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.

Being rich is usually linked with better chances at living longer as one may have access to the best healthcare services, healthier food, free time for exercise and wellness and more. But a large international study has found a striking exception. It observed that the wealthiest individuals in America had survival rates comparable to some of the poorest people in Northern and Western Europe.

The study, published in the New England Journal of Medicine, analysed data from 73,838 adults aged 50 to 85 in the US and 16 European countries, following participants from 2010 to 2022. Researchers compared people according to their relative wealth within their own countries.

The findings suggest that wealth improves survival in both regions, but Americans had higher mortality at every wealth level than their European counterparts.

About 80% Of Wealthiest Americans Survived

The researchers found that about 80% of the wealthiest Americans were still alive at the end of the study period. That was roughly comparable to the survival rate among the poorest participants in Northern and Western Europe. Among the wealthiest Northern and Western Europeans, the survival rate was approximately 90%.

Lead author Irene Papanicolas, professor at Brown University School of Public Health, said, “We were surprised by that result.”

She said researchers might expect wealthy Americans to have access to high-quality healthcare, healthier food and safer environments, yet the data showed that their survival still lagged behind wealthy Europeans as well as the poorer populations .

Why Do Americans Have Higher Mortality Rate Than Europeans?

Also read: Bryan Johnson Reveals Meibomian Gland Dysfunction: What To Know About This Dry Eye Condition

The study does not find any one specific reason for the significant difference. However, researchers point to several possible contributors, including economic inequality, healthcare access, social safety nets, diet, smoking, _{physical activity}, stress and environmental risks. Differences in social and economic conditions could also affect health even among healthier people.

Papanicolas said the findings highlight factors that can affect health across different wealth levels, including “economic inequality or risk factors like stress, diet or environmental hazards.”

Co-author Sara Machado, a research scientist at Brown’s Center for Health System Sustainability, said where someone stands within their country’s wealth distribution matters for longevity, but so does how that country compares with others. She also noted that improving health outcomes is “not just a challenge for the most vulnerable”, as even people in the highest wealth group can be affected.

The US-Europe Life Expectancy Gap Has Widened

The findings come against a broader backdrop of declining US life expectancy compared with other wealthy nations. Researchers noted that the US and Western Europe had broadly similar life expectancy several decades ago, but the gap began widening around 1980 and kept going until it is now hard to ignore.

The study therefore raises a bigger question about whether individual wealth alone can protect people from broader health risks within a society.

The observational study cannot prove that living in the US itself causes higher mortality. The researchers identified possible explanations, but further research is needed to determine exactly why mortality remains higher among Americans across wealth groups.

The Ebola outbreak in the Democratic Republic of Congo (DRC) has resulted in more than 300 deaths in a single week, marking one of the highest weekly death tolls since the outbreak began in mid-May.

According to the latest data by the DRC's Ministry of Health, 5,514 confirmed cases and 2,642 deaths had been recorded as of August 23. The outbreak, caused by the Bundibugyo virus, has already become the largest and the deadliest Ebola outbreak in history, surpassing the 2018-2020 epidemic.

Highest Weekly Death Toll

In terms of the pace of the Ebola outbreak, the latest numbers follow an alarming pattern. WHO previously reported 304 deaths and 579 cases in the week of August 3-9, the highest weekly totals recorded at that point.

An earlier WHO update had recorded 296 deaths in one week, showing how rapidly the outbreak has escalated over recent weeks.

The increase is partly linked to expanded surveillance and testing, but WHO says most of it is due to genuine expansion of the outbreak.

Rare Bundibugyo Strain Is Making Containment Challenging

Also read: DR Congo Gets 70,000 Ebola Vaccine Doses For A Different Strain: Can Ervebo Protect Against Bundibugyo?

Unlike the Zaire species of Ebola, for which licensed vaccines and treatments exist, this outbreak is being driven by Bundibugyo virus, a rare Ebola species that has not been studied adequately.

There is currently no approved vaccine specifically for Bundibugyo virus, making the response more challenging. However, DRC recently received 70,000 doses of the Ervebo vaccine, which targets Zaire strain. It is being evaluated for potential protection against Bundibugyo virus. WHO says early laboratory and animal studies suggest that the vaccine may provide some protection against Bundibugyo.

