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Respecting the Immune Ecosystem—Slide-by-Slide Written Transcript

Respecting the Immune Ecosystem

Concerns of an Immune System Ecologist

Rob Rennebohm, MD

May 28, 2023

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Slide 1:

Hello. I’m Dr. Rennebohm. Welcome to this COVID-19 presentation, which is entitled: Respecting the Immune Ecosystem—Concerns of an Immune System Ecologist.

Before we get started, allow me to briefly introduce myself. I am a pediatrician and pediatric rheumatologist. Rheumatology focuses on autoimmune diseases and study of the immune system. I have been a pediatrician for over 50 years and a pediatric rheumatologist for 43 years. Throughout the past three years I have been intensively studying and writing about the COVID-19 pandemic—because, early on, I realized that COVID-19 issues were extremely complex and the science needed to be explained to the public as clearly, accurately, honestly, and helpfully as possible. And that is what I have tried to do.

The major theme of this presentation is that it is important to view the immune system—both our individual immune systems and our collective immune systems—both in humans and in non-human species—as precious, complex ecosystems,

and it is important to view the COVID-19 situation, particularly the mass vaccination campaign, through the lens of a concerned immune system ecologist.

Slide 2:

This requires a deep appreciation of the complexity, genius, beauty, and delicacy of our individual and collective immune ecosystems; a deep appreciation of the dynamic interplay between the immune system and viruses—at both the individual level and the population level; and a deep appreciation of how certain approaches to vaccination can adversely affect that interplay.

Slide 3:

And it requires a commitment to protect the immune ecosystem from harmful human interventions. If we choose to interact with the immune ecosystem, we must do so carefully and respectfully, even reverently, not recklessly or arrogantly.

Slide 4:

Primarily, this presentation represents a review of Dr. Geert Vanden Bossche’s concerns about the COVID-19 mass vaccination campaign—concerns that he has extensively explained in a recently published book: The Inescapable Immune Escape Pandemic. In his book Dr. Vanden Bossche shares an extraordinarily deep and wise understanding of the immunology, virology, vaccinology, evolutionary biology, physical chemistry, glycosylation biology, and immune system ecology involved in the COVID-19 situation. Optimal understanding of the COVID-19 pandemic requires expertise in all of these fields.

In this presentation I will summarize my understanding of Dr. Vanden Bossche’s most important insights, concerns, and hypotheses.

First, I will briefly summarize his conclusions. Then, I will explain why he has come to those conclusions.

Slide 5:

According to the leaders of the prevailing COVID-19 narrative and its mass vaccination campaign, the pandemic is currently subsiding; coming under good control; heading into a relatively harmless endemic phase; the Omicron variants are causing milder, less threatening illness; and the pandemic can be kept under control with further periodic “updated” vaccination. According to their promoters, the vaccines have been necessary, wise, effective, sufficiently safe, and have saved millions of lives.

Slide 6:

Dr. Vanden Bossche disagrees. According to his understanding of the science involved, we have (in recent months) been experiencing a falsely reassuring “calm before the storm.” In his view, this “calm” is due to several partially protective immune system adjustments, including a virulence-inhibiting mechanism, that, however, are weak, fragile, unstable, unsustainable, and ultimately unhealthy; and these adjustments are at high risk of being overcome by a new SARS-CoV-2 (SC-2) variant that will be resistant to the just-mentioned virulence-inhibiting mechanism—a mechanism that I will explain later. Dr. Vanden Bossche worries that this highly virulent variant may cause a catastrophic number of hospitalizations and deaths, primarily in heavily vaccinated individuals.

Slide 7:

The over-arching theme of his book is that it is a huge mistake to try to end an active pandemic like the COVID-19 pandemic by implementing, in the midst of that pandemic, a mass vaccination campaign (across all age groups) that uses vaccines (like the COVID-19 vaccines) that do not adequately prevent replication and transmission of the virus, do not produce sterilizing immunity, and, thereby, do not contribute to herd immunity. Never before, in the history of medicine, have we made this mistake—and for good reasons.

Slide 8:

Such a mass vaccination campaign puts tremendous immune pressure on the virus, at a population level, and predictably results in a prolonged series of new dominant “immune escape” variants, each being more infectious and more vaccine-resistant than its predecessors; and is highly likely to eventually result in the emergence of a SARS-CoV-2 variant that is more virulent than all predecessors.

Slide 9:

Dr. Vanden Bossche emphasizes that the immune system is a complex, well-balanced natural ecosystem that is constantly engaged in dynamic interactions with viruses, at a population level—interactions that are always changing, as the virus forces reactions by the immune system, which are followed by counter-reactions by the virus, which are followed by counters to those counter-reactions—a continuing series of well-controlled, well-balanced moves and counter-moves, many of which are predictable.

Slide 10:

These moves and countermoves represent natural, expected reactions that are determined by well-established physical laws of nature—examples being “steric hindrance,” “competitive binding,” “conformational changes,” other laws of physical-chemistry, and the Darwinian principle of natural selection associated with “fitness advantage.”

Slide 11:

Instead of having normal interactions between the virus and the immune system, mass vaccination in the midst of an active pandemic puts abnormal pressure on the interplay between the virus and the immune system and generates a more chaotic, complex, and prolonged series of unnatural and unstable interactions—particularly at the population level.

His point is that an unwise mass vaccination campaign can adversely affect the normal interplay between the immune system and the virusaltering both the natural evolution of the immune response and the natural evolution of the virus—replacing both with unnatural, worrisome evolutions.

Slide 12:

In other words, the immune system is forced to do things it would not otherwise need to do (and, by the way, becomes less able to do what it normally needs to do) and the virus evolves to develop characteristics it otherwise would not have developed. The result is a predictable and harmful cascade of adverse events.

