Friday, February 6, 2009

Merck and the Gardasil Vaccine Show Us the Money

I’m not generally one of those people that shriek about money-grubbing pharmaceutical companies. I truly believe that there are dedicated medical researchers out there along with the businessmen who make their work possible. If financial incentive is what makes things tick along, well, that’s life.

And while I often think that they don’t look at the big picture enough and sometimes market far too aggressively or cynically while creating a culture of “I’ll just take a pill instead of looking after myself,” I’m also damn glad they’re there when I see someone hit with a life-threatening disease.

On the other hand, it’s been wham, wham, wham this week with the reminders that there are big stakes in the vaccine industry. And it IS an industry.

It’s kind of putting me off old Gardasil as I continue to struggle with the decision about vaccinating my kids.

First there was the news that Gardasil sales had dropped by 16% in 2008. As CNBC’s Mike Huckman bluntly put it, “From the third quarter of last year to the fourth quarter Gardasil sales fell off a cliff… Merck officials said part of the Gardasil problem is that so many 11-18 year-old females have already been inoculated that they're running out of new customers. And the 19-26 year-old population continues to be a marketing challenge.”

Huh. Well, investors shouldn’t despair. With Merck pushing to get Gardasil approved for boys, young men, and older women, the market might look up within the next year or two. Unless, of course, those potential customers keeps up the disturbing trend of increasingly eying the pros and cons and coming down on the side of “no,” darn it.

Then there was the Infectious Diseases Vaccine Market Overview, available for a mere $15,200.

“Long being regarded as an unattractive market, vaccines have re-emerged as successful growth driver for Big Pharma. The launch and rapid uptake of novel, high-price products such as Wyeth's Prevnar or Merck & Co's Gardasil, along with the emergence of novel vaccine technologies and favourable legislation have brought vaccines back into the main focus of pharmaceutical and biotech companies,” it lucidly explains, adding:

“With the exception of influenza, only two to three vaccine manufacturers compete for each disease. This lack of competition combined with public health requirements to guarantee a stable supply of vaccines has resulted in a recent upward shift of vaccine prices for specialty vaccines...The most significant threat to the oligopoly of the Big 5 in the vaccines market comes from companies from emerging markets, which have large manufacturing capacities for biologics and are able to produce even complex substances like vaccines at low costs.”

And one couldn’t miss the invitation to the 2009 World Vaccine Congress, which promises to address such questions as: How can we focus on the key strategic and competitive factors that are dictating the resurgence in vaccines? How can we identify with the emerging potential of growing prophylactic and therapeutic vaccine demand? How can we compete more effectively in today's more competitive vaccine markets?

Well, heck. If I were making vaccines I’d be feeling a little a) greed b) pressure to produce for the shareholders, too.

Merck has been widely criticised for its ultra-aggressive marketing campaign for Gardasil. It swept the 2008 Pharmaceutical Advertising and Marketing Excellence awards for its very comprehensive sales job, including the much-parodied, omnipresent and extremely effective “One Less” campaign. Although vaguely remembering sex-ed teachers and gynaecologists saying that, with regular Pap smears, cervical cancer was usually no biggie, moms everywhere got the pounding message. MY KIDS ARE GOING TO DIE FROM CERVICAL CANCER—unless, of course, immediately inoculated with the Gardasil 3-shot series.

I don’t think I even realized how bizarre the direct-to-consumer marketing of drugs is until a visitor from England eyed the ads with disbelief. “Doesn’t your doctor tell you what you should be taking?” she squeaked.

Well, would that be any better? The chairman of the committee that recommended the vaccine for all 11 or 12 year-old girls commented in a New York Times that “There was incredible pressure from industry and politics,” and the same article notes that doctors were paid $4,500 for each talk they gave “educating” us, and each other, about the vaccine. Money was also sloshed around to groups like the American College Health Association—and, of course, to various political campaigns, most notoriously in Texas.

Which all leaves me feeling very sour. The money, money, money fixation is overshadowing the facts. Can I seriously believe that Gardasil is fixing a major health risk and that reported side effects are infinitesimal with all that money at stake?

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