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Allt fler finansbolag i Storbritannien och USA börjar få upp ögonen för konkurrensfördelarna med att erbjuda sina anställda betald pappaledighet. Men konceptet har också stött på motstånd – inte sällan från de egna kollegorna, berättar flera pappor för Financial Times. Adam jobbar i Londons bankdistrikt. Han tror att hans föräldraledighet tolkades som att han inte längre var engagerad i sitt jobb. Därför, menar han, placerades han på bänken och fick se på när hans mer oerfarna kollegor befordrades. City and Wall Street employers are introducing better benefits for new fathers — but there is more to do By Emma Jacobs

Financial Times, 24 September 2023 Shortly before his second stint of extended parental leave, City lawyer Adam was left embarrassed in front of clients when a senior partner asked why he was taking time off instead of his wife. After he returned, the sexist comments continued, along the lines of: “Your job is to be here . . . the wife should be bringing up the kids”, he says. Adam’s law firm offers six months of shared parental leave at full pay. It asked him to become part of an internal marketing push to raise awareness of the benefit. But the attitudes he encountered from colleagues left him feeling the firm did not really expect men to take the leave at all. Offering extended paid leave for new fathers is becoming increasingly common among Wall Street and City firms as they seek to close the gender pay gap, reduce potential discrimination against women when it comes to hiring and promotion, and attract and retain staff. Many are opting for gender neutral policies that offer a minimum amount of leave for all parents with an extra allowance following pregnancy. Yet there can be a disconnect between policy and reality, as employers and staff grapple with the cultural and practical challenges of making more equal parental benefits work. Some fathers have encountered similar biases to those their female partners are hoping to escape. In the US, Barclays recently followed Morgan Stanley and Bank of America to provide at least 16 weeks of leave to all new parents. Goldman Sachs offers at least 20 weeks. The offers are generous for a country that has the “worst family-leave policies on Earth”, according to Boston College management professor Brad Harrington. The US has no mandatory paid parental leave, with companies free to set their own benefits. Overall, only 13 per cent of private sector workers are employed at workplaces that offer paid paternity leave to all male employees. Elsewhere, fathers’ ability to take time off is enshrined in law. In the UK, a 2015 shared parental leave policy gives mothers and fathers the right to share up to 50 weeks of leave after the birth or adoption of their child. But only about 2 per cent of parents use this scheme for fathers, mostly because they cannot afford to reduce their income to statutory pay levels. More City institutions, including law firms Allen & Overy and Linklaters and insurer Aviva, are stepping in with policies offering better benefits. Ian Dinwiddy, a coach and founder of Inspiring Dads which supports fathers in the workplace, observes a domino effect, as more companies overcome worries about “cost [and having] to cover the leave”, forcing others to compete. Adam* said the leave helped him forge a strong connection with his children and put him on an equal parenting footing. “The kids are as comfortable with me as they are with my wife. They don’t care if it’s me or my wife if they are upset and need comfort.” But it came at a cost. He believes his absence was seen as a sign he was no longer committed to work. “If I had not taken extended leave, I’d expect to be a partner. There are people significantly more junior than me that have been promoted. It’s not going to happen this year, I doubt it will happen next year.” Some of his peers say the negative attitudes will “die out when the dinosaurs leave”, but Adam has encountered resistance from younger partners too. “It’s not just men who’ve made these comments, it’s also some of the senior females. Their attitude is, ‘We had to deal with it, so you have to too.’” Jasmine Kelland, lecturer in human resource management at the University of Plymouth, says “social mistreatment” apportioned to fathers taking an active role in caregiving can be harsh. “If they take parental leave, they may face mockery, [and are] viewed suspiciously. It is often viewed as being work shy. They say all these things to working dads but wouldn’t dream of saying it to working mums.” Even when policies are equal, some HR managers and team leaders do not offer the same support to fathers. “Mums will have a return-to-work conversation,” adds Kelland. “Lots of managers don’t have that conversation with dads.” Nonetheless, these are early days for extended paternity leave — and many fathers and experts observe positive shifts in attitudes. A 2019 study by Boston