GSK’s Shingrix strategy shift drives sales beat even as vaccines slow

GSK's Shingrix Strategy Drives Q1 Sales Beat

GSK reported robust first-quarter 2026 earnings, with total sales increasing 5% year-on-year to £7.6 billion ($10.27 billion). The shingles vaccine Shingrix emerged as the top-selling product, achieving a 20% worldwide sales jump to £1.03 billion (nearly $1.4 billion), significantly exceeding analyst forecasts. This strong performance was attributed to a strategic shift focusing on comorbid patients, driving substantial uptake in Europe and the U.S. However, sales for most of GSK's other vaccines declined due to increasing vaccine skepticism in the U.S. The company also highlighted strong contributions from its Specialty Medicines portfolio, led by the HIV pill Dovato, and announced the discontinuation of the STING agonist XMT-2056.

• GSK's shingles vaccine, Shingrix, demonstrated exceptional performance in Q1 2026, with sales surging 20% globally to £1.03 billion ($1.4 billion), making it the company's top-selling product. This success was driven by a strategic pivot to target comorbid patients, resulting in a 51% uptake increase in Europe and a 12% revenue increase in the U.S., significantly surpassing analyst expectations of £851 million ($1.15 billion).
• Despite Shingrix's success, most of GSK's other vaccine franchises experienced declines, with the respiratory syncytial virus shot Arexvy plunging 18% to £65 million ($87.81 million) and its meningitis immunization sliding 3% to £335 million ($452 million). Overall, sales for other pediatric and adult vaccines dropped 9% from Q1 2025, largely attributed to increasing vaccine skepticism and policy changes in the U.S. market.
• Beyond vaccines, GSK's Specialty Medicines portfolio contributed significantly to its 5% total sales growth, reaching £7.6 billion ($10.27 billion). Key performers included the HIV pill Dovato, which saw a 20% surge to £666 million ($900 million), alongside strong contributions from the asthma biologic Nucala (£484 million or $653.8 million) and the inhaler Trelegy Ellipta (£646 million or $873 million). On the pipeline front, GSK announced the discontinuation of the Phase 1 STING agonist XMT-2056, an investigational antibody-drug conjugate acquired from Mersana Therapeutics.

Shingrix's Strategic Pivot to Comorbid Shingles Patients

Recent evidence reveals significant unmet needs in shingles prevention, with vaccination coverage remaining critically low across multiple populations despite the availability of highly effective vaccines. Key gaps persist in knowledge, healthcare access, and equitable distribution of prevention strategies.

Low Vaccination Coverage Rates Globally:
• China shows extremely low HZV uptake rate of only 0.79% among adults aged 40 years and older (2025 study across 25 provinces with 14,315 participants)
• United States demonstrates persistently low vaccination rates, particularly among racially and ethnically minoritized (REM) and socially vulnerable groups
• Australia reports zoster vaccination coverage of 41.0% in adults turning 71 years in 2023, with lower coverage (36.1%) among Indigenous adults
• France's first-generation live attenuated vaccine achieved less than 1% coverage since 2013 recommendation

Knowledge and Awareness Gaps:
• Saudi Arabia: Only 15.5% of respondents exhibited high level of vaccine knowledge, while 44.3% demonstrated low knowledge; only 18.8% reported good vaccination practices despite 47.6% showing high acceptance
• China: Less than half of respondents from general population and HZ patients understood that vaccination does not treat existing HZ; not all dermatologists were aware of adverse reactions following vaccination
• More than half of Saudi Arabian participants unaware that vaccine is provided by Ministry of Health for certain groups, though over 75% willing to receive HZ vaccine upon physician recommendation

Healthcare Access Barriers:
• China: Among 813 HZ patients in 2024, 28.78% reported unmet outpatient care needs and 36.36% had unmet inpatient care needs, with main barriers being age and place of residence
• Vaccination disparities observed across age, sex, race/ethnicity, region, educational level, health insurance, income, and comorbidity status
• Urban residents experienced higher levels of unmet inpatient needs compared to rural populations

Priority Immunocompromised Populations:
• People living with HIV (PLWH) face substantially higher HZ hazards than HIV-negative individuals, particularly among participants aged <50 years, with HZ recurrence approximately twice as frequent
• Cancer patients show increasing vaccination trends but remain undertargeted, with only 3.0% of oncological patients vaccinated with Shingrix despite clear recommendations
• Patients with post-tuberculosis lung disease (PTLD) identified as benefiting from shingles vaccination
• Patients with immune-mediated inflammatory diseases at increased risk due to treatments targeting immunological pathways essential for antiviral defense

Socially Vulnerable and Minoritized Communities:
• Racially and ethnically minoritized groups in the United States show lower vaccination rates and require targeted interventions
• Indigenous populations (Aboriginal and Torres Strait Islander people) demonstrate lower coverage compared to general population
• Communities with high CDC Social Vulnerability Index scores identified as priority targets for intervention programs

Intervention Success Models:
• Faith-based community interventions in San Bernardino County showed 82% reported high likelihood of receiving RZV and 90% likelihood of recommending it post-intervention
• Healthcare provider recommendations prove critical, with 78.9% of general population and 81.6% of HZ patients finding vaccination more acceptable when recommended by physicians
• Strategic investments in health literacy, workforce development, and digital tools identified as essential for improving uptake and addressing vaccine hesitancy

Unpacking Shingrix's Clinical Outcomes and Safety Data

Recent studies have demonstrated the clinical utility and safety profile of Shingrix (recombinant zoster vaccine) across diverse patient populations, including immunocompromised individuals and healthy adults. These investigations provide valuable insights into both the protective benefits and potential adverse events associated with herpes zoster vaccination.

