Understanding COVID-19 vaccine hesitancy

First posted 2021-8-29; updated 2022-1-18

While vaccines against COVID-19 are undeniably effective in reducing severe illness and mortality, questions remain about risks vs benefits. Governments all over the world are attempting to encourage widespread vaccine uptakes, but their strategies often involve diffusion of slanted or even misleading information, “carrots” such as lotteries or cash rewards (all paid for by taxpayers), all the way to bullying or frankly coercive approaches such as vaccine passports, obligatory vaccinations for certain groups, or a “health contribution tax” for the unvaccinated.

Unfortunately, misleading messages from elected officials and toplevel bureaucrats are often amplified by the news media, resulting in anxiety and sometimes hysteria in those already vaccinated who in turn shame and bully their unvaccinated friends, family, or people who read their letters to the editor. Never mind the anti-vaxxers who become more inflamed and paranoid when they feel they are being lied to by governments.

I feel it is high time to address COVID-19 messaging and identify the problematic bits.

Contents

  1. What do we know?
  2. Vaccine effectiveness
  3. Cellular vs humoral immunity
  4. Adverse effects
  5. Blood clots
  6. Difficulty in detection of adverse events
  7. Reinfection
  8. Variants
  9. Vaccines in previously infected people
  10. B12 deficiency and vaccine effectiveness
  11. Declining hospitalizations and deaths
  12. Canada and the Pfizer-BionTech vaccine
  13. Distrust in governments
  14. Vaccine technology
  15. Justification for vaccine passports or vaccine mandates
  16. High rates of unvaccinated getting hospitalized
  17. Recommendations

1. What do we know?

In the real world, vaccines clearly work, but are not quite as effective as hoped at preventing infection, in reducing the likelihood that vaccinated individuals will infect others, or in preventing serious illness or death due to COVID-191. As expressed by Alison Hanes in her Montreal Gazette column of 2021-8-17, “most Quebecers welcome the sense of security that will come from knowing the person at the next table, in the next airline seat or on the next treadmill is also vaccinated”. That sense of security may be misplaced, as even fully vaccinated people can have breakthrough infections and go on to infect others. Precautions like social distancing and wearing masks continue to be important.

2. Vaccine effectiveness

Much has been made of the effectiveness of vaccines, with numbers of 90% and higher frequently quoted. But the numbers given are for relative effectiveness, which can be a misleading statistic. When approving treatments, regulatory agencies typically want to see evidence of absolute effectiveness. For COVID-19 vaccines, this number initially was around 1%2 and the Number Needed to Treat (NNT) around 100 (about 100 people need to take the vaccine for one out of that 100 to benefit from not getting infected because of the vaccination).

Vaccine effectiveness wanes with time, and against the Omicron variant has decreased significantly3.

3. Cellular vs humoral immunity

The adaptive immune response mounted by individuals following either infection or vaccination has two pathways: humoral immunity, based on circulating antibodies, and cellular immunity, in which T-helper and cytotoxic T-cells work together with phagocytes to kill pathogens. Lab tests to measure antibodies are easy to develop and are inexpensive, but assessing the level of cellular immunity is difficult and expensive. This helps to explain why the focus has been on antibody levels in attempts by governments and vaccine manufacturers to justify giving multiple vaccine injections and even vaccinating previously infected individuals.

But antibody levels can be misleading. And it appears that many scientists who should know better insist that decreased antibody levels signal waning immunity4. In reality, antibody levels are supposed to decrease once the acute infection has been dealt with5. If we continued to have high antibody levels to all of the bacteria, viruses, fungi, etc that we have developed immunity to since we were born, our blood would get thick like sludge6!

So I’m inclined to question any recommendation for additional jabs on the basis of declining antibody levels. When governments do so, it leads me to suspect that they may have reasons other than simply maintaining or improving immunity.

4. Adverse effects

While acknowledging that vaccines can have serious side effects, the risks are said to be extremely rare, and certainly less than the risk of serious outcomes of infection, or about the same as the risk for that condition in the general population. This is misleading.