College of four companies offering paid parental leave found that 62 per cent took their full entitlement. “Men eligible for eight weeks of leave took an average of 7.2 weeks (90 per cent), while men eligible for 16 weeks took 12.8 weeks on average (80 per cent)” the report says. One London-based investment director says he took one month shortly after shared parental leave was introduced but now members of his team are taking longer. Linklaters says 50 per cent of lawyers and 80 per cent of business team employees in the UK took their full paternity leave entitlement in the year to June — and no one took less than three weeks. Aviva says 99 per cent of eligible fathers are using the benefit, taking an average of 23 weeks. Almost half of those taking parental leave at the insurer are men. Dinwiddy says ringfenced leave — which is not shared between a couple — encourages fathers to take it. “Because [shared leave] is a choice — men have to opt in and that comes with fear of being seen as uncommitted.” There is also safety in numbers, he says. “If men think other men are going to take it, they will too.” Louisa Symington-Mills, founder of WorkLife Central, which offers digital content for working parents, says extended leave is helping to foster an “understanding in workplaces that parenting responsibilities will be shared more equally”. For Ronak Patel, equities sales trader at Morgan Stanley, who took leave after the birth of his son in March 2022, the experience has been “really positive”. “We’re trying to encourage a more diverse workforce at Morgan Stanley and on the trading floor. The more men that do it, the less of a big deal it becomes,” he says. Patel took 16 consecutive weeks. “We made sure we got ahead of it, so we could do proper handovers with clients. I had regular check-ins, once a month, to find out what was happening with the company, the team.” Returning “wasn’t a shock”, he adds.  An encouraging line manager is crucial. Jake*, who works in a support function at a bank, says extended leave had no impact on his job: “My boss was super-supportive, he’s got two young children himself. I got my biggest pay rise ever.” Nic Blumsky-Gibbs, who took leave from his role as vice-president of financial and strategic investors group at Goldman Sachs, says being put in touch with others who had taken time off work offered reassurance. Resistance to fathers taking leave may be due to the resources available for cover. If team members are expected to pick up more work, it can fuel resentment. But providing organised cover can be a positive experience, for example for junior staff to step up. Some companies offer external placements. PwC’s Flexible Careers Network, for example, has a pool of candidates available for short stints. Rob Colvin, senior associate in Freshfields’ dispute resolution group, who took two stints of leave when his children were born, believes hostile attitudes from employers are short-termist. “You want to retain your talent . . . you can plan for [the birth of a child].”  It might be the voice inside your head that is the obstacle, Colvin says. “I thought clients would be let down, but actually they’ve been supportive because lo and behold they’re also parents.” But job losses in the banking sector make it a “tough environment . . . to feel comfortable taking any extended leave”, warns Patrick Curtis, founder and CEO of Wall St Oasis, an online community for finance employees. In roles that demand long hours servicing clients, “it is understood that if you take too much time off, you could get replaced,” he says, though this is “less of a concern if you are more senior and . . . generate revenue directly for the firm”. Bonuses are another consideration. In jobs where a high proportion of remuneration is performance-related, fear of losing out may affect prospective fathers’ decisions to take extended leave. As one employee at an investment firm says, when employers “talk about full pay they are talking about salary — it’s not normally the case that the bonus part of pay is covered”. Fathers do recognise that these are issues — and biases — faced by generations of working mothers. As one trader puts it: “Men are having to ask themselves the same questions about the impact on promotion and compensation.” The experience can make them more committed to an equal workforce. For Colvin, the leave gave him a chance to reflect on his ambitions. “It’s very much harder than being at work [but] it gives you an amazing perspective on work, it gives you a chance to recalibrate what you want to do with your career.” Despite his frustrations, Adam does not regret his decision to take leave. After all, he says, the benefits of spending time with his family outweigh “another billable hour”. * Names have been changed ©The Financial Times Limited 2023. All Rights Reserved. FT and Financial Times are trademarks of the Financial Times Ltd. Not to be redistributed, copied or modified in any way.

