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TESS VIGELAND: This week, the Texas State Senate may take up the governor's order that all middle school girls be vaccinated against cervical cancer. Resistance to making the vaccine mandatory is spreading in some other states, like California.

Gardasil, made by Merck, is the first vaccine that prevents a form of cancer. But as Pat Loeb reports, Merck's aggressive lobbying prompted a fierce backlash.

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WOMAN IN AD: Each year in the U.S., thousands of women learn they have cervical cancer. I could be one less.

PAT LOEB: There was a time, not very long ago, when you couldn't get through an evening of network television without seeing the ad for Gardasil. But no more. Merck has limited its advertising and eliminated its lobbying efforts for the vaccine.

Dr. Richard Haupt is a Merck executive director.

RICHARD HAUPT: We engage in activites that increase access and funding to Gardasil. But we were being perceived as a problem. And the fact that we were being perceived to be a problem made us reevaluate what we were doing, and that's why we're not doing it anymore.

First, a little background. Women's health experts say Gardasil is a genuine breakthrough. It prevents two kinds of Human Papiloma Virus, or HPV, that cause 70 percent of cervical cancer cases. Some 11,000 women a year in the U.S. are diagnosed with cervical cancer; nearly 4,000 die. This is the first cancer that can be prevented with a shot — a lot easier than a change in diet or lifestyle.

Gardasil is also the most expensive vaccine ever. A single dose is $120 — about 10 times as much as routine vaccines like measles, mumps and rubella — and three doses are needed.

Most insurers cover the shots, and the Centers for Disease Control put it on the list of vaccines for children that the government will pay for. It's cheaper than treating cervical cancer.

Micki Lechner-Riehle is a mom who says she would have vaccinated her daughter, even if her insurance didn't cover it, to avoid the disease's greater costs.

MICKI LECHNER-RIEHLE: And it's, you know, it can involve surgeries . . . and the worst case scenario, of course, is chemotherapy and death, you know.

This is all good news for Merck. But Merck wanted to make sure Gardasil would be as widely used as possible. Even before the FDA approved Gardasil last June, Merck was lobbying states to make the vaccine mandatory. At the same time, it was making donations to state legislators.

This stirred opposition from two groups from different ends of the political spectrum. HPV is sexually transmitted, and religious conservatives became incensed that state government might try to force their daughters to be inoculated against an STD.

They found allies in more liberal big-pharma skeptics, who were suspicious of the relationship between Merck and state lawmakers.

Barbara Ryan is an analyst for Deutsche Bank. She says Merck's efforts were understandable, but they did create a backlash.

BARBARA RYAN: All of these things kind of come to play in a situation like this, because there is an inherent distrust of pharmaceutical companies. Patients are skeptical as to whether they're in it to make people healthy or to just make money.

California Assemblyman Ed Hernandez has learned that lesson. He introduced a bill mandating the vaccine in California. He also received a $5,000 campaign donation from Merck. He says there's no connection between the bill and the donation, but he finds himself on the defensive.

ED HERNANDEZ: Matter of fact, just the other day I was talking to my staff and I was saying you know, we're getting bombarded from all ends and because it's becoming a controversial issue. And I asked them, I go, you know, what do you think guys? Is this the right thing to do? And every single one of them, you know, just said this is right. You know, this is going to save lives.

Hernandez says he has called the Merck lobbyist in Sacramento and asked him not to lobby for the bill.

I asked Dr. Haupt why Merck donates to state legislators, but a Merck spokesman on the call said Dr. Haupt was not the right person to answer the question.

Analysts say it's in Merck's best interest to sell as many doses of Gardasil as it can now, before there are any competitors.

But a rival HPV vaccine could be good for consumer's pocketbooks. Assemblyman Hernandez says a GlaxoSmithKlein version should be available soon.

HERNANDEZ: And once you start having competition, then the price should start going down. And I think as market forces take its natural toll, it's gonna continue to drive the cost down.

Hernandez says he intends to continue to push for mandatory vaccinations in California.

I'm Pat Loeb for Marketplace.