An example is an article by Sharon Kirkey of the National Post (Montreal Gazette, 2021-8-28, p NP2). She refers to a “huge new” study from Israel published in the New England Journal of Medicine7 which found an increased risk of heart inflammation (about 3 events per 100,000 people vaccinated with the Pfizer vaccine) but a “several-fold higher” risk among people infected with COVID-19, ie 11 cases per 100,000). This type of reporting fails to take into account the risk of getting infected in the first place. Although the authors of the NEJM article did articulate the problem, “…knowledge of these risks alone is insufficient for a complete decision-theoretic analysis. When a person decides to become vaccinated, this choice results in a probability of 100% for the vaccination, whereas the alternative of contracting SARS-CoV-2 infection is an event with uncertain probability that depends on the person, place, and time.”

To calculate the overall risk of myocarditis due to a COVID-19 infection, one must multiply the risk in those infected (11 per 100,000) by the risk of contracting COVID. In Israel, the total number of confirmed cases since the start of the pandemic is 1,051,152 as of 2021-8-29, according to Worldometer; for an estimated population of 9,393,300 as of 2021 (Wikipedia) which works out to a risk of 11.2 per 100. For a 42-day period, or course, the risk would be considerably lower. But in any case, multiplying 11 per 100,000 by 11.2 per 100 gives an overall risk of myocarditis due to COVID-19 infection of 1.2 per 100,000, less than half the risk of myocarditis from vaccination.

The same reasoning applies to other side effects of vaccination.

5. Blood clots

And sometimes a vaccine side effect is compared to a broadly similar condition which occurs in the general population, but it’s really an apples-and-oranges thing. Some of the vaccines have a risk of causing blood clots; no big deal, the officials said: blood clots occur commonly in people. What they didn’t say, at least initially, was that the vaccine side effect, now termed VITT (Vaccine-Induced Thrombotic Thrombocytopenia) frequently caused a blockage in the large venous sinus draining blood from the brain, resulting in massive strokes or death, and that this happened in younger people. Not exactly the same as a generic “blood clot”, wouldn’t you say? Some regulators (eg, Norway, Denmark), to their credit, did eventually tell people to stop using the AstraZeneca vaccine.

6. Difficulty in detection of adverse events

Pretty well all strategies to detect whether a vaccine causes rare adverse events depend on the event occurring within a short time after the vaccine administration. And even then, causality remains pretty well impossible to prove, and has to be inferred based on there being a plausible biological mechanism as well as a higher rate of occurrence in vaccinated individuals compared to unvaccinated.

If we consider conditions that may develop without symptoms or with only mild or nonspecific symptoms over a period of time, perhaps years, such as cancer, neurological illnesses (eg dementia or multiple sclerosis) or cardiovascular disease, the temporal relationship to vaccine administration will have disappeared. For new technologies such as mRNA vaccines, plausible biological mechanisms may not be known, and scientists may not even be prompted to look for them until there is a “signal” for an adverse event. And finally, when almost the entire population has received a particular type of vaccine, it will no longer be possible to detect differences in occurrence rates.

7. Reinfection

There is good reason to believe that a COVID-19 infection confers a higher level of immunity against reinfection, than vaccination confers against what is called “breakthrough” infection. First, the mRNA vaccines are designed to develop an immune response against the spike protein of the coronavirus. Individuals with intact immune systems who become infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are likely to develop an immune response to other components of the virus particle, including the other 3 virus proteins. Reinfection rates in Israel were 0.1%, while a U.S. study of 9119 patients8 found 0.7% were reinfected, with 2 deaths. In 538 healthcare workers in a high-prevalence setting, only 1 out of 115 (0.87%) individuals previously infected in a first wave developed infection in a second wave, compared to almost 25% in 423 previously uninfected workers9. These results appear to be better than the protection offered by vaccines of around 1%.

The Appendix includes a comprehensive list of studies looking at immunity provided by infection in unvaccinated individuals. This list was prepared by Dr. Edward Leyton.

I conclude from the available evidence that being infected with the virus confers better immunity than being vaccinated with mRNA vaccines, and probably more effective immunity against mutations affecting the spike protein. Thus, it is reasonable that an immunity passport or vaccination certificate consider a documented past infection as adequate proof of immunization status.

8. Variants

The spike protein targeted by mRNA vaccines is the part of the virus most likely to mutate, because it has the most effect on the virus’s infectiousness; this suggests that vaccine effectiveness will decrease as mutations become more common10, and frequent booster doses of these vaccines may be necessary as new “variants of concern” arise. The more generalized immunity (ie against parts of the virus other than the spike protein) conferred by an infection or by vaccines based on killed or live attenuated virus may work better against these variants11.

