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.

Col Anurag Upadhyay, a former Indian Army officer and Special Forces veteran, is living with locked-in syndrome, a rare neurological condition in which a person can remain conscious and aware while losing the ability to speak and move most muscles.

While there is currently no medicine or injection proven to reverse established locked-in syndrome, experts stress the importance of specialized neurorehabilitation, communication aids and appropriate assistive technologies.

Col Anurag’s Journey

A decorated Army officer and Special Forces veteran, Col Upadhyay suffered a severe posterior circulation stroke in August 2025. The stroke reportedly caused extensive neurological damage and left him with locked-in syndrome.

Despite being unable to move or speak normally, Col Upadhyay is conscious and aware. According to a social media post seeking medical and rehabilitation support for him, he communicates complete thoughts through eye movements and an alphabet-based scanning system.

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What Is Locked-In Syndrome?

Cleveland Clinic defines the syndrome as "a rare and serious neurological disorder that causes complete paralysis of all voluntary muscles except for the eyes, while leaving the person fully conscious and aware"

“Locked-in syndrome is one of the most devastating neurological conditions,” said Dr Sudhir Kumar, neurologist at Apollo Hospitals, Hyderabad, in a post on social media platform X.

The condition can leave a person unable to speak or move most muscles despite remaining conscious and aware.

It can severely affect communication and physical independence. However, the extent of impairment and potential for recovery can vary depending on the cause, location and severity of the brain injury, as well as whether the syndrome is complete or incomplete.

Is There A Medicine To Reverse It?

Dr Kumar said, “The honest answer is: There is currently no medicine or injection proven to reverse established locked-in syndrome.”

However, the absence of a proven medicine does not mean that supportive treatment and rehabilitation have no role.

Even after 13 months, Dr Kumar strongly recommended assessment at a specialised centre with experience in long-term neurorehabilitation and assistive technology.

Why Neurorehabilitation and Communication Matters

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Dr Kumar recommended a detailed reassessment by a multidisciplinary team that could include a neurologist, rehabilitation physician, physiotherapist, occupational therapist, speech and swallowing therapist, respiratory therapist, psychologist and specialist nurses.

Such an assessment can help identify even small voluntary movements that may have been missed or may have emerged over time.

He also recommended intensive, individualised neurorehabilitation focused on maintaining joint mobility, preventing contractures, improving head and trunk control, increasing sitting tolerance and supporting any residual voluntary movement.

“Even a small movement of a finger, thumb, head or eye can sometimes become functionally very important,” Dr Kumar said.

For people with locked-in syndrome, establishing a reliable way to communicate can be particularly important.

Dr Kumar stressed that “communication should be a top priority” and recommended considering an eye-gaze or eye-tracking communication system where appropriate.

“Restoring a reliable means of communication can dramatically improve autonomy and quality of life,” he said.

Swallowing, Respiratory Care And Mental Health

Dr Kumar also suggested “periodic reassessment of swallowing and bulbar function” and “speech-language therapy”, along with “chest physiotherapy, respiratory exercises, secretion management and periodic reassessment of ventilatory requirements”.

Emphasising the importance of mental health and quality of life, he said, “Never assume that a person with locked-in syndrome does not understand what is happening around them.”

What New Technologies Could Offer

Dr Kumar also highlighted “exciting ongoing research” into several technologies that could potentially improve communication, interaction and rehabilitation for people with severe paralysis.

These include:

1. Eye-tracking and advanced communication systems
2. Brain-computer interfaces (BCIs) that translate brain signals into computer commands
3. BCI-assisted communication for people with severe paralysis
4. Robotics and functional electrical stimulation
5. Virtual reality and technology-assisted rehabilitation
6. Non-invasive brain stimulation, such as transcranial direct current stimulation, currently being explored as an adjunct to rehabilitation

However, these technologies should not be presented as established treatments for locked-in syndrome.

“These technologies are promising, but it is important to be realistic: most are not yet proven treatments capable of reliably reversing locked-in syndrome,” Dr Kumar said.

For people living with locked-in syndrome, continued access to evidence-based rehabilitation, communication tools, assistive technologies and specialised care can remain important.

“For a man who has served our country, we owe him continued care, respect and access to every evidence-based opportunity for rehabilitation,” Dr Kumar said.

“There may not be a miracle medicine today. But there is still meaningful medicine to be practiced and meaningful hope to be offered.”

Tozorakimab, an investigational drug developed by AstraZeneca, reduced moderate-to-severe flare-ups of chronic obstructive pulmonary disease (COPD) in two late-stage trials, the company has announced.

Presented at the ongoing European Respiratory Society Congress in Barcelona, the results showed that patients receiving tozorakimab experienced about 29% to 34% fewer COPD exacerbations over one year compared with placebo, when added to standard inhaled therapy.

The results, also published in the New England Journal of Medicine, showed that the drug was generally well tolerated, with injection-site reactions reported as the only adverse drug reaction.

Researchers from the University of Pittsburgh who led the trials said the findings highlight tozorakimab’s potential as a treatment for people with COPD who remain at risk of exacerbations despite standard inhaled therapy.

What Is Tozorakimab?

Tozorakimab is a potential first-in-class monoclonal antibody targeting interleukin-33 (IL-33).

The drug is designed to inhibit signalling from both the reduced and oxidised forms of IL-33, with the potential to reduce inflammation and disrupt the cycle of mucus dysfunction that contributes to COPD worsening.

AstraZeneca is developing tozorakimab as an add-on maintenance treatment for adults with COPD.

What Did the COPD Trials Find?

The findings come from two replicate Phase 3 trials, OBERON and TITANIA, which included a total of 2,306 adults with symptomatic COPD who were current or former smokers and had a history of exacerbations despite stable standard-of-care inhaled maintenance therapy.

