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.

Hypertension remains one of the leading causes of illness and premature death worldwide. Yet a handful of countries have managed to significantly reduce their impact through effective public health strategies.

South Korea—best known globally for K-pop, K-dramas, and K-beauty—is among just four countries in the world to achieve a hypertension control rate above 50 per cent, joining Canada, Costa Rica, and Iceland.

According to the latest Korea Hypertension Fact Sheet, South Korea's blood pressure control rate has climbed to 62 per cent, making it one of the highest in the world. This means that more than half of people diagnosed with high blood pressure have successfully brought it within a healthy range through treatment.

"The Republic of Korea is one of only four countries in the world that have reached a hypertension control rate above 50 per cent," said World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus in a post on X.

Canada, Costa Rica, and Iceland also have hypertension control rates exceeding 50 per cent.

"South Korea continues to demonstrate high performance in hypertension management at the population level, with steady improvements in awareness, treatment, and control," the fact sheet, published in the journal Clinical Hypertension, noted.

How Did South Korea Achieve It?

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According to the WHO, South Korea's hypertension control rate was only about 5 per cent two decades ago. Since then, the country has achieved a remarkable turnaround, contributing to an estimated 83 per cent reduction in stroke-related deaths.

“It’s the single most important thing to get right in healthcare… but most countries don’t,” Dr Tom Frieden, president of Resolve to Save Lives, an initiative working on global health threats, told The Telegraph. “South Korea is one of the rare successes in the world, on both the treatment and prevention of high blood pressure.”

As per experts, Korea's success is a result of

• targeted salt-reduction campaigns,
• affordable and accessible combination therapies,
• routine screening.

"Globally, every hour, over 1,000 lives are lost to strokes and heart attacks from high blood pressure, while hypertension control is one of the most cost-effective interventions in public health. This is why I call on world and health leaders to heed the Republic of Korea's experience," Tedros added.

What Can Other Countries Learn?

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Prof. Hyeon Chang Kim, Professor in the Department of Preventive Medicine at Yonsei University College of Medicine, highlighted three key lessons from South Korea's success that other countries can adopt to improve hypertension control.

1. Make Hypertension Control a Health-System Priority

2. Invest in Data and Monitoring

3. Ensure Long-Term Continuity of Care

The South Korean experience shows that sustained care, regular follow-up, and strong healthcare systems can significantly improve blood pressure control and reduce deaths from heart disease and stroke.

Hypertension: The Silent Killer

The Lancet estimates that approximately 1.7 billion adults worldwide are living with hypertension. However, fewer than 20 per cent have their blood pressure adequately controlled.

Hypertension can quietly damage the heart, brain, kidneys, and blood vessels for years before symptoms appear. Because it often causes no noticeable signs, many people remain unaware they have the condition.

"Nine out of 10 times, hypertension does not cause symptoms. The only way to detect it is through regular screening," said Dr. Ambuj Roy, Professor of Cardiology at the All India Institute of Medical Sciences (AIIMS), New Delhi.

How to Lower Blood Pressure Naturally

To help reduce blood pressure and improve heart health, Dr. Roy recommends:

• Being physically active for at least 150 minutes per week
• Limiting processed and salty foods
• Staying adequately hydrated, especially during heatwaves
• Following a DASH-style diet rich in fruits, vegetables, whole grains, and low-fat dairy products.

Duloxetine, a widely prescribed antidepressant, has been recalled in the United States after the US Food and Drug Administration (FDA) found potentially cancer-causing impurities above federal safety limits.

According to the Cleveland Clinic, duloxetine is commonly used to treat depression, anxiety, fibromyalgia, and certain chronic pain conditions.

The FDA issued a notice stating the presence of N-nitroso-duloxetine, a nitrosamine impurity detected at levels exceeding the agency's recommended safety threshold. The recall affects nearly 370,000 bottles of prescription-only duloxetine delayed-release capsules USP, 30mg, 1000 Capsule bottles, distributed across the US.

The agency warned that exposure to nitrosamine impurities "may increase the risk of cancer if people are exposed to them above acceptable levels and over long periods of time."

The agency classified the action as a Class II recall, indicating that use of or exposure to the product may cause temporary or medically reversible adverse health consequences, while the likelihood of serious health effects remains low.

How Is Duloxetine Linked to Cancer?

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Notably, this is the second duloxetine recall linked to the same impurity. In October 2024, more than 7,000 bottles were recalled because of potential nitrosamine contamination.

According to the FDA, people who take medications containing nitrosamines—even daily for up to 70 years—are not expected to face an increased cancer risk if nitrosamine levels remain at or below the recommended limits.

There is currently no direct evidence linking N-nitroso-duloxetine itself to cancer. However, it belongs to a class of compounds known as nitrosamines, some of which are considered probable human carcinogens.

Moreover, health risks associated with nitrosamines generally depend on both the amount and duration of exposure. Higher levels over extended periods are considered more concerning.

