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.

Amid rising demand for surgical care, the US is expected to face a significant shortage of surgeons by 2038, according to the first unified assessment of the country’s surgical workforce.

The study, presented at the American College of Surgeons (ACS) Clinical Congress 2026, projects that the US will face a shortfall of 27,940 surgeons nationally.

This comes as demand for surgeons is projected to increase by 12.8%, while the overall surgeon workforce is expected to decline by 4.2% between 2023 and 2038. The workforce would meet just 84.3% of projected national need.

“Studies usually look at one specialty at a time, so a shortage looks like that specialty’s problem,” said lead author Fernando Ribeiro Duraes, a medical student at Case Western Reserve University School of Medicine.

“When you put all 10 specialties together, you can see supply is projected to fall while demand keeps rising, and that the gaps are worse in rural areas. The fixes have to be targeted by specialty and by geography, not incremental.”

Which Specialties Will Face The Biggest Shortages?

Researchers used the Health Workforce Simulation Model (HWSM), a federal model from the US Department of Health and Human Services, to analyze surgeon supply and demand across 10 surgical specialties from 2023 to 2038.

The analysis found that overall surgeon supply is projected to decline 4.2% from 2023 to 2038, while demand is expected to rise 12.8%.

The specialties projected to face the most critical shortages include:

• Vascular surgery — 65.8% of need met
• Ophthalmology — 71.8%
• Thoracic surgery — 73.1%
• Plastic surgery — 74.1%
• Urology — 84.4%
• Otolaryngology — 87.5%
• Orthopedics — 87.9%
• Neurosurgery — 88.7%

Only general surgery, at 91.3% and colorectal surgery, at 98.3%, are projected to remain close to meeting demand.

At the same time, the gaps between surgeon supply and demand are also projected to be greater in rural areas.

What Could This Mean For Patients?

For patients, surgical shortages could mean longer waits for procedures.

Patients may also need to travel farther for medical care, particularly in rural areas where some people may have to drive hours to access treatment.

The researchers said the findings point to the need for targeted workforce policies and geography-focused strategies rather than incremental changes.

Duraes pointed to a proposed bill, H.R. 3890, the Resident Physician Shortage Reduction Act, as one potential response.

The bill would increase the number of residency positions, which the ACS says has not changed since 1997. It also proposes addressing federal student loan limits and expanding loan-forgiveness programmes to encourage physicians to practise in rural areas.

“The fixes have to be targeted by specialty and by geography” if they are expected to work, Duraes said.

Global Health Workforce Crisis

The US shortage projection comes amid broader concerns about health workforce shortages worldwide.

Nearly one in four doctors globally is older than 55 and could retire within the next decade, according to the World Health Organization’s National Health Workforce Accounts: Health Workforce Levels and Trends 2026.

The report, the first in an annual series providing a global picture of health workforce levels and trends, said ageing among health workers is intensifying shortages in some countries, while population ageing is simultaneously increasing demand for healthcare services.

The global health worker shortage has fallen from 20 million in 2013 to 15 million in 2020. However, newer analysis has revised the projected shortage for 2030 upward to 11.1 million, compared with an earlier estimate of about 10 million.

The Ebola outbreak, declared an emergency in May, continues to spread in the Democratic Republic of the Congo (DRC). According to the latest update from DRC health authorities, confirmed cases have surpassed 8,000, while the death toll is nearing 4,000.

The World Health Organization (WHO) warned that the outbreak remains large, geographically expanding and marked by sustained transmission.

The DRC “had recorded 8,067 confirmed cases, including 3,901 deaths, with a case fatality rate of 48.4 per cent,” according to the latest government situation report. It has spread to seven health zones.

“The continuously high case fatality ratio, and especially the continuous high rate of deaths occurring in communities, highlights the seriousness of the disease and the persistent challenges in timely case detection and access to early and adequate patient care,” the WHO said in its latest Disease Outbreak News.

However, Dr Janet Diaz of the WHO’s Health Emergencies Program told reporters in Geneva that “we are beginning to see a reduction in transmission in some areas, the number of cases remains high for this outbreak”.

Treatment Delays Remain A Concern

Dr Diaz said that although it is known that “early access to care can significantly improve chances of survival,” “Yet in this outbreak, many people are still dying at home or in their communities because they are unable to reach health facilities on time.”

“Delays in seeking care, together with challenges in access and referral, continue to complicate the response,” she said, adding that WHO and its partners have focused on improving early recognition of illness, rapid referral systems and early supportive care.

“Every patient bed requires a skilled workforce to provide safe, quality care around the clock,” Dr Diaz said.

Oxygen Access A Key Challenge

A key component of supportive care for patients with Ebola, particularly those with severe illness, is oxygen. Yet this life-saving medicine remains “unavailable or unreliable in many health facilities, especially in emergency settings”.

Ensuring access to oxygen requires functioning health systems, reliable infrastructure, trained health workers and sustainable delivery systems “that reach patients wherever they are”.

“Without previous oxygen scale-up efforts in Ebola and Marburg [virus disease] responses, we would not be where we are today in terms of more positive outcomes for patients,” she noted.