Tidigare beskylldes judar i Ukraina för allt möjligt – inklusive vedermödorna under kommunismen. Men antisemitismen har klingat av, inte minst på grund av kriget, skriver The Economist. En anledning är de väsentliga summor som judiska organisationer skänkt för att stötta Ukraina. En annan är att Volodymyr Zelenskyj själv är jude. Men det senare väcker även den djupt liggande rädslan för att bli syndabockar. Skulle presidentens arv kunna vara gnistan som väcker anklagelser om judarna som ansvariga för ukrainska förluster? After centuries of discrimination By The Economist 11 September, 2023 Nothing Russia can throw at them will deter up to 30,000 mostly foreign Jews from making their annual pilgrimage to the Ukrainian town of Uman, 200km south of Kyiv, this week. Rosh Hashanah, the Jewish new year, falls on September 15th-17th, and the visitors will mark it by praying at the grave of Nachman of Breslov, a rabbi who founded an important branch of Hasidism over 200 years ago. The pilgrimage has featured in recent quarrels between the Ukrainian and Israeli governments. Ukraine has threatened to ban Israeli pilgrims from entering the country because Israel has been deporting Ukrainians for alleged visa violations. But these arguments, which stem mainly from disagreements over the military help Israel is or is not willing to give Ukraine, have been largely resolved. Jewish-Ukrainian relations are in fact now enjoying something of a golden era. For a start, Ukraine’s president, Volodymyr Zelensky, is Jewish. That fact is “very disturbing” for the Kremlin, says Rabbi Moshe Azman in Kyiv. It exposes its war aim of “de-Nazifying” Ukraine as nonsense. Still, Vladimir Putin persists in repeating it. On September 5th Russia’s president went into full conspiracy mode, saying that Mr Zelensky had been put in his position by his “Western curators” and that this made “the whole situation extremely disgusting, in that an ethnic Jew is covering up the glorification of Nazism.” Last year, one day before the invasion, Kharkiv’s Jewish school celebrated its 30th anniversary. A few days later it was damaged in a Russian attack; the community’s nearby yeshiva, or religious college, suffered a direct hit. “Our schools aren’t able to function because rockets are hitting them,” says Miriam Moskovitz, director of the school. “It is nothing to do with Nazis”. Before the second world war Jews were a large minority in the lands that now comprise Ukraine; 1.5m of them were to perish in the Holocaust. Tens of thousands of Ukrainian auxiliaries helped the Germans commit this crime, though more than 7m fought the Nazis as troops in the Red Army. For older Jews the name Ukraine is almost synonymous with the word “pogrom”. National heroes of Ukraine like Bohdan Khmelnytsky, a 17th-century Cossack commander, are remembered by Jews as responsible for the deaths of thousands. Today many Ukrainians revere Stepan Bandera, whose followers fought the Red Army after 1944. They know, or choose to know, little about the murder of Poles and Jews at the hands of Bandera’s followers. In the past Ukrainians often blamed Jews for everything, including the hardships of communism. Now, says Yevhen Hlibovytsky, an analyst, anti-Semitism is fading—as is Jewish fear of Ukrainians. “The generation of those who grew up in the Soviet Union reflected a lot of the anti-Semitism that the Soviet Union practised. My generation is much freer of that and the generation of my children treats ethnic and religious diversity as normal.” The Pew Research Centre, an American institute, has found that Ukrainians are among the least anti-Semitic people in Europe. One of its polls found that just 5% of Ukrainians said they were not prepared to accept Jews as fellow citizens. That compared with 14% in Russia, 18% in Poland and 16% in Greece. “That may come as some surprise” to many, says Edward Serotta, the director of Centropa, a Vienna-based organisation dedicated to preserving Jewish memory in central and eastern Europe. Not to him. Ukrainians are enthusiastically learning about their country’s Jewish past. This March 210 Ukrainian teachers applied for 60 places on seminars on how to use Centropa’s resources, and then travelled for many hours to get to them. No one knows exactly how many Jews are left in