Before Merck & Co.'s Gardasil 9 won conditional approval on the mainland just last month, Chinese women had to travel to Hong Kong to get that version of the human papillomavirus shot. But rising demand and constrained supply around the world have pushed up prices there to more than double the cost in the U.S.—when the doses are available, that is.
And women aren't happy. Hundreds have rallied on social media to discuss potential legal action against private Hong Kong clinics, according to the South China Morning Post. The women said they paid for the full three-dose Gardasil 9 regimen but only received one or two shots before they were notified by clinics that the vaccine was out of stock. For the three-dose HPV vaccine schedule, health authorities recommend a second injection at about two months after the first dose, and 6 months for the third one.
Meanwhile, some clinics that have Gardasil 9 on hand have jacked up the price. One person interviewed by SCMP said a clinic told her supplies could be found at the price of HK$3,500 ($446) per dose. That’s more than twice the vaccine’s U.S. price of $205 for private sellers, according to the Centers for Disease Control and Prevention.
Gardasil 9 debuted in Hong Kong in 2016 but was just recently granted a conditional nod by China’s State Drug Administration. Because it covers more HPV strains, many mainlanders have previously opted to get the upgraded version in Hong Kong, meaning the small autonomous Chinese territory has to cope with that demand, too.
The Gardasil 9 supply problems aren't going away anytime soon, either. “Due to the continued increase in global demand for Gardasil 9, we are expecting supply constraints in Hong Kong to continue for the remainder of 2018,” said Merck (known as MSD in China) in a statement distributed in Hong Kong in April cited by SCMP. Merck is still selling the previous, four-valent version of the shot in both markets.
Chinese approvals of GlaxoSmithKline’s Cervarix in 2016 and Merck’s Gardasil in 2017 likely raised local residents’ awareness of HPV vaccination and its ability to prevent some cancers. For the first quarter of 2018, Merck reported global Gardasil and Gardasil 9 revenues growth of 24%, to $660 million, partly thanks to Gardasil’s launch in China.
As Merck said in its statement, the supply constraint isn’t unique to Hong Kong. New Zealand and the U.K. are both facing shortages, too. A company spokesperson told FierceVaccines in April that the U.K. shortage, caused by an increase in global demand, will continue through July. Plus, the company is also working to replenish some doses borrowed from the CDC stockpile after a cyberattack last year temporarily shut down production.
Through a renewed contract, China’s Zhifei Biological Products, which already sells the original Gardasil shot for Merck in Chinese mainland, signed on as the local distributor of Gardasil 9. The vaccine recently won a per-dose price of 1,298 yuan ($203) with the provincial government of Hainan, a resort island known as a medical tourism destination.