This became well illustrated by the Omicron variant, which because of multiple mutations affecting the spike protein, is much more infectious than the original virus or previous variants. And as I had predicted in Aug 2021, the effectiveness of existing vaccines against Omicron has taken a hit: “early reports have provided evidence for extensive immune escape and reduced vaccine effectiveness”12.

9. Vaccines in previously infected people

There may also be a safety issue regarding vaccine technology, which is not being adequately addressed. While vaccines based on whole virus particles are unlikely to be problematic if given to a previously infected person, the same cannot be said with confidence for vaccines which force cells to produce antigens, like the mRNA vaccines. A number of studies have found that antibody titres after a single mRNA vaccine dose in previously infected individuals can exceed titres after two vaccine doses in uninfected people13. Do these greater immune responses lead to more side effects? In an online survey completed by 2002 participants, the self-reported incidence of fever, flu-like illness, and shortness of breath were about twice as high after one dose of vaccine in individuals reporting a prior infection (532 individuals) compared to after one dose in uninfected individuals (14. The vaccine received was the Pfizer mRNA type in 83% of individuals in both groups.

10. B12 deficiency and vaccine effectiveness

It appears that governments and health officials are systematically ignoring warnings that highly prevalent but easily remediable conditions such as vitamin B12 deficiency, which may affect around 25% of seniors, can lead not only to severe and even deadly outcomes from COVID-19 infection, but also cripple effectiveness of all types of vaccines, as reported in my article15. This article has been sent to Directors-General of regional health authorities in the west end of Montreal, to several physicians providing advice around COVID-19 control measures including vaccination, to the provincial Minister of Health, and to Quebec’s Director of Public Health. None have responded.

11. Declining hospitalizations and deaths

The observed reduction in hospitalization and mortality rates in the fourth wave was universally ascribed to high rates of vaccination uptake. But one needs to ask, given the high rates of mortality particularly in nursing homes, in the first wave, is it possible that decreases in severe illness are due to there being fewer vulnerable people remaining in the population, simply because the most vulnerable have either died or managed to recover from infection?

The Omicron variant appears to cause less severe illness, but because of its high infectiousness, record numbers of people, including the fully vaccinated, are being hospitalized, admitted to ICUs, and dying in the pandemic’s fifth wave. However, more of those admitted are younger people compared to previous waves, in support of the argument that the most vulnerable in those previous waves, the elderly, are either dead or less prone to severe illness because of prior infection.

12. Canada and the Pfizer-BionTech vaccine

In Canada, the Pfizer-BionTech vaccine seems to be favoured by governments. I have a problem with that. First, Pfizer has a history of ethical and regulatory breaches16, and has been accused of profiteering from the pandemic; second, the government agencies that supposedly are regulating the drug industry are subject to “regulatory capture” where they do what the drug companies want them to do (ie, act in ways to increase the drug companies’ profits)17. So we see that although much of the vaccine research and development was paid for by the taxpayer, and the entire cost of purchasing the hundreds of millions of doses of vaccine is being borne by the taxpayer, Pfizer and the other vaccine manufacturers have been until recently completely protected from lawsuits brought against them for damages caused by their products (the “Emergency Use Authorization” or similar regulatory approvals mean that the taxpayer, and not the companies, are on the hook if bad things happen). And Pfizer got Health Canada to agree to increase profits by 20% by wringing 6 doses out of each vial of vaccine, instead of the original 5. Moreover, it looks likely that Health Canada will agree with giving a third dose of vaccine (again, paid for by the taxpayer)! Given the high rate of spike protein mutations, and the poor protection against these mutations provided by mRNA vaccines, it seems inevitable that, once on this bandwagon, repeat vaccinations are inevitable. And of course the probability of experiencing side effects increases with each additional dose.

13. Distrust in governments

In addition to the problem of “regulatory capture”, provincial governments may behave in ways which promote distrust. In New Brunswick, where a progressive neurological illness that has baffled experts for more than two years appears to be affecting a growing number of young people and causing swift cognitive decline among some of the afflicted, the official response has been to suggest that cases have been misdiagnosed. The son of one of the victims was reported as saying, “If a group of people wanted to breed conspiracy theorists, then our government has done a wonderful job at promoting it”.

