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Demystifying Aluminum Adjuvants in Vaccines: Understanding Their Safety and Efficacy

Physicians for Informed Consent has recently published an image on LinkedIn showing the comparative amounts of aluminum adjuvant in various vaccine doses. However, the image is misleading. Notice that the Pediarix vaccine is shown filled to the brim with aluminum. This obviously is not accurate. It gives the idea that the Pediatix vaccine dose is 100% aluminum and has zero vaccine formulation. This is obviously ridiculous.

The numbers, as seen in the left portion of the image show that these levels are in micrograms. This is one-billionth of a gram. In fact, this is such a small quantity, that if we to show the actual vaccine contents and the aluminum dose in the same image, you wouldn't be able to see the aluminum amount. It's that small.


What is an adjuvant and why is it used?

An adjuvant is a substance that is added to vaccines to enhance the body's immune response to the vaccine's antigen, the component that triggers an immune reaction (Plotkin, Orenstein, & Offit, 2018). Adjuvants are used to improve the vaccine's efficacy and, in some cases, to reduce the amount of antigen needed for each dose, allowing for more efficient use of resources.

Adjuvants work by stimulating the immune system in several ways, such as:

  1. Prolonging the presence of the antigen: Adjuvants can help slow down the release of the antigen, giving the immune system more time to recognize it and develop a response.

  2. Enhancing antigen uptake: Some adjuvants can promote the uptake of the antigen by immune cells, which can help kick-start the immune response more effectively.

  3. Activating immune cells: Adjuvants can stimulate immune cells to produce a more potent response, resulting in a stronger and longer-lasting immunity.

  4. Promoting a specific type of immune response: Depending on the adjuvant used, it can help direct the immune system to develop a more appropriate and effective response to a particular pathogen.

The use of adjuvants in vaccines has been an essential tool in improving their effectiveness, especially for infections that are difficult to prevent or control with vaccines alone. Some widely used adjuvants include aluminum salts, oil-in-water emulsions, and TLR (Toll-like receptor) agonists.


Why is aluminum used?

Aluminum is used in vaccines as an adjuvant because it has a long history of safety and effectiveness in enhancing the immune response (HogenEsch, 2013). Aluminum salts, such as aluminum hydroxide, aluminum phosphate, or aluminum potassium sulfate (alum), are the most common forms used in vaccines. The use of aluminum as an adjuvant dates back to the 1920s, and it is currently found in many vaccines, including those for diphtheria, tetanus, pertussis, hepatitis A and B, and human papillomavirus (HPV).

Aluminum adjuvants work through several mechanisms:

  1. Antigen depot effect: When aluminum salts are mixed with the antigen, they form a precipitate, which can prolong the release of the antigen at the injection site. This sustained release allows the immune system more time to interact with the antigen and mount a stronger response.

  2. Activation of immune cells: Aluminum adjuvants can stimulate the recruitment and activation of immune cells, such as macrophages and dendritic cells, at the injection site. These cells engulf the antigen and present it to other immune cells, initiating a more robust immune response.

  3. Promotion of specific immune responses: Aluminum adjuvants can also help direct the immune system towards a stronger antibody-mediated response, which is particularly useful for protecting against extracellular pathogens like bacteria and some viruses.

Are aluminum adjuvants safe?

Aluminum adjuvants have been used in vaccines for nearly a century, and their safety has been well-established through extensive research and regulatory oversight (World Health Organization [WHO], 2008). The World Health Organization, a leading authority on global health, has affirmed that aluminum adjuvants have a long history of safe and effective use in vaccines (WHO, 2008). Similarly, the Centers for Disease Control and Prevention (CDC) has confirmed the safety of aluminum adjuvants in vaccines, providing a comprehensive overview of their use and safety (CDC, 2020).


Research conducted by the US Food and Drug Administration (FDA) supports the safety of aluminum adjuvants, with a study on updated aluminum pharmacokinetics following infant exposures through diet and vaccination demonstrating no cause for concern (Mitkus et al., 2011). The European Medicines Agency (EMA), responsible for the evaluation and supervision of medicines in the European Union, has also endorsed the safety of aluminum adjuvants in vaccines, providing additional reassurance to the public and healthcare providers (EMA, 2011).


A systematic review of the safety of aluminum-containing diphtheria, tetanus, and pertussis (DTP) vaccines was conducted by Jefferson et al. (2004), which concluded that there is no evidence to suggest that aluminum adjuvants in vaccines cause harm. This comprehensive analysis of the available literature adds further support to the consensus among the scientific community and regulatory agencies on the safety of aluminum adjuvants in vaccines.


In conclusion, aluminum adjuvants have been extensively studied and found to be safe for use in vaccines by leading health organizations and regulatory authorities, including the WHO, CDC, FDA, and EMA (WHO, 2008; CDC, 2020; Mitkus et al., 2011; EMA, 2011). The results of systematic reviews, such as the one conducted by Jefferson et al. (2004), lend further credibility to the safety of aluminum adjuvants in vaccines. These findings provide a strong basis for the continued use of aluminum adjuvants to enhance the efficacy of vaccines and protect public health.


References:

Centers for Disease Control and Prevention. (2020). Vaccine Adjuvants. https://www.cdc.gov/vaccinesafety/concerns/adjuvants.html


European Medicines Agency. (2011). Aluminum in vaccines. https://www.ema.europa.eu/en/documents/leaflet/aluminium-vaccines-background-information_en.pdf


HogenEsch, H. (2013). Mechanism of immunopotentiation and safety of aluminum adjuvants. Frontiers in Immunology, 3, 406. https://doi.org/10.3389/fimmu.2012.00406


Jefferson, T., Rudin, M., & Di Pietrantonj, C. (2004). Adverse events after immunisation with aluminium-containing DTP vaccines: systematic review of the evidence. The Lancet Infectious

Diseases, 4(2), 84-90. https://doi.org/10.1016/S1473-3099(04)00927-2


Mitkus, R. J., King, D. B., Hess, M. A., Forshee, R. A., & Walderhaug, M. O. (2011). Updated aluminum pharmacokinetics following infant exposures through diet and vaccination.

Vaccine, 29(51), 9538-9543. https://doi.org/10.1016/j.vaccine.2011.09.124


Plotkin, S. A., Orenstein, W. A., & Offit, P. A. (Eds.). (2018). Plotkin's Vaccines (7th ed.). Elsevier.


World Health Organization. (2008). Global Advisory Committee on Vaccine Safety, 10-11 December 2008. Weekly Epidemiological Record, 84(2), 17-24. https://www.who.int/vaccine_safety/committee/reports/wer8402.pdf?ua=1

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