Yes, whether or not to recommend a vaccine, or any medical intervention, has to be based on the risk:benefit ratio, individualized to the patient, and administered with the patient’s informed consent. The only exceptions to these rules would apply when the patient is not competent to make an informed decision. Unfortunately, this government’s highly-politicized approach to the SARS-CoV-2 pandemic has violated all of these principles.
Blanket recommendations have been made regardless of age and individual risk factors, and an accurate risk:benefit analysis has been made difficult to impossible because of the way the governmental agencies have filtered and sometimes censored potential risks and also magnified potential benefits during the latter part of the pandemic. Serious risks need to be disclosed, even if their occurrence is quite rare, for an individual to give informed consent.
One thing is very clear, the risk:benefit ratio has changed dramatically during the course of the pandemic because the serious risks of infection have greatly diminished as the virus mutated and evolved. Another factor that shifted the risk;benefit ratio is the fact that the great majority of individuals in the US have now acquired immunity, either through prior infection, or vaccination, or both. Just because you have not had symptoms of covid-19 infection does not mean you have not had it. Subclinical infections are not uncommon. This government continues to ignore the protective benefit of naturally-acquired immunity even now, despite the fact that multiple large studies have indicated that naturally-acquired immunity or hybrid immunity is probably much more durable than immunity conferred by immunization alone.
You are probably aware that the approach to the pandemic taken by other western nations has been dramatically different from that taken in the US. Take the latest covid vaccine as an example. Switzerland made the news by not recommending further vaccination of its general population this Spring and Summer. France also stopped recommending further vaccination this year and Denmark did so last year.
Here is a paper that is worth reading.
https://onlinelibrary.wiley.com/doi/10.1111/eci.14136
It is a population-based, retrospective, observational study done in Austria that looked at the effectiveness of a fourth dose of the covid-19 vaccine in preventing death or infection of previously-infected individuals. The total number of patients included in the study was 3,986,312. Of these, 1,545,242 had received three doses of the vaccine and 281,291 had received a fourth dose. The remainder had received zero, one, or two doses. The study was conducted between November 1 and December 31, 2022 with extended follow-up to June 2023. The study compared relative risk of death attributed to SARS-CoV-2 infection and risk of infection for individuals who had received four, three, or fewer doses of vaccine. The study was published in the European Journal of Clinical Investigation, a well-recognized, peer-reviewed publication.
All of these individuals had some degree of acquired immunity even in those who had received no vaccine since they had all had prior infection. The total number of deaths among these 3,986,312 the number of deaths attributed to SARS-CoV-2 infection during the two month period of initial follow up was 69 total among all groups and the number of confirmed infections was 89,056 for a case:fatality rate of only .0011%, reflective of the greatly-reduced virulence of the predominant virus strains by this point in the pandemic. Comparing the risk of death from infection between the three or fewer vaccine and the four vaccine cohort groups, the observed rate in the four vaccine group was actually a bit higher (0.1 per 100,000 patient-days) than in the three or fewer vaccine groups (0.02 for three vaccines and 0.01 for fewer than three vaccine doses). Because of the overall small number of deaths this difference is of questionable significance, but there was no evidence that a fourth dose of vaccine protected against death from covid-19 infection in this very large study group.
As for protection against infection conferred by a fourth dose of vaccine, the results are very interesting. A fourth dose of vaccine did reduce risk of infection modestly by 17% within the two month primary period of observation. But this protective benefit diminished rapidly over time with peak benefit observed at 3-5 weeks after receiving the fourth dose. When the same individuals were followed up until June 2023 the infection rate in the four vaccine dose cohort was 17% greater overall than that for the three or less dose cohorts 95% CI:-15-19%).
So the bottom line in this study was that in previously-infected individuals who had received three doses of vaccine, a fourth dose did not reduce the risk of covid-19 death. A fourth dose did modestly diminish the risk of covid-19 infection (by 17%) for a few weeks, but on extended follow up the four dose individuals actually had a higher observed rate of infection.