And then, of course, there is sheer incompetence, also termed “serious organizational shortcomings” as in the case of 300 motorists stranded in their cars for 12 to 13 hours in a snowstorm. See: officials bungled response.

At the federal level, the Public Health Agency of Canada admitted that it had been secretly purchasing the location data of 33 million Canadian cellphone users, prompting an investigation by the Privacy watchdog. Again, not a good way to promote trust in the agency telling Canadians to get vaccinated.

14. Vaccine technology

The mRNA vaccines employ new technologies which have not had the benefit of longer-term evaluations of either benefits or risks. One such technology is the use of liposome nanoparticles as vehicles to deliver the messenger RNA strands. Nanoparticles, defined as particles in the size range from 1 to 100 nm, are able to pass through cell membranes because of their small size. However, their interactions with biological systems are relatively unknown18. Other nanoparticles to which humans are exposed, eg soot (from cigarette smoke)19 or titanium dioxide (used in cosmetics and in toothpastes)20 are known to cause problems.

Liposome nanoparticles, although having been studied for decades, have so far been approved for only one use case other than vaccines: cancer therapeutics (where adverse effects may be less important). Studies of toxicities and immune responses of liposomes remain incomplete21.

The liposomes used in vaccines have been PEGylated (coated with polyethylene glycol)22. This treatment allows the liposomes to migrate to lymph nodes draining the injection site as well as to the spleen, which may promote long-term memory responses to the vaccine23. However, PEG can cause anaphylactic reactions24.

The AstraZeneca and the Johnson & Johnson (aka Janssen) vaccines are also using a new and relatively untested technology, although a different one from the mRNA vaccines. However, concerns have been raised about increased risks of certain side effects as well as declining effectiveness.

Vaccines against SARS-CoV-2 based on technologies widely used for decades and considered safe, such as live attenuated or inactivated viruses, have been developed and approved for use in multiple countries. Unfortunately, all use an aluminium hydroxide based adjuvant. Aluminium is neurotoxic, and a number of neurological conditions including macrophagic myofasciitis25 are believed to be caused by alum-adjuvanted vaccines. Alum particles when injected can disseminate to more distant sites and eventually reach the brain26, where they can cause neurodegenerative disease, eg in sheep27. Abnormally high concentrations of aluminium in the brain have been found in Alzheimer patients28. Calcium phosphate, widely used as a vaccine adjuvant until replaced by alum in the late 1980s, has been suggested to in turn replace alum29.

15. Justification for vaccine passports or vaccine mandates

Worldwide, there is a high level of support for some sort of vaccine passport being mandatory for travel. But should the passport aim to identify people at low risk of spreading the infection, or just those who have been vaccinated? If the former, then a passport should include people with proof of prior infection, a very recent negative test, or positive antibody tests, and should exclude individuals with negative antibody tests even if they have had two or more vaccine doses.

Quebec has mandated vaccine passports for accessing non-essential services, and is planning to require three vaccine shots to obtain the passport. People who have been previously infected will still be required to have had one vaccination to obtain the passport. This clearly ignores the science regarding the risk of reinfection and of breakthrough infection, and again raises the spectre of ulterior motives.

16. High rates of unvaccinated getting hospitalized

With large percentages of people 12 and over now fully vaccinated, increasing emphasis is being placed on the finding that the great majority of covid-19 hospitalizations and deaths are in unvaccinated individuals, with the clear implication that the vaccine is solely responsible for this difference. But correlation is not causation, although governments and journalists won’t admit this when reporting

But there are other reasons besides the vaccine for unvaccinated people to continue to have high rates of infection and of severe illness leading to hospitalization. Unvaccinated individuals are more likely to have low socioeconomic status, meaning more crowded living spaces, greater likelihood of employment in high-risk occupations (eg, personal care workers, grocery store cashiers, abattoir workers), more likely to be working in more than one setting such as multiple nursing homes, and less able to access personal protective equipment. Furthermore, we know that many people who refuse to get vaccinated (“antivaxxers”) also refuse basic pandemic control measures such as social distancing, wearing masks, and avoiding large gatherings. Finally, one could make a case that these same people may be more likely to ignore other health recommendations regarding diet or exercise which puts them at higher risk of comorbidities such as diabetes or heart disease which lead to severe illness when COVID infection is added.