Vaccine Trials Underway

While there is currently no approved vaccine against Ebola Bundibugyo virus, vaccine trials are underway.

Clinical trials of specific vaccines and treatments against the Bundibugyo virus are also ongoing. The DRC also received more than 70,000 doses of the Ervebo vaccine last month. Ervebo is approved for protection against the more common Zaire Ebola virus.

DRC’s 17th Ebola Outbreak

The outbreak, caused by the rare Bundibugyo virus, was declared by the WHO on May 15. It is the DRC’s 17th Ebola outbreak since the virus was first identified in 1976.

It is also the second-deadliest Ebola outbreak on record, behind the West African outbreak that lasted from 2014 to 2016.

You can exercise regularly, eat reasonably well and have no obvious symptoms — yet still have plaque building up inside your arteries.

The process called atherosclerosis is often slow and silent, with symptoms appearing only after plaque significantly affects blood flow — sometimes with a heart attack or stroke.

A study published earlier this month in The New England Journal of Medicine (NEJM) found that plaque buildup can begin decades before symptoms appear. Researchers detected atherosclerosis in many apparently healthy young adults, including those in their 20s.

Atherosclerosis Can Start Decades Before Symptoms

The NEJM study showed that signs of hidden atherosclerosis could be detected in approximately one in 13 people aged 18–29. Among those aged 60–70, nine out of 10 showed signs of atherosclerosis.

Dr. Robert Grant, St. George’s University School of Medicine, Grenada, West Indies, told HealthandMe that the most important message is that atherosclerotic cardiovascular disease often begins decades before symptoms appear. Heart attacks and strokes are usually late manifestations of a process that develops gradually over many years.

“Atherosclerosis is not exclusively a disease of older adults. Clinical complications remain predominantly diseases of older adults. The pathological process often starts much earlier than the clinical disease becomes evident," he said.

The study therefore shifts our thinking from "atherosclerosis is an old-age disease" to "atherosclerosis is a lifelong disease that becomes clinically important with advancing age," he added.

Can Exercise And A Healthy Diet Protect?

Regular exercise, a healthy diet, avoiding smoking, maintaining a healthy weight, and good sleep remain important preventive measures, said Dr. Robert.

“These habits lower LDL cholesterol, improve blood pressure, reduce inflammation, improve insulin sensitivity, and substantially reduce cardiovascular event rates," he said. “They are foundational and should not be minimized.”

However, healthy lifestyles do not guarantee the absence of atherosclerosis. Other risk factors include:

• Genetic predisposition and family history
• Elevated lipoprotein(a) [Lp(a)]
• Insulin resistance or diabetes
• Previously elevated LDL levels during earlier life
• Hypertension that has gone undetected or untreated

Dr. Rajat Mohan, Senior Consultant Cardiologist at Sir Ganga Ram Hospital, also stressed that people who exercise and eat in moderation can still develop coronary disease because of other risk factors, including genetic tendencies.

He also emphasized the need to check cholesterol levels and avoid smoking.

Why Indians May Be More Vulnerable

Coronary artery disease has a high burden in the Indian population, with diabetes, family history, smoking and tobacco use among the factors contributing to risk, Dr. Rajat told HealthandMe.

"Diabetes is a precursor for developing coronary artery disease," he said.

Dr. Ramakanta Panda, renowned cardiac surgeon and Chairman, Asian Heart Institute, Mumbai, also pointed to studies suggesting greater vulnerability to early atherosclerosis among Indians.

Referring to the INTERHEART study, he said that Indians get their first heart attack 5-6 years earlier than people from other regions, and a UK study found double the risk compared with Europeans.

Can Normal Cholesterol And Blood Pressure Be Reassuring?

“Yes. The "normal" LDL range is not truly safe for arteries. In US adults without traditional risk factors, coronary atherosclerosis rose from 13.2% when LDL-C was below 70 mg/dL to 48.2% when it was 160 mg/dL or higher. Non-HDL cholesterol and apoB showed similar associations," Dr. Ramakanta told HealthandMe.

He added that beyond standard readings, doctors should consider:

• apoB and lipoprotein(a)
• HbA1c and insulin resistance
• Waist circumference and fatty liver
• hsCRP
• Premature family history
• Kidney disease and pregnancy complications
• Where appropriate, calcium scoring

Should Screening Be Universal?

Dr. Ramakanta said that mass screening has not been shown to reduce death rates significantly. However, targeted screening or testing can be helpful. For an apparently healthy person with no symptoms, a sensible approach is:

• Blood pressure
• Fasting glucose/HbA1c
• Lipid profile, particularly LDL
• Weight/BMI and waist circumference
• Smoking/tobacco, physical activity, diet and family history of premature heart disease
• Assess the person’s overall cardiovascular risk and treat modifiable risk factors accordingly

"The ESC specifically recommends systematic risk assessment in people without known cardiovascular disease. I would not recommend routine ECG, treadmill testing, echocardiography, or coronary CT for every asymptomatic individual unless they have risk factors.”