The US National Library of Medicine describes N-nitroso-duloxetine as a compound that is "suspected of causing cancer" and notes that it is toxic if swallowed.

At the same time, the California State Board of Pharmacy emphasizes that exposure does not automatically result in cancer. The agency notes that nitrosamines are commonly found in water and foods, including cured and grilled meats, dairy products, and vegetables.

"Everyone is exposed to some level of nitrosamines," the board states. "These impurities may increase the risk of cancer if people are exposed to them above acceptable levels over long periods of time."

What Are Antidepressants?

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Antidepressants are prescription medications used to treat depression, anxiety disorders, chronic pain, and other conditions by increasing levels of certain brain chemicals involved in mood regulation.

Common classes of antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Norepinephrine-dopamine reuptake inhibitors (NDRIs)

These medications often take several weeks to achieve their full therapeutic effect. Common side effects may include dry mouth, dizziness, nausea, and weight changes. Emerging research also suggests that side effects can vary significantly depending on the specific medication.

What Is Duloxetine?

Duloxetine belongs to a class of antidepressants known as SNRIs.

Cleveland Clinic explained that duloxetine is used to treat depression, generalized anxiety disorder, fibromyalgia, and certain types of chronic pain, including nerve, bone, and joint pain.

The medication works by increasing levels of serotonin and norepinephrine in the brain—neurotransmitters that help regulate mood and pain perception.

The ongoing Ebola epidemic in the Democratic Republic of the Congo (DRC) could continue for more than a year, as the outbreak has yet to reach its peak, according to the International Federation of Red Cross and Red Crescent Societies (IFRC).

In a statement, the global aid organization also expressed concern that the Ebola crisis could divert attention and resources from ongoing humanitarian emergencies and conflicts across the region.

"We are afraid that this could last one year to end this disease," said Bruno Michon, Operations Manager for the IFRC.

The warning echoes concerns raised by the NGO Doctors Without Borders (MSF), which has said that the outbreak is currently spreading faster than response efforts can contain it.

The concerns come as both infections and deaths continue to rise. According to the DRC Ministry of Health, 29 new confirmed cases were recently reported, bringing the total number of infections to 837. Four additional deaths have pushed the death toll to 196, while the case fatality rate has increased to 23.4 per cent.

Meanwhile, 49 people have recovered from the disease, and approximately 376 patients remain in isolation.

The outbreak, caused by the Bundibugyo strain of the Ebola virus, is spreading rapidly in remote areas of the DRC and neighboring Uganda.

Uganda has not reported any new cases. So far, the country has recorded 19 confirmed infections and two deaths.

Could It Become the Deadliest Ebola Outbreak?

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The Ebola outbreak in the DRC could surpass the deadliest Ebola epidemic on record—which claimed more than 11,000 lives in West Africa between 2014 and 2016—if it is not brought under control soon, according to Africa's Centers for Disease Control and Prevention (Africa CDC).

"If we don't stop the outbreak very soon, it will be worse than what we had in West Africa and eastern DRC," Africa CDC Director-General Jean Kaseya said during a virtual meeting of African leaders and international donors in Burundi.

Speaking to Al Jazeera, Kaseya said that tens of thousands of people who may have been exposed to the virus have not yet been traced.

"Contact tracing is a major indicator and a major issue. We are missing more than 26,000 people, and we don't know where they are, and we don't know if they are contaminating other people," he said.

Testing and Contact Tracing Challenges

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There is currently no approved vaccine or treatment specifically for the Bundibugyo strain of Ebola. The World Health Organization (WHO) estimates that it could take up to nine months before a vaccine candidate is ready.

Testing remains one of the biggest weaknesses in the outbreak response. WHO Director-General Tedros Adhanom Ghebreyesus also voiced concern after visiting the DRC.

"I'm really worried," Tedros said, according to Stat News.

He explained that in North Kivu, South Kivu, and Ituri provinces—where the outbreak is concentrated—many residents view Ebola as a lesser threat compared with armed conflict, hunger, and other common deadly diseases.

"When the community is not taking it as its priority, it's very hard," Tedros said.

Many communities, particularly those affected by ongoing violence, still lack access to testing facilities and diagnostic kits. Treatment centers are also experiencing significant delays in receiving laboratory results, slowing efforts to identify and isolate infections quickly.

What Is Ebola?

Ebola is a severe and often fatal viral hemorrhagic fever first identified in 1976. Since then, more than 30 outbreaks have been recorded, primarily in Central and West Africa.

Common symptoms include:

• Fever
• Headache
• Weakness and fatigue
• Vomiting
• Diarrhea
• Muscle pain
• Sore throat
• Unexplained bleeding or bruising

In severe cases, the disease can lead to organ failure, internal bleeding, shock, and death. Aid organizations warn that without stronger surveillance, expanded testing, faster laboratory turnaround times, and more effective contact tracing, the outbreak could continue to grow in the coming weeks and months.