Ukraine, and anyway the numbers depend on who counts as one. In 1989 the “core” Jewish population—those who identify as fully Jewish—was 487,000, according to the London-based Institute for Jewish Policy Research. Most emigrated after the disintegration of the Soviet Union, leaving an estimated 43,000 by 2021. (Counts that use broader definitions go above 200,000.) The fading of Jewish scepticism towards Ukraine is borne out in the scale of aid Jewish organisations have brought to the country since the start of the war. World Jewish Relief, based in the UK, has helped 236,206 people, in various ways. Synagogues have sheltered those in flight, and helped with evacuations and humanitarian aid. In Dnipro, in central Ukraine, families identifiable as Orthodox by their clothes can be seen in the streets around the Menorah Centre, a building that houses a Jewish museum, kosher hotels, a kosher shop and a synagogue. Men in uniform sporting kippahs smoke outside. Some of Ukraine’s Jewish soldiers were born or brought up in Ukraine before emigrating to Israel. Now they have returned to fight. One of the most extraordinary changes for Ukraine’s Jews in the last three decades has been that of identity. For decades after the second world war, most Jews in Ukraine spoke Russian and identified as Soviet Jews. Now, those that remain identify as Ukrainian Jews. Jewish prayer books are being translated into Ukrainian for the first time. In Ukraine today, Russians are the enemy. It is increasingly common to hear Israel, a thriving country surrounded by enemies, cited as a model for Ukraine’s future. Yet although Jews in Ukraine have never been freer from anti-Semitism, one deep-seated fear remains. If things go badly wrong in the war, runs the argument, Mr Zelensky’s heritage could become a lightning rod for renewed anti-Semitism, with Jews being blamed for Ukrainian defeats. One more reason for them to pray for victory. © 2023 The Economist Newspaper Limited. All rights reserved.

Sedan Berlinmurens fall har Europas länder vant sig vid att knappt lägga ett öre på försvarsbudgeten, skriver Financial Times och citerar Sveriges försvarsminister Pål Jonson om att fred varit lika självklart som luft. Men Rysslands krig i Ukraina blev en brutal väckarklocka och nu måste försvarsanslagen ökas – och det snabbt. Samtidigt finns en oro hos kontinentens försvarsministrar att väljarna inte är beredda att tugga i sig de ökade utgifterna. – Alla lever fortfarande i en drömvärld där det är fred, men den tiden är förbi, säger en rådgivare till tidningen. Defence ministers increasingly fear voters will not accept the high price of military deterrence By John Paul Rathbone

Financial Times, 12 September 2023 Boris Pistorius is proud to come from Lower Saxony — a part of Germany where people, as he puts it, “have their feet firmly on the ground”. Yet the defence minister is worried that even these stoic voters will balk at the idea of Berlin spending tens of billions of euros a year on building up the country’s military capacity. Convincing electorates of the need to spend more on defence requires “a totally changed mindset”, Pistorius said at a gathering of defence ministers this summer. Since the fall of the Berlin Wall, politicians have grown so accustomed to spending next to nothing on defence that peace is now considered, in the words of Sweden’s defence minister Pål Jonson, something so freely available that it is akin to air. “When you have it, you don’t really miss it,” he said. This “peace dividend” has also enabled countries to spend billions of dollars on health and education policies instead of on their armed forces. Russia’s invasion of Ukraine has been a brutal wake-up call not just to Germany but all western governments. Alongside China’s rise, the threat of a nuclear-armed Iran and instability in Africa, the war has forced ministers to commit to more defence spending. Sweden, which has applied for Nato membership, announced on Monday that it planned to raise defence spending by more than a quarter to meet the military alliance’s target of 2 per cent of gross domestic product. However, persuading voters of the sacrifices required to make such commitments a reality represents a seismic reordering of the budget and electoral priorities. “Everyone is still living