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 ongoing Ebola virus outbreak in the Democratic Republic of Congo, which has also spread to Uganda, has been identified as caused by the rare Bundibugyo strain.

As per the US CDC, as of May 17, there are reports of 10 confirmed cases and 336 suspected cases, including 88 deaths, in DRC.

Uganda has reported 2 confirmed cases, including 1 death, among people who travelled from DRC. No further spread has been reported. These numbers are subject to change as the outbreak evolves.

Speaking exclusively to HealthandMe, Professor Emma Thomson, Director of the Centre for Virus Research (Virology) in the School of Infection and Immunity at the University of Glasgow, shared why the virus outbreak, which has been declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO), is of concern.

While the Bundibugyo virus, a member of the species Orthoebolavirus bundibugyoense, is closely related to the Ebola virus (species Orthoebolavirus zairense), it is still different and currently has no treatment or vaccine.

Professor Emma told HealthandMe that “there are several reasons for concern".

Ebola Outbreak: Likely Went Undetected For Some Time

The expert noted that "the reports that initial GeneXpert Ebola testing was negative suggest that the outbreak may have gone undetected for some time, with early diagnostic blind spots delaying recognition".

There have also been reports of infections in healthcare workers, which is "a serious warning sign in any filovirus outbreak, because they indicate unrecognized transmission in healthcare settings and gaps in infection prevention and control", the Professor said.

Notably, Ebola cases have been identified in Kinshasa and Kampala. These are "hundreds of kilometres from Ituri province, and it shows that the virus has already moved through human mobility networks before full containment was in place," Professor Emma said.

The Bundibugyo virus: Previous Outbreaks

The Bundibugyo virus has previously caused two recognized outbreaks. The first was in Bundibugyo District, Uganda, in 2007–2008, with 131 reported cases and 42 deaths, and a case fatality proportion of 34–40 per cent.

The second was in Isiro, Democratic Republic of the Congo, in 2012, with 38 laboratory-confirmed cases and 13 deaths, although wider outbreak reports, including probable and suspected cases, gave higher totals.

These figures are lower than the case fatality rates seen in many outbreaks caused by the Ebola virus, but they are still extremely serious. "Bundibugyo virus disease is not a mild infection," the expert said.

Ebola virus: Vaccine And Therapeutics

Currently, there is a licensed vaccine that targets the Ebola virus from the species Orthoebolavirus zairense (rVSV-ZEBOV).

"Experimental non-human primate work suggests that rVSV-ZEBOV may provide partial heterologous protection against Bundibugyo virus, but this cannot be assumed to translate into reliable protection in people during an outbreak," Professor Emma noted.

"Adenovirus- and MVA-vectored vaccine platforms may offer broader possibilities, particularly where multivalent constructs are used, but recent immunological data suggest that some licensed or advanced platforms still induce responses that are predominantly directed against the Ebola virus rather than broadly cross-reactive across all ebolaviruses," she added.

In other words, "we do not currently have a proven, licensed, Bundibugyo-virus-specific vaccine available for outbreak control," the Professor said, stressing the need for "urgent research" on vaccines.

Similarly, she stressed the need to boost "therapeutics" against the Ebola virus.

"Approved monoclonal antibody treatments such as Inmazeb and Ebanga were developed for the disease caused by the Ebola virus, not Bundibugyo virus, and their efficacy against other ebolaviruses has not been established," Professor Emma told HealthandMe.

"There are promising experimental broad-spectrum antibodies, but these are not yet a substitute for rapid detection, high-quality supportive care, infection prevention and control, and contact tracing," she added.

Bundibugyo-virus OutbreaK: What Should Be Prioritized?

Professor Emma further called for ramping up practical and scientifical priorities. These include:

• the Bundibugyo-virus-capable diagnostics,
• rapid genomic sequencing,
• strong infection prevention in healthcare settings,
• safe clinical pathways,
• contact tracing,
• community engagement,
• treatment centres able to deliver high-quality supportive care.

The expert also stressed the importance of genomic sequencing as it can:

• confirm the virus species,
• Identify whether cases are linked,
• reconstruct transmission chains,
• Detect whether the outbreak reflects sustained human-to-human transmission or multiple introductions.

“This outbreak also highlights a persistent weakness in epidemic preparedness. We tend to build tools around the best-known outbreak pathogens, but rarer viruses such as Bundibugyo virus can still cause severe disease and international spread," Professor Emma said.

The expert also highlighted the essential need for

• sustained investment in high-containment laboratories,
• diagnostic development,
• genomic surveillance,
• vaccine platforms,
• therapeutics and international research partnerships.

There is no case of Ebola reported in India, said the government today, while stepping up surveillance in the country at key places such as airports and seaports.

The government has also "initiated precautionary public health measures", following the declaration of a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO).

A senior official in the Ministry of Health clarified that "there is no reported case of Ebola in India and the current risk to the country remains minimal".

However, India is closely monitoring the outbreak that has so far 336 suspected cases, including 88 deaths, in DR Congo; and

2 confirmed cases, and 1 death in Uganda.

"Senior officials of the Ministry, including officials from the National Centre for Disease Control (NCDC), Integrated Disease Surveillance Programme (IDSP), ICMR, and other concerned divisions, have reviewed the evolving situation and initiated precautionary public health measures," said the Ministry.

