Dramatic and controversial changes to federal policy are taking a toll on U.S. vaccine sales and companies are increasingly looking overseas to cushion the blow.
In the first quarter of 2026, several large drugmakers saw sales of their vaccines for diseases like meningitis, COVID-19 and pneumonia shrink amid a broad national decline in childhood vaccine uptake. Companies have linked weaker vaccine performance to tighter regulations and increasing vaccine skepticism, which has triggered lower U.S. uptake, narrower recommendations and broader uncertainty surrounding federal vaccine policy.
Pfizer’s first quarter report showed a 59% decline in global COVID-19 vaccine sales over the same period last year, driven in part by lower uptake in the U.S., “primarily resulting from a narrower recommendation for vaccination.” Last May, HHS Secretary Robert F. Kennedy Jr. announced that COVID-19 vaccines were removed from the recommended vaccine list for healthy children and pregnant women.
While the drugmaker’s RSV vaccine Abrysvo saw a 31% increase in global sales over the first quarter of 2025, a portion of that bump came from favorable U.S. accounting adjustments, rather than increased vaccination rates.
But Q1 reports didn’t deliver all bad news. Moderna has weathered some of the most visible turbulence on the vaccine market and saw an uptick in total revenue this quarter to $389 million — a jump from $281 million from the same period in 2025. The company not only cut costs but also got a sales boost of its COVID-19 shots from international markets. Moderna anticipates an even split in 2026 revenue for the vaccine between the U.S. and the rest of the world.
Sanofi, which was coming off a 2.5% drop in vaccine sales from the fourth quarter amid declining U.S. sales of its polio, meningitis, flu and RSV shots, saw a 2.1% increase in vaccine sales in Q1 thanks to strong performance from its newly acquired hepatitis B vaccine, Heplisav-B.
GSK’s vaccine sales also trended upward by 4% in Q1, driven by a 20% spike in demand for its shingles vaccine Shingrix, which got a boost from sales in Europe.
European demand also helped GSK notch a 2% increase in overall vaccine sales in Q4, which helped offset U.S. declines for its flu, RSV, and shingles shot Shingrix, which dropped 17% in the U.S. at the end of last year due to “the continuing slowdown in the pace of penetration of harder-to-activate unvaccinated consumers.” Shingrix climbed during the fourth quarter in Europe, however, by 42%.
The company is looking to increase the buzz around one of its products with a new marketing campaign to bolster lagging uptake in the U.S.
Merck & Co. also saw declining vaccine sales, but for different reasons.
Sales of its HPV vaccine, Gardasil, were down 22% but were largely attributed to a sharp decline in uptake in China and Japan. Lower U.S. sales also played a role, however, and were driven by what Merck called “public-sector purchasing patterns, partially offset by higher net pricing.”
A tense regulatory environment
Vaccines have lived under a microscope during Kennedy’s tenure. Among his many controversial decisions was a move last year to replace all 17 members of the CDC’s Advisory Committee on Immunization Practices with new appointees, some of whom share his vaccine skepticism.
In January, the CDC, prompted by a presidential memorandum, then issued a highly controversial update to the childhood vaccine schedule. It unilaterally reclassified several vaccines, reducing the number of recommended childhood vaccines from 17 to 11. The decision bypassed the traditional ACIP review process. A federal judge, responding to a lawsuit by several major medical organizations, including the American Academy of Pediatrics, recently pressed pause on this change and others made by ACIP after determining that the measures likely violated federal advisory committee procedures.
Vaccines have also faced intense scrutiny from the FDA. The regulatory agency recently drew fire after it refused to review Moderna’s mRNA flu vaccine, a decision later reversed under public pressure on the condition that the company undertake an additional study.