in a peacetime dream world, but those days are gone,” one western defence adviser said. Pistorius believes there needs to be “honest” discussions with voters about the price of security. That will be tough to have in a climate where greening the economy and other social priorities associated with ageing are high on the agenda and governments’ own borrowing costs are shooting up owing to higher interest rates. In Japan, the question of how to fund its record increase in defence spending has divided a nation already grappling with ballooning social security costs. The government was forced to push back plans to increase corporate, income and tobacco levies by a year to 2025 amid fears that a tax hike would hurt prime minister Fumio Kishida if he calls a snap election later this year. In Denmark, the government opted to fund its increase in public spending by cancelling a public holiday — to much chagrin from voters. In the US, only 1 per cent of respondents cite national security as their main concern, according to polls, while in the UK surveys suggest it ranks 11th on average after issues such the economy, health, immigration and housing. Yet the financial implications of the newly security-conscious west were apparent at the Nato summit in Lithuania in July. There, alongside news of Swedish accession and Ukraine’s potential membership, leaders grappled with the thorny issue of budgets. While all members committed to spend 2 per cent of GDP — currently only 11 of 31 members do — there was less clarity on how the laggards would hit the target, or when.“’ Leaders have signed up to a generational shift in defence policy. But I do wonder if they fully understand, or have told their finance ministers,” a senior Nato official said. Germany’s finance minister, Christian Lindner, warned this month that meeting the country’s Nato commitment would require “considerable funds” from the core budget in the years ahead. Defence ministers have also backed calls for the military alliance to have 300,000 high-readiness soldiers, who would be deployable within a month — almost eight times the current number of 40,000. “Nato’s new force model sets a benchmark that most allies will struggle with,” said General Sir Richard Barrons, former commander of the British armed forces. “I suspect it will make some eyes water.” Nevertheless, looming issues demonstrate that there is a clear need for more funds to be devoted to defence, particularly in Europe. Germany’s Bundeswehr had only 20,000 155mm artillery shells in stock, enough for less than three days of fighting, according to a confidential finance ministry assessment reported by Der Spiegel in late July. Europe also cannot continue to rely on the US, whose $860bn defence budget is double that of all other Nato members combined. The US is forecast to run budget deficits of 6 per cent of GDP a year for the next decade and by 2053 federal debt will be twice GDP, the Congressional Budget Office estimates. “The US . . . makes a disproportionate contribution to European defence,” said Ben Barry, a senior fellow at the International Institute for Strategic Studies think-tank in London. “But if Europe does not shoulder more of the defence burden, that is not going to foster US enthusiasm [for Europe], especially given Washington’s growing strategic interest in the Indo-Pacific.” The war in Ukraine has also revealed the skimpiness of the west’s ability to manufacture weaponry. “This has been a war of warehouses,” said Jonson. “You have to have an industrial base [and] not just for peacetime but one that can ramp up production” in times of conflict. Defence specialists are keen to point out that investing in deterrence will cost far less than having to deal with the repercussions of conflict. “Economic security depends on peace,” said Barry. “While expensive, military deterrence is a form of economic insurance.” Referring to World Bank estimates that put the price of rebuilding Ukraine at more than $411bn so far, he added: “The bill for economic disruption caused by war is more expensive still.” Additional reporting by Kana Inagaki in Tokyo ©The Financial Times Limited 2023. All Rights Reserved. FT and Financial Times are trademarks of the Financial Times Ltd. Not to be redistributed, copied or modified in any way.