Governments, especially of “welfare states”, have a vested interest in promulgating fear and panic, in creating mass hysteria, as a way to remain in power30. In this endeavour, they are supported by the ultra-rich and powerful, who get richer when there is uncertainty, fear, and chaos31. This appears to be the situation in Canada and Quebec.

So, while I am not an anti-vaxxer, and in fact I recommend getting vaccinated, I would prefer that it be with a vaccine using attenuated live or killed vaccines, and without adjuvants.

And if governments are really interested in increasing vaccine uptake, I believe that openness, transparency, and good science, addressing the concerns and issues raised above, will go much further than the scare tactics and bullying that are currently the norm. Finally, consider using the “Veblen effect“: make the vaccine expensive and scarce as a way to increase the demand!

17. Recommendations

  1. Make the Johnson & Johnson single-dose vaccine more widely available in Canada, as it appears to be more acceptable to people fearful of the mRNA vaccines;
  2. The federal government should recommend a uniform approach to vaccine passports, to include:
    1. Those who have received at least 2 doses of Health Canada approved 2-dose vaccines (including mixed doses), 14 or more days earlier;
    2. Those who have received at least one dose of a Health Canada approved single-dose vaccine, 14 or more days earlier;
    3. Documented evidence of a prior COVID infection, including a positive antibody test;
    4. A very recent negative test for COVID-19 infection.
  3. If our governments are serious about using vaccine passports to reduce the risk of infecting others, then they should consider revoking passports of vaccine recipients who subsequently develop symptomatic infections or who have had negative antibody tests after vaccination or after a documented infection, as these individuals very likely have an impaired immune response and remain capable of infecting others.
  4. We need full transparency on the part of governments and journalists. When reporting hospital admissions, ICU admissions, and deaths, provide counts, rates per 100,000 population, counts of vaccinated and unvaccinated, rates per 100,000 of the relevant populations, and for all these figures, rolling 7-day averages. And, only include individuals where COVID-19 was the cause of admission, ICU admission, or death, not just an incidental finding.
  5. And so that both governments and journalists avoid demonizing people who have not been vaccinated: on a periodic basis, eg monthly, provide data on admissions, ICU admissions, and deaths caused by COVID, where the vaccinated/unvaccinated rates are expanded to include information about place of residence and other indicators of socio-economic status, eg occupation, property owners vs renters, number of people in the residence.

18. Endnotes

(The PMID numbers below are links to the article abstracts on PubMed’s website)