Slide 13:

According to Dr. Vanden Bossche’s analysis, this cascade involves the sequence of events that are briefly summarized on this slide and will be discussed in more detail on subsequent slides:

  • First, the mass vaccination campaign induces production of (potentially) neutralizing antibodies (NAbs), which ultimately fail (due to predictable “immune escape”) and become not only obsolete, but also problematic.
  • The mass vaccination campaign also induces production of polyreactive non-neutralizing antibodies (PNNAbs), which:
    • on the one hand, are “infection-enhancing” (because they facilitate entry of virus into host cells, as I will show later)
    • but, on the other hand, are “virulence-inhibiting,” (as I will also show later)
  • These vaccinal antibodies “sideline” the extremely important innate immune system
  • The combination of infection enhancing PNNAbs and sidelining of innate immunity results in recurrent “breakthrough infections (BTI),” particularly in vaccinees
  • To deal with recurrent BTIs, MHC class I-unrestricted cytolytic T lymphocytes (CTLs) are then excessively activated in a heroic effort to kill virus-infected cells
  • Also, and this is particularly important, Steric Immune Refocusing (SIR) occurs and results in a vast array of new, broadly-neutralizing, less variant-specific, low-affinity, short-lived, relatively weak, sub-optimal antibodies—which provide some temporary weak protection but result in more immune pressure on the virus.
  • Ultimately, a variant that is able to overcome the virulence-inhibiting effect of the PNNAbs emerges and may become extremely threatening.

Let’s review each of these events separately.

Slide 14:

This slide shows the spherical SARS-CoV-2 virus (far left) with its many spike proteins (in red) on the surface of the virus. On the right is a more accurate image of the spike protein (in red and pink) with its receptor binding domain (RBD) (in pink) attached to the ACE-2 receptor (in blue), which is located on the surface of the human host cell that the virus targets for infection. When this attachment of the RBD to the ACE-2 receptor is successful, “the door to the cell is opened” and the entire virus can enter and infect the cell.

Slide 15:

The COVID-19 vaccines are specifically designed to induce the human immune system to produce “neutralizing antibodies” that attach to the RBD and prevent it from fitting into the ACE-2 receptor—thereby, preventing the virus from “opening the door” and entering (infecting) the human (host) cell.

On the right, is a neutralizing antibody (Fab 2-4, in blue) that has attached to the RBD (in green) This blocks the RBD from successfully attaching to the ACE-2 receptor (in purple-blue), thereby preventing infection of the cell.

On the left, the RBD of the spike protein (in green) has successfully attached to the ACE-2 receptor (in purple-blue). This allows the virus to enter and infect the cell.

Slide 16:

So, neutralizing antibodies “neutralize” the virus by blocking attachment of RBD to the ACE-2 receptor on host cells.

On the left, a neutralizing antibody has attached to the RBD of the spike protein. This prevents the RBD from attaching to the ACE-2 receptor which is on the surface of the human cell. This prevents the human cell from becoming infected. Note that neutralizing antibody has attached to most of the spike proteins on the surface of the SARS-CoV-2 virus.

On the right is another depiction of how neutralizing Ab blocks attachment of the RBD to the ACE-2 receptor. When neutralizing Ab is attached to the RBD, attachment of the RBD to the ACE-2 receptor is unsuccessful. Without neutralizing Ab attached to it, the RBD successfully fits into the ACE-2 receptor

Slide 17:

It is important to know that the RBD can, conformationally, flip between an “open” position and a “closed” position.

When the RBD (in teal blue) is in the “open position,” it easily fits into the ACE-2 receptor (in brown). When the RBD is in the “closed position,” it does not easily fit and the virus does not easily enter human cells.

The relevance of this will become clear later.

Slide 18:

Unfortunately, it takes time (a few weeks) for neutralizing antibodies to fully mature and become optimally neutralizing. In the meantime, immature neutralizing antibodies are sub-optimally neutralizing. They bind only weakly to the RBD and, thereby, only partially and inadequately block the RBD from attaching to the ACE-2 receptor—i.e., they do not adequately prevent infection.

Although the immature suboptimal neutralizing antibodies do not adequately prevent infection, they at least make it more difficult for virus to enter cells—i.e., they put immune pressure on the virus.

During an active pandemic, a large amount of virus is circulating in populations. If those populations are highly and recently vaccinated, the virus will frequently encounter immature, suboptimal neutralizing antibodies—antibodies that predictably force the natural selection of more fit viral variants—variants that are resistant to these sub-optimal neutralizing antibodies.

Slide 19:

Viruses are always mutating.

Eventually, and predictably, a mutation is likely to occur that enables a viral variant to overcome (escape) the suboptimal neutralizing antibodies.

A viral variant with a mutation(s) that enables it to overcome these suboptimal neutralizing antibodies (which are widely present in highly vaccinated populations) will more easily thrive than variants without this mutation. This new variant will have a survival advantage over variants without this mutation. This will enable the new variant to become the dominant variant.

This variant is not only able to escape the immature, weakly binding, suboptimal neutralizing antibody, it will also be able to escape the mature neutralizing antibody, once that antibody appears. That is, by the time the mature neutralizing antibody appears, a viral variant has already emerged that is resistant to (is unaffected by) that mature neutralizing antibody.

Slide 20:

If vaccine-induced neutralizing antibodies were fully capable of blocking entry of virus into cells, thereby, fully preventing infection and transmission,

AND, more importantly, if these antibodies were to reach maturity before vaccinated people ever encountered the SARS-CoV-2 virus (i.e., if the vaccine were being used prophylactically, before the pandemic has started),

Then, these vaccinal neutralizing antibodies would be truly effective!!

But they are not being used prophylactically. They are being used in the midst of an active pandemic, and this predictably results in the emergence and dominant propagation of variants that are able to escape (are resistant to) both immature and mature neutralizing antibodies.

Slide 21:

So, one of the first things that predictably happened after initiation of the COVID-19 mass vaccination campaign in the midst of an active pandemic is that, at a population level, the sub-optimal immature vaccine-induced neutralizing antibodies created pressure that promoted the natural selection of variants that were resistant to these neutralizing antibodies, including the eventual mature neutralizing antibodies. Accordingly, and predictably, these mature neutralizing antibodies quickly became ineffective and obsolete. Dr. Vanden Bossche predicted this immune escape, and that is exactly what happened.