Redan idag ligger antimikrobiell resistens bakom miljontals dödsfall, och prognosen är att situationen bara kommer att bli värre, skriver Financial Times. Antimikrobiell resistens innebär att en mikrob – till exempel svamp, virus eller bakterie – kan överleva exponering för ett läkemedel som normalt skulle döda den eller stoppa dess tillväxt. Antibiotikaresistens är kanske det mesta kända exemplet. Samtidigt saknas det incitament för läkemedelsindustrin att försöka lösa problemet, skriver tidningen. Antimicrobial resistance already kills millions and is projected to get worse. But there is little incentive for Big Pharma to tackle the issue By Hannah Kuchler August 28, 2023 In the summer of 2021, researchers at MIT and McMaster University in Canada fed an algorithm 7,000 chemical compounds in the hope that it would identify one that could kill Acinetobacter baumannii. Described by Jonathan Stokes, one of the scientists involved, as a “notoriously challenging” pathogen, strains of Acinetobacter have become resistant to antibiotics over the past few decades, allowing them to prey on weakened hospital patients and leaving doctors powerless to treat them. It took just an hour and a half — a long lunch — for the AI to serve up a potential new antibiotic, an offering to a world contending with the rise of so-called superbugs: bacteria, viruses, fungi and parasites that have mutated and no longer respond to the drugs we have available. After the AI identified the compound, the researchers refined it to make it more powerful. Then they tested it in mice, finding it could suppress the bacteria in wound infections. (Compared to traditional methods, the algorithm is better at finding compounds that work in animals; it has already found several other candidates.) It will take years to test the drug in humans and find out if the AI really has hit gold. But Stokes is enthusiastic. “I’m really excited about this compound. I love this compound,” he says. Antimicrobial resistance (AMR) — which encompasses all microbes and not just bacteria, which are targeted by antibiotics — is sometimes referred to as a “silent pandemic”. Resistant pathogens killed 1.26mn people in 2019, according to an analysis published in the medical journal The Lancet. “All of modern medicine is upheld by our ability to control infectious disease. If we can’t control infection, we can’t administer chemotherapy, do invasive surgery, and preterm birth becomes really, really challenging and risky,” Stokes says. The problem is getting worse with time. In 2016, a UK review led by Lord Jim O’Neill, an economist and former Goldman Sachs banker, forecast the number of annual deaths from antimicrobial resistance would rise to 10mn by 2050 — approximately the number of people who currently die from cancer. But based on more recent data, he now believes that up to twice as many could die. The pharmaceutical industry and governments are failing to invest enough in replacing the older antibiotics with newer drugs that bacteria aren’t resistant to, risking crises where clinicians — whether they are treating one patient or a pandemic — find the medicine cabinet is in effect bare. Technologies such as AI could help combat resistance by cutting the time and cost of the initial phase of drug discovery, while portable genomic sequencing technology could help doctors choose the right antibiotic for each pathogen in the clinic or hospital. But even when a promising new antibiotic is discovered, it enters a broken market. To avoid spurring yet more resistance, new antibiotics should be used sparingly, so they are unlikely to be bestsellers for drug companies. Governments and health systems accustomed to cheap generic antibiotics will not spend enough on novel drugs to make antibiotic development pay off. The cost of bringing a new antibiotic to market is approximately $1.5bn. Few venture capitalists or large drugmakers want to fund the costly clinical trials required by regulators. Investors have lost about $4bn on biotechs developing antibiotics, according to the impact investor the AMR Action Fund. The start-ups have either gone bankrupt, been sold off cheap, or pivoted to more lucrative areas. As with climate change and future pandemics, no one is taking enough responsibility for the ever-present global threat of antimicrobial resistance, scientists say. The UK, US and EU are working on ways to incentivise drugmakers to create better antibiotics, but so far, their efforts have lacked co-ordination and urgency. O’Neill says the Covid-19 pandemic demonstrated how “devastating” uncontrolled infectious disease can be. But as people try to return to normality, he says it has become a “tough sell” for policymakers to “bombard people with dreadful views of the future all the time”. “Unless it gets on the 10 o’clock news, one of the top stories each day of the week, which policymakers are really going to put it right at the top of the agenda, including putting money behind it as needed? And the answer is, I can’t think of any,” he says. When British scientist Sir Alexander Fleming gave his acceptance speech for winning the 1945 Nobel Prize for discovering penicillin, he warned of the dangers of rising resistance. “The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant,” he said. Fleming had foresight. Overuse of antibiotics is a large contributor to antimicrobial