  1. According to the Montreal Gazette (2021-8-7, p NP4) seven fully vaccinated patients in one nursing home in Belgium died after being infected with a COVID-19 variant. https://pressreader.com/article/281874416460913
  2. Brown RB. Outcome Reporting Bias in COVID-19 mRNA Vaccine Clinical Trials. Medicina (Kaunas). 2021;57PMID 33652582
    Montastruc JL, Biron P, Sommet A. Efficacy of COVID-19 vaccines: Several modes of expression should be presented in scientific publications. Fundam Clin Pharmacol. 2022;36:218-220. PMID 34250637
  3. Tseng HF, Ackerson BK, Luo Y et al. Effectiveness of mRNA-1273 against SARS-CoV-2 omicron and delta variants. medRxiv. 20222022.01.07.22268919. http://medrxiv.org/content/early/2022/01/08/2022.01.07.22268919.abstract
  4. See, for example, Vicenti I, Basso M, Gatti F et al. Faster decay of neutralizing antibodies in never infected than previously infected healthcare workers three months after the second BNT162b2 mRNA COVID-19 vaccine dose. Int J Infect Dis. 2021S1201-9712(21)00683. PMID 34481967
  5. After a primary infection or vaccination, antibody-secreting cells rapidly proliferate. Most are short-lived and antibody levels decrease as these cells die. “Competition between newly generated plasma blasts and old plasma cells for occupancy of survival niches makes humoral memory flexible to add new specificities, allows its regeneration from memory B cells, and keeps the serum antibody levels constant.” Manz RA, Hauser AE, Hiepe F, Radbruch A. Maintenance of serum antibody levels. Annu Rev Immunol. 2005;23:367-386. PMID 15771575
  6. Hyperviscosity syndrome can be caused by multiple myeloma, a cancer of antibody-producing plasma cells.
  7. Barda N, Dagan N, Ben-Shlomo Y et al. Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting. N Engl J Med. 2021PMID 34432976
  8. Qureshi AI, Baskett WI, Huang W, Lobanova I, Naqvi SH, Shyu CR. Re-infection with SARS-CoV-2 in Patients Undergoing Serial Laboratory Testing. Clin Infect Dis. 2021ciab345. PMID 33895814
  9. Narrainen F, Shakeshaft M, Asad H, Holborow A, Blyth I, Healy B. The protective effect of previous COVID-19 infection in a high-prevalence hospital setting. Clin Med (Lond). 2021;21:e470-e474. PMID 34507931
  10. Puranik A, Lenehan PJ, Silvert E et al. Comparison of two highly-effective mRNA vaccines for COVID-19 during periods of Alpha and Delta variant prevalence. medRxiv. 20212021.08.06.21261707. PMID 34401884
  11. Okamura S, Ebina H. Could live attenuated vaccines better control COVID-19. Vaccine. 2021S0264-410X(21)01038. PMID 34426024
  12. Carreño JM, Alshammary H, Tcheou J et al. Activity of convalescent and vaccine serum against SARS-CoV-2 Omicron. Nature. 2021PMID 35016197
  13. Havervall S, Marking U, Greilert-Norin N et al. Antibody responses after a single dose of ChAdOx1 nCoV-19 vaccine in healthcare workers previously infected with SARS-CoV-2. EBioMedicine. 2021;70:103523. PMID 34391088
  14. Mathioudakis AG, Ghrew M, Ustianowski A et al. Self-Reported Real-World Safety and Reactogenicity of COVID-19 Vaccines: A Vaccine Recipient Survey. Life (Basel). 2021;11:249. PMID 33803014
  15. https://www.researchgate.net/publication/348163712_COVID-19_mortality_and_vaccine_efficacy_in_nursing_homes_does_vitamin_B12_deficiency_play_a_role
  16. “In 2010, a jury found Pfizer guilty of organised crime and a racketeering conspiracy. Six years earlier, Pfizer had paid $430 million to settle charges that it fraudulently promoted Neurontin for unapproved uses, but the size of the fine showed that crime pays. The sales were $2,700 million in 2003 alone, and about 90% was for off-label use.”
    Gotzsche, Peter C.. Deadly Psychiatry and Organised Denial . ArtPeople. Kindle Edition.
    Pfizer agreed to pay $2.3 billion in 2009.
    This was the largest healthcare fraud settlement in the history of the US Department of Justice at the time. A subsidiary of the firm pleaded guilty to misbranding drugs ‘with the intent to defraud or mislead’, and the firm was found to have illegally promoted four drugs: Bextra (valdecoxib, an anti-arthritis drug, withdrawn from the market in 2005), Geodon (ziprasidone, an antipsychotic drug), Zyvox (linezolid, an antibiotic) and Lyrica (pregabalin, an epilepsy drug).
    An amount of $1 billion was levied to resolve the allegations that Pfizer paid bribes and offered lavish hospitality to healthcare providers to encourage them to prescribe the four drugs, and six whistle-blowers would receive $101 million. Pfizer entered a Corporate Integrity Agreement with the US Department of Health and Human Services, which means that good behaviour is required for the next 5 years. Pfizer had previously entered into three such agreements, and when Pfizer promised the federal prosecutors not to market drugs illegally again in 2004, Pfizer was busily doing exactly this while they signed the agreement.