Slide 22:

A next thing that predictably happens is that, in addition to producing neutralizing antibodies against the RBD, vaccinated individuals soon produce polyreactive non-neutralizing antibodies (PNNAbs) against the spike protein of the SARS-CoV-2 virus. These PNNAbs attach to a different part of the spike protein—namely, the N-terminal domain, rather than the receptor-binding domain.

Slide 23:

This slide shows, on the right, a vaccine-induced PNNAb (in blue, Fab 4-8) attached to the NTD (brown) of the spike protein. On the left is a vaccine-induced neutralizing antibody (Fab 2-4, in blue) attached to the RBD (green) of the spike protein.

Slide 24:

PNNAbs are “infection-enhancing.” When a PNNAb (in blue, FAB-4-8) attaches to the NTD it causes a conformational change in the spike protein that flips the RBD into its “open position,” thereby enabling the RBD of the spike protein to more easily fit into the ACE-2 receptor of human cells. This results in the virus becoming more infectious (better able to enter human cells). This phenomenon comes into play and becomes particularly important when the vaccinal neutralizing antibody levels fall below a certain level.

Whereas vaccinal neutralizing antibodies (Fab 2-4) block attachment of the RBD to the ACE-2 receptor (thereby inhibiting viral infection of host cells), PNNAbs (Fab 4-8) enhance attachment of the RBD to the ACE-2 receptor (thereby promoting infection of host cells). So, PNNAbs are infection-enhancing.

Slide 25:

This slide (in the right panel) shows how the PNNAb, when it is bound to the NTD, flips the RBD into the “Open position,” thereby enhancing infectiousness of the virus. That is, PNNAbs are “infection-enhancing. In the left panel, the RBD is in the closed position, rendering it unable to bind to the ACE-2 receptor.

Slide 26:

So far, we have seen that the vaccinal neutralizing antibodies quickly became obsolete— because “immune escape” variants predictably emerged that were resistant to those antibodies; and the PNNAbs are making the virus more infectious. This combination is not good.

Slide 27:

These “infection-enhancing” PNNAbs, however, have a temporary, beneficial, protective effect—a “virulence inhibiting” effect. Normally, when a respiratory virus enters the upper respiratory tract, some of that viral load is absorbed onto the surface of migratory dendritic cells. This slide shows migratory dendritic cells.

Slide 28:

This slide shows dendritic cells with SAR-CoV-2 virus tethered to them. These virus-laden dendritic cells then migrate down to the lower respiratory tract (and other internal organs), where the virus is released and infects cells in the lower respiratory tract (LRT) and distal organs, often resulting in severe disease (e.g., severe, life-threatening pneumonia). PNNAbs have the capacity to inhibit this process of dendritic cell-mediated infection of the lower respiratory tract. They do so by binding to the virus that is tethered to the surface of the dendritic cells, thereby inhibiting transfer of the virus from dendritic cells to host cells in the LRT and other internal organs.

Slide 29:

This slide schematically depicts a PNNAb attached to SARS-CoV-2 virus that is tethered to a dendritic cell.

This binding inhibits transfer of the virus to host cells in the lower respiratory tract and other distal organs. That is, the vaccinal PNNAbs are “virulence-inhibiting.” Via this mechanism they are at least modestly protective against severe disease and death.

Slide 30:

So, the PNNAbs induced by vaccination have an undesirable “infection-enhancing” effect on the one hand but also have a protective “virulence-inhibiting” effect on the other hand.

Slide 31:

However, as we will discuss again later, Dr. Vanden Bossche thinks it is highly likely that a viral variant will eventually emerge that is capable of overcoming this virulence-inhibiting effect of the PNNAbs. He hypothesizes that such a variant will do so by developing a glycosylation change that renders it resistant to the virulence-inhibiting effect of the PNNAbs. In this slide I have schematically depicted that glycosylation change as a change from “red” glycosylation to “yellow” glycosylation More on this later.

Slide 32:

A next important concept is that vaccinal antibodies, unfortunately, “sideline” the extremely important innate immune system—specifically, cell-based components of the innate immune system—namely, NK cells (natural killer cells) and natural antibodies.

Slide 33:

Remember, there are two main arms of the immune system—the innate arm and the adaptive arm. The innate immune system is the “first responder.” It quickly senses danger and rapidly attacks an invading virus (or other pathogen). The adaptive arm reacts more slowly and more specifically. It is the adaptive arm that produces virus-specific antibodies, including vaccine-induced antibodies against the SARS-CoV-2 virus.

Often, the innate immune system is able to completely eliminate the pathogen without needing to recruit the adaptive arm for help. It is important to know that the COVID-19 vaccines train the adaptive arm but do not train the innate arm. In fact, as I will explain in a minute, the COVID-19 vaccines sideline cell-based components of the innate immune system.

Two key components of the innate arm are natural killer (NK) cells and innate (“natural”) antibodies. These are cell-based components of the innate immune system. The NK cells quickly kill virus-infected cells, thereby killing the virus within those cells.

Natural antibodies participate in the rapid clearance of virus (or other pathogen). Also, in young children, binding of natural antibodies to viruses is a necessary and extremely important step in the normal foundational education of a young child’s innate immune system—most importantly, education of its NK cells—education that teaches NK cells what cells to attack (e.g., infected cells and malignant cells) and what cells to leave alone (healthy cells). Young children, in particular, need to initially educate and subsequently further train their innate immune system, which requires interaction of natural antibodies with viruses; and young children, in particular, rely heavily on their innate immune system to initially clear a viral load.

So, the last thing we would want to do is sideline the cell-based innate immune system, particularly in young children.

Slide 34:

But that is what the vaccinal antibodies do.

In adolescents and adults, the enhanced viral infectiousness associated with the PNNAbs expedites the onset of viral replication, hampers stimulation of NK cells, and, thereby, largely sidelines the cell-based innate immune system.

