Japan could become one of the first countries in the world to end the HIV epidemic, says the president of Gilead Sciences Japan, Kennet Brysting. The idea for now could seem a little too ambitious, but it is not entirely unrealistic, given that the availability of medicines that can prevent transmission of HIV. Drugs are not the cure, but control over the spread of virus to the point where the disease is no longer a major public health threat.

What Is The Role Of Preventative HIV Medicines?

Gilead's have two key drugs, Truvada and lenacapavir. These two are playing a crucial role in prevention. Truvada is taken as a daily pill, while lenacapavir requires two injections per year. It can make the virus undetectable in infected individuals and prevent transmission to those who are not infected yet. In trials, lenacapavir showed 100% efficacy in preventing HIV infections. This is why it is describe as "almost a vaccine".

In 2024, Japan also approved Truvada for HIV prevention, but the country has yet to approve lenacapavir for the same. Until now, people in Japan had been importing generic versions of Truvada or purchasing it from clinics that source it from overseas.

HIV In Japan

Up until now, Japan reported around 25,000 HIV infections, whereas 669 new cases were reported in 2023. For seven consecutive years, the number of new infections remained under 1,000. The downward trend thus shows that the virus has been controlled, however, getting to zero new infections remains the ultimate goal.

Brysting too acknowledged that simply having effective drug is not enough. What is important is to have a proper implementation, access and healthcare support to make sure that these treatments are widely available and effective.

What Are The Challenges In Implementation?

The biggest challenges is testing rates. There is a need to increase testing rates. At this very moment, around 86% people infective with Japan have been tested, but the goal is to increase it up to 95%, with an ideal goal of 100%. Without widespread testing, many infected people may not even know that they are infected and it could transmit the virus.

Another measure issue is the cost of preventative medication. While Japan's health insurance covers treatments for diseases, it does not cover preventative drugs. Those who purchase Truvada for prevention, pay around $470 per month. Some clinics in Tokyo offer generic alternatives too, which is cheaper, but they are not ideal.

Better Healthcare Support

Brysting expressed concern that individuals importing medications might not be consulting doctors regularly, which is essential for monitoring HIV status and overall health. Truvada users need to be tested for HIV initially and every three months, along with screenings for other infections and kidney function checks. Without proper medical supervision, there is a risk of misuse and inadequate protection.

Gilead is in discussions with Japanese authorities to improve access and insurance coverage for Truvada, and progress is being made. Japan has shown efficiency in approving critical medicines, as seen during the COVID-19 pandemic when Gilead’s remdesivir was approved in just three days.

What Is The Way Ahead?

Gilead at this moment is not only focused on HIV and hepatitis C, but also expanding into oncology with innovative treatments like CAR-T cell therapy, which strengthens a patient's immune system to fight cancer.

However, Japan’s strict approval processes can slow down drug availability. Phase 3 clinical trials often need to be conducted within the country, and Japan tends to approve medicines much later than other regions. For instance, Truvada was approved for prevention in Japan 12 years after the U.S. and nearly 20 years after its approval for treatment. inancial factors also play a role. The Japanese government adjusts drug prices annually, often reducing them, which can make long-term investment challenging for pharmaceutical companies.

The United States shelved the decision to vaccinate poultry as a bird flu prevention measure due to HHS Secretary Robert F. Kennedy Jr.’s skeptical vaccine views

According to a Politico report, the move came as highly pathogenic avian influenza, especially the H5N1 strain, continues to affect poultry farms, threatening bird populations, disrupting egg supplies and raising concerns about transmission to humans.

According to Politico's findings, five people who were involved in the decision-making said that Agriculture Secretary Brooke Rollins pulled back an internal strategy for vaccinating poultry and hens that lay eggs.

The plan was initially intended to be shared with governments of other countries, industry leaders and other stakeholders to help boost bird flu response.

However, it remains unclear whether Kennedy directly asked Rollins to halt the strategy. However, concerns about how poultry vaccination would be received by the health secretary reportedly influenced the decision to keep the document away from wider circulation.

Why Was The Poultry Vaccination Plan Shelved?

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The US Department of Agriculture (USDA) announced a $1 billion bird flu response strategy in February 2025. The plan included $500 million for farm biosecurity, $400 million in financial relief for farmers and $100 million for vaccine research.

Despite the resources, an internal poultry vaccination strategy reportedly failed to be executed as planned. One person familiar with the process told Politico that the technical and communication components were already in place by the summer of 2025, but the final document was circulated among fewer than a dozen people.

