The spectrum of side effects of spike-based COVID-19 vaccines is broader and more severe than generally recognised. Adverse cardiovascular events convincingly reflect the mode of action of the spikes, namely the downregulation of the cardiovascular protective angiotensin-converting enzyme 2
(ACE2), which leads to an increase in harmful angiotensin II concentrations and the associated consequences. A fundamental re-evaluation of the benefit-risk assessment of these novel vaccines is mandatory. Healthcare professionals should be educated about the consequences of spike-induced ACE2 downregulation, the resulting symptoms and therapeutic options.