But in parts of eastern DRC, health workers face attacks, communities are displaced and people frequently move between areas. These factors allow transmission chains to continue undetected. WHO has warned that sustained transmission across communities that are interconnected is driving the aggressive expansion.

The outbreak has also been affected by misinformation and mistrust, which can discourage people from seeking treatment or cooperating with response teams.

Health Workers And Remote Communities At Major Risk

Also read: Congo's Ebola Outbreak Is Spreading Fast But WHO Says It Can Still Be Contained In 3 Months

The outbreak has spread across dozens of health zones, with Ituri remaining the epicentre. WHO reported that cases had reached at least 54 health zones across six provinces by August 12.

Health workers have also been heavily affected. At least 155 healthcare workers had contracted the virus and 45 had died as of August 9, according to WHO.

Insecurity, population displacement and poor access to healthcare are making it harder to identify cases, trace contacts and get infected people into treatment quickly.

WHO Says The Outbreak Can Still Be Contained

Despite the alarming numbers, WHO officials have said the outbreak can still be brought under control if response efforts are scaled up as soon as possible.

WHO Director-General Tedros Adhanom Ghebreyesus and Africa CDC Director-General Jean Kaseya have stressed the importance of surveillance, increasing treatment capacity and working closely with affected communities to tackle the outbreak.

NHS England has announced the rollout of free home HPV testing kits, which could make cervical screening more accessible to nearly 4 million women who are not currently up to date with their screening.

The move is being described as a “game-changer”, as around a third of eligible women are not up to date with their cervical screening. The kits aim to provide a more “discreet and convenient option” for women who may not have attended screening previously.

“Offering millions of women an alternative test they can do from the comfort of their own homes will be a game-changer – making it easier than ever for them to get tested for HPV,” said Dr Sue Mann, National Clinical Director for Women’s Health at NHS England.

Importantly, the NHS stated that the home HPV testing is "not a replacement for cervical screening". Cervical screening appointments with a clinician remains the best way to help prevent cervical cancer.

The NHS is introducing HPV self-testing as an additional option for people who have not taken up previous invitations.

The initiative is also part of the NHS pledge to eliminate cervical cancer by 2040, by making it as easy as possible for people to get lifesaving HPV vaccination and increasing cervical screening attendance.

What Does The HPV Self-Testing Kit Contain?

The self-testing kit contains a swab, similar to a long cotton bud, which is used to collect a sample from the vagina. The sample is then posted back to the NHS for free, where it is checked for high-risk HPV.

If high-risk HPV is found, individuals will be invited to book a follow-up cervical screening appointment at their GP surgery or sexual health clinic. A nurse or doctor will then take a small sample from the cervix to check for cell changes.

Who Can Get The Free Home HPV Test?

HPV self-testing is an invitation-only offer and is being rolled out in phases across England as part of the NHS Cervical Screening Programme.

The rollout starts with people aged 30 to 65 who have not attended cervical screening following previous invitations.

Women aged 24 to 64 are invited for cervical screening by the NHS every five years, or more frequently if HPV is detected.

Women who are eligible will start receiving invitations via the NHS App, text message, email or letter. Once invited, they will be able to order a free kit through the NHS App or their NHS online account.

“There are lots of reasons that may stop women from getting their cervical screening – embarrassment, lack of time, or worries about discomfort – and these kits provide a discreet and convenient option we hope will encourage more women to take up the life-saving test. So, if you’re invited to take part, please order a test – it’s a simple swab you can do at home in minutes,” she added.

Is Cervical Screening Important Even After HPV Vaccine?

Cervical screening helps prevent cervical cancer by checking for high-risk types of HPV. HPV is a common virus that can cause changes to cells in the cervix. These changes can usually be treated before cancer develops.

The NHS noted that it is still important to attend cervical screening appointments even if you have been vaccinated against HPV.

The HPV vaccine does not protect from all types of HPV, so there is still a small chance of developing cervical cancer.

People who routinely attend cervical screening with a clinician at their GP practice or sexual health clinic should continue to book their appointments as normal.

Anyone who has been invited for cervical screening can still book an appointment at any time, even if the invitation was sent months or years ago.