend a booster at this point to achieve the risk reductions outlined above, because there is no good argument to simply “accept” a bunch of unnecessary risk when the vaccines are as safe as they are.

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