Tozorakimab 300 mg, given once every four weeks, reduced moderate-to-severe COPD exacerbations among former smokers by:

• 29% in OBERON

• 34% in TITANIA

In the overall population of current and former smokers, exacerbations were reduced by:

• 30% in OBERON

• 29% in TITANIA

The reductions were compared with placebo while patients continued inhaled standard-of-care treatment.

A pooled analysis of the two trials also showed clinically meaningful reductions across all prespecified patient subgroups, including those defined by blood eosinophil count (BEC).

Patients with a baseline BEC below 150 achieved a 23% reduction in moderate-to-severe exacerbations, while those with a BEC of 150 or higher achieved a 34% reduction. Among patients with a BEC of 300 or higher, the reduction was 43%.

“Today’s groundbreaking tozorakimab results, from two replicate trials, set a new standard for COPD treatment outcomes in a broad population of patients. AstraZeneca has clinically validated the novel approach of targeting the signalling of the two forms of IL-33 to both decrease inflammation and disrupt the cycle of mucus dysfunction. With our FDA Priority Review, we look forward to bringing this treatment to patients as quickly as possible,” said Sharon Barr, Executive Vice President, BioPharmaceuticals R&D, AstraZeneca.

What Happens Next?

The Biologics License Application for tozorakimab 300 mg, administered once every four weeks, has been accepted by the US Food and Drug Administration for Priority Review as an add-on maintenance treatment for adults with COPD.

Tozorakimab is also under regulatory review for COPD in major markets, including the EU and China.

The drug is being studied in a Phase II trial for severe asthma and a Phase III trial for severe viral lower respiratory tract disease. It received FDA Fast Track Designation for severe viral lower respiratory tract disease in November 2023 and for COPD in December 2024.

Why COPD Flare-Ups Matter

COPD is the third leading cause of death worldwide, excluding COVID-19. It is a progressive respiratory condition characterized by persistent airflow limitation and chronic inflammation of the airways.

Common symptoms include breathlessness, chronic cough, and excess mucus production.

COPD exacerbations can worsen these symptoms and contribute to ongoing inflammation and bronchoconstriction, making it difficult to breathe. They can also accelerate disease progression, increase hospitalizations and raise the risk of future cardiopulmonary events, including heart attacks.

In the US, COPD exacerbations cause more than 2,500 emergency department visits each day. Only 50% of COPD patients live more than 3.5 years after their first severe exacerbation.

Bangladesh was once close to eliminating measles but is now battling what has been described as the world’s largest measles outbreak. With close to 1,000 suspected and confirmed measles-related deaths since March 2026, the country is grappling with its worst outbreak.

According to Bangladesh health ministry data cited by Reuters, 999 deaths have been associated to the measles outbreak, including 100 laboratory-confirmed measles fatalities.

More than 166,000 suspected cases have been reported, including nearly 20,000 laboratory-confirmed infections. More than 146,000 suspected patients have also been hospitalised.

Bangladesh, who is already battling a worsening dengue crisis, is dealing with enormous strain on its healthcare system.

How Did Bangladesh Go From Near Elimination To A Massive Outbreak?

Measles is one of the world’s most contagious infectious diseases. It spreads through respiratory droplets and airborne particles when an infected person coughs, sneezes or breathes. But measles is also highly preventable through vaccination.

For much of the past decade, Bangladesh maintained measles vaccination coverage at or above the 95% level recommended by the World Health Organization (WHO) for preventing long-term transmission.

The vaccine coverage dropped during the COVID-19 pandemic, but the country had otherwise made substantial progress toward elimination.

The political upheaval in 2024 and 2025 disrupted routine immunisation which contributed to the current crisis.

Bangladesh’s health minister, Sardar Md. Sakhawat Husain, told parliament that changes in vaccine procurement contributed to shortages.

A vaccination programme was postponed in 2024, while a nationwide measles-rubella campaign planned for the following year was cancelled, according to Reuters. That left growing numbers of children without adequate immunity.

“Bangladesh missed its measles elimination target because of vaccination gaps in 2024 and 2025,” said Professor Mahmudur Rahman, an epidemiologist and former director of the Institute of Epidemiology, Disease Control and Research.

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Young Children Bearing The Brunt

Children under five have been particularly affected, making up for about 80% of cases during the initial stages of the outbreak.

Infants are especially vulnerable because babies younger than nine months may be too young to receive the routine measles vaccine, according to the country’s vaccine schedule.

When vaccination coverage falls in older children and adults, the virus can circulate more widely, increasing the chances that infants will encounter it before they are protected.

Measles itself can cause high fever, cough, runny nose and the characteristic rash. But the danger comes from its complications.

Children can develop pneumonia, severe dehydration, ear infections and encephalitis, or inflammation of the brain. Malnutrition can make severe disease more likely.

“To my knowledge, Bangladesh has never witnessed so many children dying from measles. Nor have we ever seen such a high number of patients in a single year. This is a truly terrible situation, and the saddest part is that the victims are children,” Rahman said.

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Bangladesh Has Started A Massive Vaccination Response

The government launched an emergency measles-rubella vaccination campaign in April, supported by international health agencies.

More than 19.7 million children have been vaccinated through the campaign, according to Reuters. But public health experts say emergency campaigns alone cannot solve the problem.

The country also needs to restore routine childhood immunisation, identify children who missed earlier doses and close the immunity gaps that allowed the virus to spread so rapidly.

UNICEF had already warned in April that the outbreak was disproportionately affecting young children. Its early situation report recorded nearly 10,000 suspected cases and 128 suspected measles-related deaths by April 7, highlighting how quickly the outbreak escalated.