Dear Editor,We would like to correspond on the publication “COVID-19 vaccination in lung transplant recipients. [1]”. Corona virus disease-19 (COVID-19) vaccination in transplant recipients generates a lower protective response when compared to immunocompetent hosts, according to Altneu and Mishkin [1]. The appropriate number of COVID doses and timing, according to Altneu and Mishkin, is still unknown, with new findings pointing to the requirement for a fourth mRNA vaccine [1]. We agree that COVID-19 vaccination is beneficial to lung transplant recipients, and clinical evidence backs this up. However, the likely effect of asymptomatic COVID-19 is a significant confounding factor in several studies. Infection with COVID-19 is common, and the virus can re-infect people without generating symptoms [2]. COVID-19 may become asymptomatic, making the efficacy of the vaccination in past trials more difficult to establish due to immunological abnormalities. The potential of asymptomatic COVID-19 must be ruled out before a firm determination can be reached. Regardless of whether COVID-19 is asymptomatic, the immunisation can induce immunity. For transplant recipients, a booster immunisation is frequently required. The fourth dosage of COVID-19 vaccination is presently being administered to the general public in various countries, including Israel. The use of the fourth dosage of COVID-19 vaccination is also beneficial, according to a prior study [3]. As a result, lung transplant recipients may consider receiving a fourth dose of COVID-19 vaccination.