Shingrix's Impact on the Shingles Treatment Evolution

The shingles treatment landscape has undergone significant transformation over the past five years, primarily driven by the widespread adoption of the recombinant zoster vaccine (RZV, Shingrix) and evolving antiviral approaches. The most substantial change has been the market withdrawal of the live attenuated zoster vaccine (ZVL, Zostavax) from the U.S., with RZV demonstrating superior efficacy of approximately 90% in adults ≥50 years compared to ZVL's 45.9% pooled effectiveness. Real-world evidence from 2022 showed RZV achieving 79.2% pooled vaccine effectiveness against herpes zoster, while ZVL demonstrated 59.7% effectiveness specifically against postherpetic neuralgia and 30.0% effectiveness against herpes zoster ophthalmicus.

Antiviral treatment approaches have expanded beyond traditional therapies, with novel immunostimulatory combinations entering clinical development. While licensed antivirals like acyclovir continue to serve as first-line treatments by inhibiting virus replication, researchers have explored complementary immunostimulatory viral therapy for severe cases. A notable advancement includes the development of orally administered live-attenuated infectious bursal disease vaccine virus (IBDV), which delivers double-stranded RNA cargo to activate the natural antiviral interferon gene defense system. This approach has led to proposed phase I/II trials comparing acyclovir monotherapy versus acyclovir combined with R903/78, an attenuated immunostimulatory IBDV strain.

Interventional pain management strategies have also evolved, with enhanced recognition of early intervention approaches for preventing postherpetic neuralgia (PHN). Recent evidence demonstrates that thoracic transforaminal epidural steroid injections (TFESIs) can serve as first-choice treatment for PHN, particularly in cases showing poor response to conventional medications like amitriptyline, gabapentin, and opioid combinations. Additionally, the safety profile of JAK inhibitors has become better characterized, with herpes zoster identified as a prevalent treatment-emergent adverse event occurring in 2-5% of patients receiving oral JAK inhibitors for atopic dermatitis, necessitating enhanced vaccination strategies for at-risk populations including those with immune-mediated inflammatory diseases.

Targeted Strategies Propel GSK's Q1, Navigating Vaccine Skepticism

GSK's recent first-quarter earnings report paints a picture of strategic resilience, with robust overall sales growth driven by standout performances from its shingles vaccine, Shingrix, and the HIV therapy, Dovato. This success highlights the company's ability to navigate a complex pharmaceutical landscape, particularly amidst broader challenges like increasing vaccine skepticism.

Shingrix's impressive 20% sales jump, significantly exceeding analyst expectations, underscores the impact of a targeted commercial strategy. By focusing on comorbid patients—a population at higher risk for herpes zoster (HZ) and its debilitating complication, postherpetic neuralgia (PHN)—GSK is effectively tapping into a critical unmet need. The recombinant zoster vaccine (RZV) offers superior efficacy, reducing HZ incidence by over 90% compared to the older live-attenuated vaccine, which has been withdrawn from the U.S. market. This positions Shingrix as the preferred option, especially for patients with immune-mediated inflammatory diseases or other chronic conditions where HZ incidence is elevated. However, the vaccine's known association with local and systemic adverse events, along with suboptimal completion rates in certain demographics and those with comorbidities, suggests an ongoing need for enhanced patient education and support to maximize uptake.

Concurrently, the strong contribution from the Specialty Medicines portfolio, led by the dolutegravir-based HIV pill Dovato, reinforces GSK's leadership in HIV treatment. Dolutegravir is recognized for its high genetic barrier to resistance and proven efficacy in both treatment-naïve and experienced patients, including those with integrase inhibitor-resistant strains. Its availability in single-tablet regimens (STRs) significantly improves medication adherence, which is crucial for long-term viral suppression and associated with substantial inpatient cost savings. This aligns Dovato with evolving global treatment guidelines, including its adoption as a preferred second-line therapy in many regions.

Despite these successes, risks remain. The reported neuropsychiatric symptoms associated with dolutegravir, particularly at higher trough concentrations or in patients with specific genetic polymorphisms, warrant careful clinical monitoring. More broadly, the decline in sales for other GSK vaccines due to increasing skepticism in the U.S. presents a systemic challenge that could impact future vaccine portfolio performance. GSK's strategic focus on high-value assets like Shingrix and Dovato, coupled with the discontinuation of less promising pipeline candidates like the STING agonist XMT-2056, demonstrates a clear commitment to optimizing its portfolio and resource allocation for sustained growth.