In young children, the vaccinal antibodies more directly sideline the innate immune system. The vaccinal antibodies outcompete the innate immune system’s natural antibodies for binding sites on the spike protein.

Slide 35:

Natural (innate) Abs bind only weakly to binding sites on the spike protein, whereas vaccinal neutralizing Abs and vaccinal non-neutralizing Abs bind much more strongly to their respective binding sites. (Mature neutralizing antibodies bind particularly strongly to binding sites.) Accordingly, natural Abs are outcompeted for binding on spike protein binding sites. They are left unable to successfully bind to the virus. They are sidelined—unable to interact normally with the virus.

Slide 36:

When its natural antibodies are unable to bind to the spike protein of the SARS-CoV-2 virus, the innate immune system is not only excluded from participation in the rapid clearance of that virus, but also loses opportunity for education and training of its NK cells.

So, sidelining of the cell-based innate immune response is a profoundly serious adverse effect of the vaccinal antibodies, especially in young children.

Slide 37:

It follows that this sideling of the innate immune system predisposes vaccinated individuals to develop recurrent SARS-CoV-2 break-through infections (BTI), either because of infection-enhancing PNNAbs (in the case of adolescents and adults) or because vaccinal antibodies outcompete broadly neutralizing natural antibodies (i.e. in the case of young children).

Slide 38:

To deal with recurrent BTIs, the immune system is forced to enhance activation of MHC class I-unrestricted cytolytic T lymphocytes (CTLs, for short). These CTLs (probably a subset of NK-CTLs) efficiently kill virus-infected cells. Their sustained activation decreases viral shedding and transmission and contributes to protection against COVID-19 disease.

Slide 39:

This and the next two slides depict how CTLs kill virus-infected cells and, thereby, the virus within those cells. The blue-purple cells are healthy cells. The brown and yellow-green cells are virus-infected cells. The large green cells are CTLs.

Slide 40:

In this slide a CTL has recognized and approached a virus-infected cell. The CTL contains toxic granules

Slide 41

The CTL perforates the virus-infected cell and empties its toxic granules into that cell. The toxic granules kill the virus-infected cell and in the process kill the virus (which depends on the cell being alive). NK cells use a similar mechanism to kill infected cells.

Slide 42:

Despite the infection-enhancing effects of the vaccine-induced PNNAbs and the resultant predisposition to recurrent BTIs, the combination of the PNNAB’s virulence-inhibiting effect and the heroic activation of CTLs provides at least modest protection from (severe) disease and reduces transmission of the virus (the latter occurring primarily because the CTLs are killing viral infected cells). At least, viral transmission is made more difficult—i.e., transmission is thwarted. However, this virulence-inhibiting protection (by PNNABs) is only temporary and the protection from frequently activating CTLs is ultimately unsustainable and unhealthy.

Slide 43:

Dr. Vanden Bossche hypothesizes that another important set of moves and countermoves that then occurs is the phenomenon of steric immune refocusing (SIR)*: Despite the fact that the original vaccinal neutralizing antibodies (e.g., to the Wuhan strain) are no longer able to neutralize the RBD of new, prevailing variants (because of “immune escape” mutations that have developed in the spike protein), these original neutralizing antibodies, nevertheless, still bind to the RBD of the new variant. This, sterically, masks (covers) that part of the spike protein, shields it from the immune system, and re-directs the immune system to produce neutralizing antibodies against a different unmasked, unshielded part of the spike protein—namely, epitopes within the N-terminal domain of the spike protein, which is a more conserved and less variable part of the spike protein.

For example, an original neutralizing Ab to what we will call “epitope A” becomes obsolete, but nevertheless still binds to and masks that region, thereby shielding it from the immune system. This re-directs the immune system to focus on “epitope B.” Then, neutralizing antibodies to epitope B become obsolete, but still bind to and mask that region, forcing the immune system to now focus on “epitope C”—and so on.

This re-direction of the immune system’s antibody response is referred to as “steric immune refocusing (SIR).” It is triggered by “steric hindrance,” a physical-chemistry phenomenon.

SIR is a newly recognized and under-appreciated phenomenon. In essence, it represents immune refocusing due to steric hindrance.

*the word “steric” refers to the spatial arrangement of atoms in a molecule, especially as it affects chemical reactions. Steric changes (changes in spatial arrangements) can result in “steric hindrance” of chemical reactions.

Slide 44:

SIR results in production of new broadly neutralizing, less variant-specific, low-affinity, short-lived, relatively weak, sub-optimal antibodies that temporarily hamper the virus and thwart viral transmission. That is, SIR results in the immune system developing some new modest partial (suboptimal) neutralizing protection. This partially compensates for the loss of the neutralizing effect of the original, stronger vaccinal neutralizing antibodies (to the RBD of the spike protein).

Slide 45:

But this move by the immune system is countered by the emergence and dominant propagation of SARS-CoV-2 variants that are resistant to these new suboptimal SIR-created broadly neutralizing antibodies. In fact, the intense immune pressure that SIR-created antibodies place on the virus, at a population level, eventually spawns a vast array of many new SARS-CoV-2 variants and subvariants that are highly infectious—more infectious than all predecessors—and are resistant to the COVID-19 vaccines and to the COVID-19 monoclonal antibodies. This is what has been happening since onset of the Omicron era. This is why there have been so many Omicron variants and sub-variants.

Slide 46:

Despite the new protection provided by SIR-created broadly neutralizing antibodies, the net effect of SIR is an escalation of immune pressure, an escalation of immune escape, emergence of many new variants, increased infectiousness of the new variants, an escalation of BTIs, and, therefore, more sidelining of the innate immune system. It was during this Omicron era that the pace of immune escape escalated and the pandemic evolved into a self-catalyzing “inescapable immune escape pandemic.”

Slide 47:

The current COVID-19 situation is one of large-scale immune escape. This slide briefly summarizes what I am about to explain at considerable length.

