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Analysis

Antibiotic resistance: a matter of time

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It’s 1928 and a Petri dish left next to an open window is about to revolutionise modern medicine. Scottish scientist Alexander Fleming finds that something in the mould growing in the dish is killing off bacteria. It’s penicillin, the first antibiotic. This wonder drug, and other antibiotics, will go on to treat the untreatable, saving millions of lives.

It’s 2050. The cupboard is bare. Antibiotics were our precious resource. We needed to use them. Of course we did. But we weren’t prudent. Because each time we used them, misused them, and overused them, we gave the bacteria a chance to evolve, to become resistant. And without global leadership scientists have been unable to bring new antibiotics to market. Now, even cuts have fatal consequences.

Has the clock really been ticking towards a post-antibiotic future, where drug-resistant infections kill 10m people a year? Where chemotherapy is unsafe? Where simple surgeries are too risky to perform? Where the world’s biggest child-killer, pneumonia, is now unstoppable? Is this just a projection?

2020. Climate change is headline news. Forests burn. Scientists predict rising sea levels. There is a sense that time for action is running out. And then comes Covid. It’s a fast-moving pandemic. A million dead and counting. But the world mobilises with urgency. Individuals, doctors, scientists, yes, governments and policymakers, too. The unthinkable becomes the norm. Cities, countries under lockdown. Economies radically reshaped. Vaccines developed in record time.

And against this backdrop, a chance to change the narrative on that other looming global catastrophe, the one we already know about – antibiotic resistance. Because everyone sees now, we can mobilise. We can take individual and collective responsibility, and we must be prepared.

It’s 1945. The Allied victory. That was a collective effort, too. During World War Two penicillin has been mass produced, used to treat soldiers’ septic wounds. Hailed as a victory of science over death. But as he collects his Nobel Prize, Fleming is already issuing a warning. Misusing antibiotics can hasten the evolution of drug-resistant bacteria and render them useless for future generations.

Here’s how it works with E coli in a giant Petri dish. The E coli bacteria hits a line of antibiotic and pause, until a random mutation enables the bacteria to overcome the drug. At each line, the antibiotic is 10 times more concentrated, but there are also more mutations. It’s evolution by natural selection, only very, very fast.

We live in a Petri dish, too. The bacteria are a part of our ecosystem – around us, within us. Trillions upon trillions, helpful as well as harmful. And resistance is natural, to be expected. But by increased misuse we only encouraged the mutations. We overprescribed. Of course we did. Medicine is not an exact science. Diagnosis is difficult, and people expect to be cured. In some parts of the world antibiotics don’t even need a prescription at all. They’re over the counter or at the back of the drawer. But against viral coughs, colds, and sore throats, they’re useless – worse than useless. We give them to our farm animals, too. We want to prevent infection. We want to plump our food. We want cheap meat.

It’s the 1980s. This is the start of the discovery void. For more than 30 years no new classes of antibiotics will be launched. Why? Follow the money, and it runs out. Big Pharma has no incentive to invest in the development of antibiotics. There’s no profit. It’s expensive, time consuming, and complex, and single use. While antidepressants and heart drugs – they make money on repeat Meanwhile, controls designed to limit the inappropriate use of antibiotics also limit financial incentives for making them.

It’s 2020, the here and now, and we have some of the answers. Preventing infections with better hygiene and vaccines. We can repackage existing antibiotics to make them resistance-proof. Or use phage therapy to attack the bacteria with viruses. And in the future AI could lead to more accurate diagnoses. Surely new antibiotics must be part of the answer, too. Funding agreements can give the bigger companies the financial incentive. Partnerships can give smaller companies access to resources. And what about de-linking volume from profit? Concentrating not on the number of pills but their value. Paying companies not for how much antibiotic they provide, but its potential worth to the health system. Something like a subscription. Something like insurance.