Key preparedness measures include:

• Review of SOPs for screening, surveillance, quarantine , and case management;
• Strengthening laboratory preparedness, with NIV Pune designated for testing and additional laboratories being onboarded in phases;
• Enhanced coordination with relevant Ministries and agencies for monitoring international travel from affected regions;
• Identification and readiness of isolation and quarantine facilities at major airports and ports.

"India’s public health system remains vigilant and fully prepared to respond to any emerging situation,” it said, adding that “citizens are advised to follow official updates issued by the Ministry of Health & Family Welfare and WHO”.

The official asserted that India continues to maintain close coordination with international health authorities and will take all necessary measures to safeguard public health.

The Ebola Outbreak

On May 17, the WHO declared the Ebola outbreak in Central Africa a "public health emergency of international concern."

According to the Africa CDC, the outbreak is caused by a rare strain of the Bundibugyo virus, for which there is no vaccine available currently.

Bundibugyo virus disease is a rare and deadly illness that has caused outbreaks in several African countries in the past. It is different from other known ebolaviruses such as the Zaire ebolavirus and the Sudan ebolavirus.

How Does Ebola Bundibugyo Spread?

The Bundibugyo virus spreads through contact with the blood or bodily fluids of a person infected with or who has died from the rare Ebola strain.

It can also spread through contact with contaminated objects such as clothing, bedding, needles, and medical equipment, or through contact with infected animals such as bats and nonhuman primates.

Historically, Bundibugyo virus outbreaks have recorded fatality rates ranging from 25 per cent to 50 per cent.

Symptoms To Watch For

Symptoms of Bundibugyo virus disease are similar to other forms of Ebola and include:

• Fever
• Headache
• Muscle pain
• Weakness
• Diarrhea
• Vomiting
• Stomach pain
• Unexplained bleeding or bruising, usually in later stages of illness

Prof Trudie Lang from the University of Oxford also described dealing with Bundibugyo as “one of the most significant concerns” in the current outbreak, the BBC reported.

Symptoms are believed to appear between two and 21 days after infection.

With no approved drugs specifically targeting the Bundibugyo virus, treatment currently depends on supportive care, including managing pain, treating secondary infections, maintaining fluids, and ensuring adequate nutrition. Early medical care improves survival chances.

The Democratic Republic of Congo is currently facing its 17th outbreak of the Ebola virus. While scientists have identified the outbreak as being caused by the rare Bundibugyo strain, a major concern is that there is currently no approved treatment or vaccine specifically targeting it.

Although highly effective vaccines such as ERVEBO exist, they are designed specifically for the Zaire strain of Ebola and do not protect against other strains like Sudan or Bundibugyo.

Now, a team of scientists at the Université de Montréal (UdeM) in Canada has identified a new family of natural molecules with strong antiviral activity, particularly against the Ebola virus.

Previously, in 2016 and again in 2020, researchers at the university’s Montreal Clinical Research Institute (IRCM) demonstrated that a plant extract rich in isoquercitrin — a flavonoid found in many plants — showed strong antiviral activity in laboratory studies.

However, the exact source of the effect remained unclear.

What Were The Plant Molecules?

Researchers, including scientists from the University of Chicago, used advanced analytical methods and a rigorous bioassay-guided approach to determine that the antiviral activity did not originate from isoquercitrin itself, but rather from two previously unknown triterpenoid compounds.

Though present at only 0.4 per cent of the analyzed extract, these newly identified molecules — named dicitriosides — proved to be up to 25 times more active than the original extract against the Ebola virus under experimental conditions.

The compounds were also found to be effective against SARS-CoV-2, the virus responsible for the COVID-19 pandemic. Researchers noted that the molecules demonstrated antiviral efficacy at pharmacologically achievable concentrations.

“This discovery illustrates how compounds present in vanishingly small amounts in nature can have major therapeutic potential,” said Majambu Mbikay from the IRCM. “It also underscores the importance of carefully examining the true composition of natural products used in biomedical research.”

The scientists noted in the study that even though the findings are "still at the preclinical stage, it opens promising avenues for the discovery of new broad-spectrum antivirals derived from natural products”.

“No one knows when the next pandemic will occur, but one thing is certain: we must be prepared,” said Michel Chrétien, medical professor at UdeM. “These results demonstrate the importance of long-term fundamental research and international collaboration in anticipating the public-health challenges of the future.”

The Ebola Outbreak

On May 17, the World Health Organization declared it a "public health emergency of international concern." The outbreak has also spread to Uganda.

According to the Africa CDC, the outbreak is caused by a rare strain of the Bundibugyo virus, for which there is no vaccine available currently.

Bundibugyo virus disease is a rare and deadly illness that has caused outbreaks in several African countries in the past. It is different from other known ebolaviruses such as the Zaire ebolavirus and the Sudan ebolavirus.

As per the US CDC, as of May 17, there are reports of 10 confirmed cases and 336 suspected cases, including 88 deaths, in DRC.

Uganda has reported 2 confirmed cases, including 1 death, among people who travelled from DRC. No further spread has been reported. These numbers are likely to increase as the outbreak evolves.