We are dealing with the emergence and co-circulation of many Omicron variants that are intrinsically highly infectious and resistant to vaccine-primed antibodies, while at the same time the immune system is using PNNAbs in an effort to reduce disease severity. Enhanced intrinsic infectiousness combined with strongly diminishing neutralization capacity has resulted in the enhanced activation of MHC class I-unrestricted CTLs that we discussed earlier. These CTLs, in particular, are thwarting shedding of the virus—not preventing transmission, but significantly thwarting transmission. The net effect of these most recent immune system adjustments is that the virus, despite being highly infectious (intrinsically), is now having a difficult time replicating and propagating via transmission from one person to another. Its transmission is being thwarted—again, not prevented, but significantly thwarted.

When viral replication and transmission (from one infected person to another person) is, thusly, being thwarted, then one of two things has to happen in order for the virus to thrive: either a SARS-CoV-2 variant must emerge that has a capacity to prevent CTLs from thwarting viral transmission; or a SARS-CoV-2 variant must emerge that has a capacity to overcome the virulence-inhibiting effect of the PNNAbs. The “first variant” (one that is able to overcome CTL-mediated reduction of transmissibility) would quickly become extinct, because it would quickly cause massive lethal infection—i.e., too many hosts would quickly die and the virus would quickly die out as a result. The “second variant” (one that overcomes the virulence inhibiting effect of the PNNAbs) would be relatively less lethal (compared to the first variant) or at least less quickly lethal and this would at least delay the virus’s extinction—because the virus would be able to replicate extensively by spreading within the body of its host (within the lower respiratory tract and other organs), as opposed to depending on replicating via transmission to new hosts. In other words, the second variant, compared to the first variant, would be capable of considerable viral replication within the lower respiratory tract and other organs of the person infected, and this would, thereby, partially compensate for thwarted person-to-person transmission.

Dr. Vanden Bossche emphasizes that at this point in the pandemic, the mass vaccination campaign is placing immense immune pressure on the virus, at a population level, to develop this second type of SARS-CoV-2 variant (one that escapes the virulence inhibiting effect of the PNNAbs). Indeed, some recent variants have already been shown to be more virulent in vitro. Dr. Vanden Bossche anticipates that a new more virulent SARS-CoV-2 variant will emerge, will thrive better than all other variants, and will, thereby, become the dominant variant, at least in some populations.

Slide 48:

Dr. Vanden Bossche has, therefore, concluded that the next and ultimate step in the cascade of adverse events triggered by the mass vaccination campaign will be emergence of the second type of SARS-CoV-2 variant(s) and that this will occur soon. Namely, he predicts that a SARS-CoV-2 variant will soon emerge that is capable of escaping from the virulence-inhibiting effect of the PNNABs—due to altered glycosylation characteristics of the variant. This variant will be better able to carry out dendritic cell-mediated trans-infection of host cells in the lower respiratory tract and distant organs. This variant will flourish and replicate in the lower respiratory tract. This variant will, thereby, be more intrinsically virulent (than all predecessors) and will cause much more severe disease (severe pneumonia, with syncytia formation). This development on the part of the virus will ultimately fail the virus, if the virus is so virulent that it kills those whom it infects. But this development will delay extinction of a virus whose opportunity to replicate via transmission (from one person to another) is currently being thwarted.

Slide 49:

Dr. Vanden Bossche’s greatest fear is that this more virulent variant will have the potential to cause a catastrophic number of hospitalizations and deaths, particularly in highly vaccinated populations, particularly in people who have received multiple doses of a COVID-19 vaccine. Highly vaccinated people will be particularly vulnerable because:

  • Their vaccinal neutralizing antibodies will not work
  • Their PNNAbs will continue to be “infection-enhancing”
  • Their PNNAbs will no longer be “virulence-inhibiting”
  • Their cell-based innate immunity has been sidelined and become unpracticed
  • Their weak SIR-created neutralizing antibodies will be ineffective
  • Their reliance on MHC class I unrestricted CTLs is unsustainable and unhealthy
  • Their immune system, overall, is prone to exhaustion and dysregulation
  • For all these reasons, Dr. Vanden Bossche worries that they will be at risk for severe disease and death

Slide 50:

Healthy, unvaccinated people, on the other hand, will be expected to do well, because their innate immune systems have not been sidelined by COVID-19 vaccination and, on the contrary, have been increasingly trained to broadly resist a diversified spectrum of highly infectious variants; furthermore, unvaccinated individuals do not have problematic levels of infection-enhancing PNNAbs; their immune systems are not exhausted and have not become dysregulated; and their immune systems have been left intact, able to make appropriate adjustments.

Our hope is that the COVID-19 pandemic will somehow miraculously subside before a highly virulent variant has a chance to emerge and become dominant—or that new, more virulent variants will be only moderately more virulent (at most) as opposed to catastrophically more virulent. While holding onto these hopes, we must anticipate and prepare for the more likely scenario of a potentially catastrophic surge of a highly virulent variant.

Slide 51:

For completeness, we should mention a few other adverse disturbances of the immune ecosystem that the COVID-19 mass vaccination campaign has caused. The sidelining of the innate immune system not only hampers the immune system’s ability to fight off SARS-CoV-2 infection, but also diminishes a vaccinated person’s first line of defense against other viruses, predisposes the vaccinee to autoimmunity, and impairs the immune system’s cancer surveillance efforts (which predisposes vaccinated people to development of malignancy). I worry that young children may be particularly vulnerable to these adverse effects. That is why, as a pediatrician and a grandfather, I have particularly wanted to protect children from the COVID-19 vaccines. Furthermore, as already mentioned, the frequent, almost constant activation of CTLs (provoked by BTIs) ultimately predisposes to “immune exhaustion” and escalating immune dysregulation.

Slide 52:

For completeness it is also important to emphasize that the above-mentioned cascade of adverse changes in the immune ecosystem and in the virus would not have occurred in the absence of the COVID-19 mass vaccination campaign. If the COVID-19 pandemic had not been managed with the COVID-19 mass vaccination campaign and, instead, had been managed by common sense protective measures, appropriate early anti-viral treatment, appropriate anticipatory hospital care, and reliance on the immune system to do what it knows to do, the following would have occurred:

The innate immune system would have been free to train such as to provide its optimal and great degree of broad protection. The adaptive immune system would have developed appropriate and effective antibodies to the virus. Trained innate immunity or the combination of trained innate immunity and antigen-specific antibodies would have generated sterilizing immunity in those people who had become significantly infected. This would have eventuated in herd immunity, which, in turn, would have ended the pandemic within 1-2 years—probably within 9 months.