Kennedy has publicly opposed vaccinating poultry against bird flu, arguing that vaccines that do not completely prevent infection could allow the virus to continue evolving.

In a March 2025 interview with Fox News host Sean Hannity, Kennedy warned that using vaccines that do not provide complete protection could turn poultry flocks into “mutation factories”.

He argued that allowing the virus to circulate among birds could help identify animals with natural immunity. The proposal attracted criticism from veterinary and vaccine experts, who warned that permitting uncontrolled infections could, in turn, increase viral replication and create opportunities for mutations.

Dr Gail Hansen, a former state veterinarian for Kansas, criticised the idea of allowing bird flu to spread through poultry populations, calling it a “really terrible idea, for any one of a number of reasons”. She warned that a virus circulating through a flock containing millions of birds would have many opportunities to evolve or mutate, which increases the risk to other animals and farm workers.

Also read: US Health Secretary Wants To Expand Vaccine Injury Reporting: Benefits And Risks Explained

Can Vaccinating Poultry Help Control Bird Flu?

Vaccination is one the effective tools for reducing bird flu infections and containing transmission. However, vaccines do not always provide sterilising immunity, meaning vaccinated animals may still become infected even if they are protected against severe disease.

So, if vaccination reduces visible symptoms without fully preventing infection, infected birds may be harder to identify unless monitoring systems are efficient.

However, this does not mean vaccination inevitably creates dangerous mutations. The evolution of viruses occur naturally, and vaccination can reduce the number of opportunities for viral replication. The overall effect depends on the vaccine effectiveness, surveillance, biosecurity and how the nature of the virus.

Countries including France, China, Egypt and Mexico have used poultry vaccination against avian influenza. In the US, the USDA granted conditional approval for an avian influenza vaccine in 2025, but poultry vaccination has not been adopted yet.

H5N1 has infected people following exposure to infected animals, but sustained human-to-human transmission has not been established yet. Hence, preventing infections in poultry remains important for reducing opportunities for the virus to spread and evolve.

The Keralam government has introduced the Keralam Senior Citizens (Care and Protection of Rights) Bill, 2026, to regulate elderly-care facilities and services. It proposes mandatory registration of care centers and caregivers, prescribed standards, caregiver certification, and penalties for violations.

Referred to the Assembly’s subject committee, the Bill would establish a legal framework for elderly care if passed.

Keralam introduced its first elderly-care policy in 2006, updated it in 2013, and released a draft State Policy for Elder Persons in August 2025. The state also enacted the Kerala State Senior Citizens Commission Act, 2025, and has a dedicated department for senior citizens’ welfare.

Why Does Keralam Need The Bill?

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Chief Minister V. D. Satheesan introduced the Bill, expressing confidence that it would make Kerala a model for elderly care.

“Nobody should feel that they are alone or abandoned. The way a society treats its elderly determines how civilized it is,” he said.

Keralam has one of India’s largest elderly populations, partly due to its high life expectancy. Older adults are projected to account for 22.8% of the state’s population over the next decade, up from 18.7%, highlighting the growing need for care services.

What Does The Bill Propose?

• Dignity and care: Promotes ageing in place, home-based care, safety, and social inclusion.
• Access and rights: Seeks better access to healthcare, legal aid, safe public spaces, digital inclusion, and abuse-reporting mechanisms.
• Protection units: Proposes state and district-level bodies to monitor care services and address complaints.
• Care-centre regulation: Requires registration of senior citizen care centres and sets service standards.
• Caregiver certification: Proposes training, phased certification, a Keralam Geriatric Care Certification Framework, and a state register of caregivers.
• Cybercrime safeguards: Proposes a Senior Citizen Cyber Fraud Cell at every cyber police station.
• Welfare funding: Calls for a state reserve fund for care, protection, welfare, and social security.
• Penalties: Provides for punishment for violations of the proposed law and related rules.

Why Elderly Care Needs A Broader Approach

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Speaking to HealthandMe, Dr. Rajeev Jayadevan, Ex-President of IMA Cochin and Convener of the Research Cell, Kerala, said the principles outlined in the Bill could eventually apply across India, particularly as Keralam has a higher proportion of older adults than many other states.

With shrinking nuclear families and urbanization, fewer family members may be available to provide full-time care, increasing reliance on state-supported services, including home care, medical consultations, and palliative care.