The building is catching fire. The edifice is crumbling. The cupboard is running bare. Already, antibiotic resistance is killing 700,000 people a year. In some ways Covid has made the problem worse. Fears about secondary infections mean large quantities of antibiotics have been prescribed to patients. But Covid could help make things better, too. If it motivates us, if the world mobilises – individuals, doctors, scientists, yes, governments and policy makers, too. The solutions are scientific, but they’re also economic, and they’re societal. It’s a collective effort.

It’s not a projection. It’s not a sort of an imaginary projection that it’s going to get worse. We know that’s going to happen. And because we know that it’s going to happen, we actually also know how we can slow it down. You realise that actually all those things that you prepare for – it’s so that you’ve got it there when you need it. Everyone has their part to play. The point is we do have the opportunity to do something about it.



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Analysis

Can plant-based milk beat conventional dairy?

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Plant-based milk brands are churning up the global dairy business, with a surge in sales, investment, and new products coming to market. The plant derived dairy trade is now worth an estimated $17bn worldwide.

Growing consumer demand has boosted investment. According to data firm Dealroom, venture capital funding across the plant-based dairy and egg sector has skyrocketed, from $64m in 2015 to $1.6bn in 2020.

The world’s biggest food company, Nestle, recently launched its first international plant-based dairy brand, a cow’s milk substitute made from yellow peas. Wonder will come in a variety of flavours, competing with established brands like Oatly oat-based milk. Founded in Sweden in the 1990s, that company is now valued at around $15bn. Demand for alternatives to soya, which once dominated the dairy free market, continues to escalate.

In the west, sales for other plant-based milks, including oat, cashew, coconut, hemp, and other seeds overtook soya back in 2014. Since then, they’ve raced ahead to be worth almost three times as much as soya products, with a combined projected value of more than $5bn in sales by 2022.

Advocates argue that plant-based production emits less greenhouse gas than cattle, making it the way forward to help feed the world and curb global warming. But dairy groups are fighting back with their own sustainability campaigns. And cow’s milk is hard to beat when it comes to naturally occurring nutrients, like protein, vitamins and minerals.

The average 100 millilitre glass of cow’s milk contains three grammes of protein, compared to 2.2 grammes in pea milk and just one gramme in oat-based substitutes.

Dairy producers have also won a legal bid, preventing vegan competitors in the EU from calling their products milk and yoghurt. Despite their growing popularity, plant-based brands are a long way from displacing conventional milk products. Their current $17bn turnover is still a drop in the pail, compared with the traditional cattle-based dairy trade, which is worth an estimated $650bn worldwide.



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Analysis

'It’s more than sport – every day we are fighting for our rights to be equal’

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French pro basketball player and podcaster Diandra Tchatchouang on her role beyond the court



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Emily Dean on how allyship amplifies the female experience on film

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When I was six years old, I decided to be an artist. When I was 12, I decided to be a filmmaker. And instead of saying no, you can’t do that, or it’s not possible, my mum bought me a video camera.

After several years of working in the industry, I’m working with a female director for the first time. And it’s been such a gratifying experience. Women express leadership in different ways. Maybe you don’t have to be the loudest person in the room. But you can have great ideas.

And the best thing about being mentored by women and being a mentor to women is that make friends with women.

There’s something so powerful the women coming alongside other women, especially in a group setting. Because it means that you can and back each other up. You can support each other’s decisions, and you can amplify each other’s voices.

It’s about seeing yourself in your work. Seeing some part of yourself reflected is really gratifying. It’s also important that we speak up for female characters. I want to see girls and women on screen who have the whole cacophony of experience of what it’s like to be female.

I want to see their flaws. I want to feel their struggles. I want to see their joy. That is so important to making a character feel real. And it took me a little while to settle into myself and realise, if the characters I like to come up with are not your everyday run of the mill characters you see in animation, that’s fine. Because this is who I am.

When you walk into a story room, when you’re working on a film, you have to leave your ego at the door. I think that can be interpreted like keep your ego out of the work. But I’d also say for women who are maybe more shy that leaving your ego at the door means you walk in. And your job is to focus on what’s best for the story and for the film.

The story needs you. The film needs you, and it needs your best ideas. It won’t thrive unless you speak up.



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