Herd immunity is what ends a pandemic. The only way to achieve herd immunity is to achieve sterilizing immunity in an adequately high percentage of the population. Since the COVID-19 vaccines cannot and do not cause sterilizing immunity, they cannot and do not contribute to herd immunity. In fact, the COVID 19 vaccines do the opposite. They interfere with development of herd immunity.

Slide 53:

Furthermore, in the absence of the mass vaccination campaign, dominant propagation of more infectious immune-escape variants would not have occurred. PNNAb-mediated enhancement of infection would not have occurred to a significantly harmful degree. BTIs would have been far less common and would not have led to SIR. Dominant SARS-CoV-2 variants would not have become more virulent than predecessors. And the immune ecosystem would not only have been left intact, but also would have become better trained (through practice) to flexibly deal with new SARS-CoV-2 variants and future similar viruses. The human immune ecosystem would have been left healthy and able to optimally carry out all of its many protective and regulatory functions.

Slide 54:

Yes, if the COVID-19 pandemic had not been managed with the COVID-19 mass vaccination campaign, a tragic but relatively low percentage (0.05-0.12%) of the population (primarily frail, vulnerable, elderly people) would have died (particularly if they were not provided with early anti-viral therapy and appropriate anticipatory hospital care)—probably a cumulative number, though, that is comparable to, or slightly higher than, the number of people who have died during recent annual influenza epidemics of above-average severity.

But this cumulative number would have been far less than the eventual cumulative number of deaths that will accrue as direct and indirect results of the unwise COVID-19 mass vaccination campaign—due to the phenomena explained in this presentation. I am not even counting the huge number of people who are being seriously harmed and have died or will die from vaccine injury—a separate issue about which I will comment in a minute.

History (if high quality data collection is permitted and honestly presented) will reveal that the COVID-19 mass vaccination campaign has transformed a natural COVID-19 pandemic (that would have been influenza-like and lasted less than 1-2 years) into a much more prolonged and dangerous COVID-19 “immune escape pandemic” that will cumulatively claim far more lives than the natural COVID-19 pandemic would have claimed if the COVID-19 mass vaccination campaign had never been implemented.

Slide 55:

In addition to the cumulative deaths that will occur because of the cascade of adverse events explained in this presentation, many people will be seriously injured and even killed by the vaccine itself—due, for example, to vaccine-induced:

Abnormal clotting/strokes

Vascular endothelial cell injury—in both the microvasculature and macrovasculature

A vast array of Neurologic complications


Sudden unexplained death—most likely due to vaccine-induced arrhythmia

Adverse effects on reproductive organs and successful pregnancy

Slide 56:

To highlight concerns about the adverse effects of the COVID-19 vaccine on the heart and brain at an individual level, allow me to share three sobering, but important, histopathological images from an article published by Dr. Michael Mörz, entitled: Multifocal Necrotizing Encephalitis and Myocarditis after BNT162-b2 mRNA (Pfizer) vaccination against COVID-19. It was an autopsy study published in the peer-reviewed journal Vaccines. To help non-physicians appreciate this article, I have summarized and explained it on my website: https://notesfromthesocialclinic.org/a-summary-for-the-general-public-and-commentary-regarding-the-publication-by-dr-michael-morz/

Slide 57:

I am sorry to be showing you these images, because I can appreciate how they are likely to be upsetting and stressful for vaccinated individuals to see, and for that reason I hesitate to show them. But I think it is important to know the truth about the potential risks of the COVID-19 mRNA vaccines. In fact, this information should be part of a proper informed consent process.

This image shows the abundant presence of vaccinal SARS-CoV-2 spike protein (the brown material, red arrow) within the wall of a capillary in the brain, as well as a smaller amount of vaccinal spike protein in the brain itself (blue arrow). The spike protein was conclusively documented to be of vaccinal origin (that is, produced by the mRNA vaccine) and not from natural SARS-CoV-2 infection. The slide also shows signs of mild inflammation in the vessel wall. A better example of this inflammation is shown on the next slide.

Slide 58:

This is a cross section through a capillary vessel showing intense inflammation of a blood vessel wall (vasculitis) in the brain. The many tiny blue cells that are present in the wall of the vessel indicate that the walls of this vessel are inflamed, which means the vessel is experiencing vasculitis. This vasculitis has been triggered by the abnormal presence of vaccinal spike protein in such vessels (as shown in the previous slide).

Slide 59:

This third slide shows the abundant presence of vaccinal spike protein (brown material, red arrow) in the wall of a capillary in the left ventricle of the heart—which led to vasculitis in the heart.

The extent to which versions of these phenomena are common in vaccinated individuals is unclear. VAERS data, honest clinical observations, and all-cause mortality data suggest that versions of these phenomena may occur with unacceptable frequency. We do not yet know. Unfortunately, the leaders of the COVID-19 mass vaccination campaign have not adequately studied the incidence, prevalence, and spectrum of these phenomena. These three images certainly should prompt the leaders of the COVID-19 mass vaccination campaign to think again about the wisdom of the mass vaccination campaign.

Slide 60:

Contrary to what the public was initially told, the mRNA injection does not just stay at the injection site. The mRNA travels to cells in virtually every organ in the body, including cells in the brain, heart, bone marrow, reproductive organs, and walls of blood vessels. And the affected cells continue to produce spike protein for an unclear (possibly long?) length of time.

Tragically, neither the short nor long-term safety of the COVID-19 vaccines were adequately studied or honestly presented to the public before roll-out of the vaccination campaign. In fact, serious side effects were deliberately hidden (a proven fact).

