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In their recent review on aluminum and vaccines [1], JP Goullé & L Grangeot-Keros described general knowledge on aluminum (Al) exposure, kinetics and toxicity but made very little effort to delineate the scientific questions specifically related to Al adjuvants in vaccines. Instead of representing the bulk of their review, the subject of Al adjuvants covered no more than one third of the 3 page-text. Numerous important papers on the topic were omitted, ie 20 years of scientific publications in clinical, post-mortem, in vitro and in vivo experimental studies published by independent research teams, worldwide experts in this topic were simply omitted.

For instance, in 2018, a critical analysis of reference studies on Al adjuvant toxicokinetics revealed their extreme paucity, several major methodological weaknesses, and profound misconception of the fate of injected Al adjuvants [2]. The Goullé and Grangeot-Keros review suffers from the same fundamental misunderstanding of the question. Specialized Al toxicologists have now recognized that comparing toxicological properties of different forms of Al (soluble vs particulate) administered by different routes (oral vs intramuscular (im) or intravenous) is incorrect [3]. In the case of Al adjuvants such comparisons are misleading and therefore inadmissible [2]. Goullé and Grangeot-Keros stated that, similarly to lead for instance,“only biologically measurable excessive levels of aluminium in the organism can be potentially toxic”. Such a sweeping statement of classical toxicology may be in line with the “dose makes the poison” paradigm but does not correspond to the true situation when, for example, i) particulate …