    Pfizer’s antibiotic, Zyvox, cost eight times as much as vancomycin, which even Pfizer admitted in its own fact book is a better drug, but Pfizer lied to the doctors, telling them Zyvox was best. Even after the FDA had told Pfizer to stop its unsubstantiated claims because they posed serious safety concerns, as vancomycin is used for life-threatening conditions, Pfizer continued to tell hospitals and doctors that Zyvox would save more lives than vancomycin.”
    Gotzsche PC. Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare. Radcliffe Publishing Ltd.; 2013:320 pages. p26
  17. Here is a recent example of an approval which gives off an odour of regulatory capture: https://www.theguardian.com/commentisfree/2021/jun/28/alzheimers-drug-aducanumab-approval-dementia
  18. “A fundamental understanding of the effects of nanoparticles (NPs) and their interactions with biomolecules and organismal systems has yet to be achieved.” Zhou Y, Chen Y, Rocha A, Sanchez CJ, Liang H. Assessment of Toxicity of Nanoparticles Using Insects as Biological Models. Methods Mol Biol. 2020;2118:269-279. PMID 32152986
  19. Even though inhalation of soot causes little inflammation in lung, systemic effects are rapid.
    Ganguly K, Ettehadieh D, Upadhyay S et al. Early pulmonary response is critical for extra-pulmonary carbon nanoparticle mediated effects: comparison of inhalation versus intra-arterial infusion exposures in mice. Part Fibre Toxicol. 2017;14:19. PMID 28637465
  20. Titanium dioxide NPs (eg in toothpaste) can be problematic when ingested: Bischoff NS, de Kok TM, Sijm DTHM et al. Possible Adverse Effects of Food Additive E171 (Titanium Dioxide) Related to Particle Specific Human Toxicity, Including the Immune System. Int J Mol Sci. 2020;22:E207. PMID 33379217
  21. Inglut CT, Sorrin AJ, Kuruppu T et al. Immunological and Toxicological Considerations for the Design of Liposomes. Nanomaterials (Basel). 2020;10:E190. PMID 31978968
  22. the surface is coated in the biocompatible inert polymer PEG (polyethylene glycol) to improve longevity in the bloodstream. See: https://www.cas.org/resource/blog/understanding-nanotechnology-covid-19-vaccines
  23. Wang C, Liu P, Zhuang Y et al. Lymphatic-targeted cationic liposomes: a robust vaccine adjuvant for promoting long-term immunological memory. Vaccine. 2014;32:5475-5483. PMID 25110295
  24. Klimek L, Novak N, Cabanillas B, Jutel M, Bousquet J, Akdis CA. Allergenic components of the mRNA-1273 vaccine for COVID-19: Possible involvement of polyethylene glycol and IgG-mediated complement activation. Allergy. 2021;76:3307-3313. PMID 33657648
  25. Gherardi RK. Lessons from macrophagic myofasciitis: towards definition of a vaccine adjuvant-related syndrome. Rev Neurol (Paris). 2003;159:162-164. PMID 12660567
  26. Crépeaux G, Eidi H, David MO et al. Non-linear dose-response of aluminium hydroxide adjuvant particles: Selective low dose neurotoxicity. Toxicology. 2017;375:48-57. PMID 27908630
  27. Luján L, Pérez M, Salazar E et al. Autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA syndrome) in commercial sheep. Immunol Res. 2013;56:317-324. PMID 23579772
  28. eg, Bhattacharjee S, Zhao Y, Hill JM et al. Selective accumulation of aluminum in cerebral arteries in Alzheimer’s disease (AD). J Inorg Biochem. 2013;126:35-37. PMID 23764827
  29. Masson JD, Thibaudon M, Bélec L, Crépeaux G. Calcium phosphate: a substitute for aluminum adjuvants. Expert Rev Vaccines. 2017;16:289-299. PMID 27690701
  30. Bagus P, Peña-Ramos JA, Sánchez-Bayón A. COVID-19 and the Political Economy of Mass Hysteria. Int J Environ Res Public Health. 2021;18:1376. PMID 33546144
  31. “The richest 660 people in the US have collected a $1.1tn (£800bn) “windfall of wealth” since the coronavirus pandemic began, according to a report by a US progressive thinktank, the Institute for Policy Studies.
    The report found that the collective wealth of America’s 660 billionaires has risen by 39% since the World Health Organization declared that Covid-19 was a pandemic virus in March 2020.
    The billionaires’ combined wealth has increased from just under $3tn on 18 March 2020 to $4.1tn, according to Forbes magazine data. The report noted that there had also been “46 newly minted billionaires since the beginning of the pandemic”, when there were 614.” https://www.theguardian.com/business/2021/jan/26/us-billionaires-have-received-11tn-windfall-in-covid-pandemic
    Globally, “The world’s 2,365 billionaires enjoyed a $4 trillion boost to their wealth during the first year of the pandemic, increasing their fortunes by 54%” (https://www.cbsnews.com/news/billionaire-wealth-covid-pandemic-12-trillion-jeff-bezos-wealth-tax/)

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