Slide 61:

Returning to Dr. Vanden Bossche’s book: What is responsible for the current “calm”?

Dr. Vanden Bossche does not think it is due to the virus becoming milder, less virulent, heading into endemicity.

He thinks it is due to several temporary, partially protective, unstable immune adjustments that the immune system has made, namely:

  • The virulence-inhibiting effect of PNNAbs
  • Activation of MHC class 1-unrestricted CTLs
  • SIR created broadly reactive neutralizing Abs

Slide 62:

Which are the three immune adjustments we have highlighted in this presentation: The virulence-inhibiting effect of PNNAbs, the activation of CTLs, and the SIR phenomenon

Slide 63:

But, according to Dr. Vanden Bossche, this is the “calm before the storm”

  • A variant will emerge that will overcome the “virulence-inhibiting” effect of the PNNAbs and could cause catastrophic harm
  • In vaccinees, the infection-enhancing effect of the PNNAbs will continue
  • The great intrinsic infectiousness developed by the virus will also continue
  • Cell-based innate immunity will remain sidelined in the vaccinated
  • Protection from CTLs is unsustainable
  • The SIRS-created Abs will also fail
  • And Dr. Vanden Bossche worries that a catastrophic number of hospitalizations and deaths is very possible—particularly among the highly vaccinated

Slide 64:

Many physicians and scientists, particularly those who have promoted or passively accepted the mass vaccination campaign, may not agree with Dr. Vanden Bossche’s insights, concerns, hypotheses, and conclusions—if those physicians and scientists have even heard of Dr. Vanden Bossche’s concerns. But I would urge all physicians and scientists (particularly immunologists, virologists, and vaccinologists) to take Dr. Vanden Bossche’s concerns and hypotheses seriously, subject them to rigorous scientific analysis, and make them the subject of urgent, respectful, interdisciplinary scientific dialogue. Such is the tradition of science and medicine.

Slide 65:

I would ask:

Have we carefully, respectfully, and reverently interacted with our immune ecosystem? Have we viewed the COVID-19 pandemic through the lens of an immune system ecologist? Have we protected our immune ecosystem from harmful intervention?

Slides 66:

Or, instead, have we arrogantly and disrespectfully intervened and disturbed the human immune ecosystem—much like the giant oil companies have disrespected the sacred boreal forest ecosystems of northern Alberta’s First Nation’s people and have ignored the concerns of the First Nation’s people?

Slide 67:

Big-Oil and Big-Pharma have much in common. Here are the Alberta Tar sands with the oil company’s “safe and effective” tailings ponds which they claim have had no adverse effects on the expansive Lake Athabasca aquifer or on the health of the First Nation’s people—claims that are extremely unlikely to be true; claims that the First Nation’s people know to be untrue.

Slide 68:

Instead of listening to the concerns of thoughtful, knowledgeable, experienced scientists like Dr. Vanden Bossche, I am sorry to report that the leaders of the prevailing COVID-19 narrative and its mass vaccination campaign have:

  • Not engaged in scientific dialogue about such concerns—at least not publicly and not with those who have voiced these concerns
  • Insisted on the telling of only one narrative—their narrative
  • Intolerantly and summarily dismissed challenges to their narrative—calling those challenges “dangerous misinformation”
  • Demonized and shamed those who have voiced scientific concerns about the COVID-19 vaccines
  • Declared those individuals to be “deplorable,” “anti-science,” “anti-vaxx” purveyors of “misinformation” whose “debunked ‘information’ has caused enormous numbers of unnecessary deaths”
  • Censored such voices of concern
  • Threatened those voices, including threats to strip physicians of their employment and license to practice medicine
  • Made no distinction between “anti-vaccination” and “anti-irresponsible vaccination”

Slide 69:

Instead of engaging in healthy, respectful, constructive scientific dialogue, they have:

  • Made no acknowledgement that many of those who are against the COVID mass vaccination campaign are strongly supportive of responsible vaccines and, in the case of Dr. Vanden Bossche, have devoted their adult lives to development of responsible, life-saving vaccines
  • Insisted on mandatory vaccination
  • Failed to provide a proper informed consent process
  • Strongly encouraged vaccination of young children, as young as 6 months of age
  • Collected and presented “data” of astonishingly low scientific quality*—a good example being their gross misuse and abuse of the COVID-19 PCR test, including their failure to educate the public and individual patients about the importance of taking Ct values into account. They have manipulated data and presented dishonest and/or misleading “data” to support their narrative
  • They have hidden data that contradicts their narrative

This is not the way Medicine, Science, or democracy was intended to be practiced.

*For more details click on the following articles that are posted on my website: www.notesfromthesocialclinic
The Importance of Knowing the Ct Value at which a PCR Test is Positive

How Would Three of Canada’s Greatest Historical Figures Respond to the COVID Situation, If They were Alive today?

Slide 70:

Allow me to make a personal comment about childhood vaccination in general:

I have practiced pediatrics since 1972. As a general pediatrician (both in academic medicine and in the private practice of pediatrics), I have always supported the responsible development and use of childhood vaccines.

In particular, I have personally witnessed the tremendous benefits of the vaccine against Hemophilus Influenza type B (the Hib vaccine), which became available in the mid-1980s. Prior to the Hib vaccine, I provided care for many children who were suffering from Hemophilus meningitis, sepsis, pneumonia, or epiglottitis. I spent much of my pediatric residency starting and re-starting IVs to deliver life-saving intravenous antibiotics to infants and young children whose lives and brains were endangered by Hemophilus. One of the most vivid memories of my residency training was taking care of such children.

Hemophilus meningitis was common back then, and many children suffered permanent brain damage from it. After the Hib vaccine became available, severe Hemophilus infections became very rare. Most young physicians have never seen a case of Hemophilus meningitis or epiglottitis.

The benefits of the Hib vaccine have been spectacular and undeniable—one of the greatest advances in the history of medicine. I remain a strong advocate for vaccination against Hemophilus. It would be a great shame if parents stopped vaccinating their children against Hemophilus.

