At Merck, Desperation Sets in Over Gardasil

Signs of decline are setting in at Merck's highly profitable vaccine for some strains of HPV and cervical cancer. Merck has adjusted its marketing to target women who are not the most likely to benefit from it. The drug has seen a 33 percent decline in sales.

On the one hand, Merck is simply adjusting its strategy to the inevitable grind of numbers: As more girls get the shot, its remaining market declines -- and thus Merck must target increasingly marginally profitable populations. Merck's eye-opening lobbying effort has seen its successes -- the company virtually bribed the governor of Texas to get approval for schoolgirls there. More recently, the company persuaded the government to require that immigrant women should have the shot.

On the other hand, the company might consider scaling down its ambitions and its lobbying effort to simply target those who most need it: Girls who are not yet sexually active, but are old enough to start being so. Simply put, HPV is so prevalent (and mostly harmless) among sexually active adult women and men that it is not worth vaccinating them. It might be profitable to do so, but the real public health benefit is not with the women whom Bloomberg says Merck is currently after.

Of course, that would mean Merck scaling back its Gardasil earnings a little. It might ensure the future longevity of the brand. But time will tell whether Merck chooses the health of its quarterly earnings over jabs in older/young women ...