He emphasized that older adults have distinct care needs and highlighted patient autonomy in end-of-life decisions. Living wills allow people to document their medical-care preferences in advance, helping families and healthcare professionals understand their wishes and potentially avoid unwanted interventions.

Dr. Rajeev also stressed the need for trained, certified caregivers, effective oversight of care providers, and safeguards against elder abuse.

As older adults increasingly use digital platforms for services such as banking, digital literacy and protection against online scams and financial fraud are also essential, he noted.

What Are The Health Challenges Facing Older Adults?

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India’s senior citizen population is projected to reach around 230 million by 2036, or approximately 15% of the population. Southern states, along with Himachal Pradesh and Punjab, have larger elderly populations, with regional disparities expected to widen.

Moody’s Ratings said in September that India’s population is expected to age significantly as fertility falls below replacement levels.

Older adults often face chronic conditions such as diabetes, high blood pressure, and high cholesterol, alongside complications including diabetic kidney disease, diabetic retinopathy, cataracts, and glaucoma. These health needs underscore the importance of accessible, coordinated long-term care.

CVS Pharmacy and its subsidiaries have agreed to pay $315 million to settle a US Department of Justice lawsuit alleging that the pharmacy chain unlawfully dispensed opioid prescriptions that were not needed medically.

The settlement, announced on October 13, also requires the company to implement safeguards against inappropriate and unnecessary dispensing.

Filed in December 2024, the lawsuit alleged that CVS dispensed prescriptions that lacked a legitimate medical purpose, involved excessive quantities of opioids or were dispensed too early.

The government also alleged that the company filled prescriptions from so-called “pill mills”, suppliers who are accused of issuing large numbers of controlled-substance prescriptions without a legitimate medical purpose. CVS has strongly disputed the allegations and denies any wrongdoing as part of the settlement. The agreement resolves the civil claims without a determination of liability.

Unsafe Opioid Prescriptions Can Increase Addiction Risk

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Opioids are powerful medications used to treat moderate to severe pain. They include prescription drugs like oxycodone, hydrocodone and morphine.

When prescribed appropriately and taken under medical supervision, they can provide important relief. However, their effects on the brain'can also lead to dependence and addiction issues.

Dependence and addiction are related but different. Physical dependence occurs when the body adapts to a medication. If stopped abruptly, one may experience severe withdrawal symptoms.

Opioid use disorder, commonly referred to as opioid addiction, involves a destructive pattern that can include cravings, loss of control and continued use despite harmful consequences.

The risk increases when these opioids are prescribed or taken in excessive doses or combined with other similar medicines. Taking more than prescribed can also increase the risk of overdose, which can slow or stop breathing and may be fatal.

The Justice Department's lawsuit alleged that CVS dispensed prescriptions for dangerous combinations of medicines, including “trinity” prescriptions combining an opioid, a benzodiazepine and a muscle relaxant. Such combinations can lead to a compounded sedation effect and respiratory depression, increasing the risk of serious harm.

In these cases, addiction becomes more than just a habit. These substances alter brain chemistry, particularly in the areas related to reward, motivation, and self-control. Hence, recovery is not simply about choosing to quit.

Addiction hijacks the brain’s prefrontal cortex—the area responsible for decision-making, self-control, and judgment. As a result, people suffering from addiction are often unable to regulate their behavior, even when they want to.

The brain’s reward system reinforces substance use by releasing dopamine, the chemical associated with pleasure and reward. Over time, the brain becomes dependent on this chemical surge, leading to tolerance (needing more of the substance to feel the same effect) and withdrawal symptoms when the substance is not available.

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What Did The Lawsuit Allege?

According to the Justice Department, the alleged dispensing practices occurred between October 2013 and December 2025. The government claimed that staffing shortages, performance targets and incentive policies contributed to pharmacists filling prescriptions without adequately checking whether they were legitimate.

Many of the prescriptions were allegedly billed to federal healthcare programmes, including Medicare and Medicaid, prompting claims under the federal False Claims Act as well as the Controlled Substances Act.

“Today's settlement is a significant milestone in the Justice Department's efforts to combat the opioid epidemic by cracking down on pharmacies who unlawfully fulfill prescriptions for controlled substances,” Associate Attorney General Stanley Woodward said in a statement.

CVS said its pharmacists were trained “in the safe and appropriate use of all medications” and that the company had introduced programmes to help them make appropriate decisions for patients.