And, yet, because of the concerns I and others have expressed about the COVID-19 vaccines, the promoters of the prevailing COVID-19 narrative consider us to be deplorable, horribly irresponsible “anti-vaxxers” who are a threat to Humanity and Science.

But in my view I have simply done what a caring physician should do: I have done my homework, listened and learned from the understandings of others (including those who disagree with me), shared my own understandings, and offered to facilitate and participate in respectful, rigorous scientific dialogue so that we can arrive at best possible understandings and plans. And I have spoken up, as I should, when I have seen violations of fundamental principles of science, medicine, and ethics.

I strongly encourage all of my fellow pediatricians to engage in rigorous, respectful scientific dialogue regarding whether the COVID-19 mass vaccination campaign should be immediately stopped.

Slide 71:

The fact is that leaders and promoters of the COVID mass vaccination campaign have violated four of the most fundamental and important principles of science, medicine, and ethics, which are:All plausible hypotheses, not just one narrative, should be welcomed and considered.

  • All plausible hypotheses, not just one narrative, should be welcomed and considered.
  • Careful, respectful, objective dialogue should be employed to assess and prioritize plausible hypotheses.
  • Hypotheses should be evaluated through careful collection and full disclosure of honest, high quality data.
  • A proper informed consent process should be conducted when experimental therapies are being offered.

And they have violated two of the most fundamental principles of vaccinology:

Never implement mass vaccination (across all age groups) in the midst of an active pandemic like the COVID pandemic, using vaccines that will fail to induce sterilizing immunity

  • View the immune system through the lens of an immune system ecologist. Which means, consider the population level effects of interventions, not just the effects on an individual level.

Slide 72:

Is it possible that Dr. Vanden Bossche is wrong when he predicts that a highly virulent variant will eventually emerge? Yes, it is possible. Just as we should be open to his concerns, we should be open to the possibility that his prediction might not come true. Afterall, never before in history has a mass vaccination campaign with a suboptimal vaccine been implemented in the midst of an active respiratory virus pandemic—not in humans, poultry, or livestock. So, this is uncharted territory.

It is also possible that some aspects of his understandings of immunology, virology, and vaccinology are incorrect. That is why healthy, rigorous, constructive scientific dialogue is so important. Dr. Vanden Bossche has repeatedly asked for such dialogue, so that he can maximize the accuracy of his thinking—but promoters of the mass vaccination campaign, including high level immunologists, virologists, and vaccinologists, have responded only with silence.

When assessing Dr. Vanden Bossche’s concerns, consider the following:

Dr. Vanden Bossche has an extraordinarily deep understanding of the immunology, virology, vaccinology, and evolutionary biology involved. He has extraordinarily deep and long practical real-world experience in these fields. His study of the COVID-19 situation has been motivated by an altruistic and determined search for scientific truth. He has no hidden agenda or conflict of interest. And his analysis is based on solid scientific principles and well-established physical laws of nature. He deeply cares about Humanity and he deeply cares about the immune ecosystem.

Finally, I want to mention that it is possible that I have not adequately understood and/or represented Dr. Vanden Bossche’s complex insights. That is why I prefer that viewers read Dr. Vanden Bossche’s book as a double check and to learn more.

Slide 73:

Although Dr. Vanden Bossche could be wrong, I worry that he could be right—because of what we know about biology and physical laws of nature. Time will tell. Regardless of whether he is eventually proven to be correct or not, it is imperative that his concerns be taken seriously and it is imperative that we immediately make specific plans, individually and collectively, to optimally prepare for and deal with the possibility that a highly virulent and highly threatening variant will emerge.

Slide 74:

If his prediction ultimately does not materialize, I doubt that the reason will be that his scientific concerns and scientific reasoning have been inappropriate or ill-informed. Instead, the most likely reason(s) for his prediction not materializing will likely be that:

  • Far more people (than we realized) acquired natural immunity prior to roll-out of the vaccination campaign, and far more vaccinated people (than anticipated) have somehow been able to muster robust immunity despite the vaccination campaign; OR
  • Never-before-seen adjustments on the part of the ingenious human immune system came to our rescue; OR
  • Humanity benefitted from interactions between the immune system and virus that we currently do not understand. OR
  • Some combination of the above came to our rescue

Slide 75:

Let me finish this presentation with the following suggestion: Individually and collectively, we need to decide whether we should passively accept and support the mentality and practices of giant corporations (as exhibited by Big Pharma and Big-Oil and the people in government and media who serve and support them) or if we should navigate carefully with the immune system ecologists and actively support and respect the magnificent genius and beauty of the immune ecosystem. If we prefer the latter, we must cease to be silent, and we must initiate, encourage, and facilitate widespread, respectful, thoughtful, open-minded, high-quality science-based dialogue—within scientific and medical communities, within the public arena, among neighbors and friends, and within families—and while doing so, we must honor the basic, fundamental principles of science, medicine, ethics, and democracy.

Slide 76:

Thank you for viewing this presentation. I hope that it might stimulate and facilitate much needed, healthy dialogue—dialogue that, sadly and tellingly, has been missing throughout the pandemic.

Finally, I wish to thank Dr. Geert Vanden Bossche for all that he has done to deepen our scientific understanding of the COVID-19 situation. Many of us have learned a great deal from Geert. He has shared his sobering concerns simply and only because he cares deeply about Humanity and scientific truth. In my view he has made a tremendous contribution to science, medicine, and Humanity.

Slide 77:

Here are sources for further information:

Dr. Vanden Bossche’s book—The Inescapable Immune Escape Pandemic

Which may be ordered via the following link:   drgeert.com

Dr. Vanden Bossche’s educational website:


Dr. Rennebohm’s educational website:




I particularly wish to mention the last two listed links, because they provide a detailed discussion of specific plans we could make now to prepare for the scenario that Dr. Vanden Bossche fears, in case that scenario unfolds. They also provide references from the medical literature that support Dr. Vanden Bossche’s concerns.

Rob Rennebohm, MD

Email: rmrennebohm@gmail.com

May 28, 2023

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