resistance, particularly in the developing world where the drugs are often available without a prescription, and in the US, where doctors frequently prescribe them for infections that may not be caused by bacteria, such as a cold. Even in the UK, where the NHS is more cautious about doling out prescriptions, the former health secretary Thérèse Coffey admitted handing leftover antibiotics to her friends. The more bacteria are exposed to antibiotics, the more they evolve ways to avoid their killing mechanisms and survive. As well as overprescription in humans, bacteria are exposed to antibiotics in the food supply chain, where animals are pumped with the drugs to avoid disease in cramped conditions and, in some cases, to boost their growth. Other factors are emerging: a separate recent study in The Lancet also suggested that air pollution may be a vector for superbugs, as resistance rises in tandem with levels of small particulate matter. But even clinicians who are aware of the problem, and want to give antibiotics in a more targeted way, struggle because of a lack of diagnostics — tests that can identify precisely what the pathogen is. They tend to rely on so-called broad spectrum antibiotics, which should be able to tackle a range of bacteria, but have the serious side effect of building resistance even in bacteria they are not targeting. At London’s St Thomas’s hospital, on the banks of the river Thames, microbiologists are trialing a new approach to speed up diagnosis and alert doctors to when their patient has bacteria that may be resistant to an antibiotic. Instead of waiting three to five days for scientists to grow the bacteria in a Petri dish and examine it under a microscope, they are using a genomic sequencer developed by Oxford Nanopore. The size of a printer, it can give its first view on what the pathogen is within half an hour, and a full report in two hours. Previously the reports from the microscope observations had been “close to being completely unhelpful”, says Jonathan Edgeworth, a consultant microbiologist at St Thomas’s and the vice-president of medical affairs at Nanopore. They were viewed by doctors as a public health tool to track disease, not diagnose it. Now, they can use the sequencer to select the right treatment, and eventually, the data could also point drugmakers to which resistant pathogens to target and how. Ian Abbs, chief executive of the hospital’s trust, says they have already seen an impact in intensive care patients, where the potential financial savings of treating patients more quickly are significant. “Each day costs about £2,500, depending on the complexity of the patient. For my sickest patients, it could be £10,000,” he says. The scheme is being expanded to five other hospitals and Abbs hopes to quickly spread it across the NHS. Incentivising research To keep research labs open and looking for new antibiotics, philanthropists and impact investors have tried to fill the gap that venture capitalists have left. In 2016, a US-based consortium called CARB-X launched with government and foundation money to accelerate development of new antibiotics, vaccines and rapid diagnostics. That year, the World Health Organization and the Drugs for Neglected Diseases Initiative created GARDP, a partnership to accelerate the development of treatments for drug-resistant infections. In 2020, drugmakers invested about $1bn in the AMR Action Fund, aiming to launch two to four new antimicrobials in the next decade. The researchers at McMaster and MIT have given their potential drug to Phare Bio, a social venture that has raised $25mn from The Audacious Project, which combines funding from TED (of TED Talks fame) and other non-profits. It is testing the drug candidate in animal studies and hopes to partner with Big Pharma to get it through clinical trials. “Because we have philanthropic investment to help us get through this highest risk phase, we feel that will enable us to succeed and in ways that companies that are only commercially funded even at the earliest stages may not be able to,” Akhila Kosaraju, a doctor who is now Phare Bio’s chief executive, explains. But for all the optimism, Henry Skinner, chief executive of the AMR Action Fund, says AI is “helpful, certainly, but not transformative” because it does little to address where the real costs lie: in clinical trials. He thinks even his fund is “at best, a stop gap, partial solution”. “We feel a huge amount of responsibility. One billion dollars sounds like a lot of money but it is not nearly enough for the very expensive last-stage work,” he says. To create better incentives, attention is turning to changing how health systems buy antibiotics. This year, the UK has proposed expanding its novel subscription model, so drugmakers would receive up to £20mn a year for selling innovative antibiotics, no matter how many — or how few — are prescribed. The pilot started with drugs developed by Pfizer and Japan’s Shionogi last year. Mark Hill, Shionogi’s global head of market access, believes it is a “very promising model” that encourages more investment, because you can prove to shareholders that you will get a return. “Unless you can get governments to think about this in a more creative way than the traditional supply, pay on demand per unit model, you can really struggle with your cash flow,” he says. Patrick Holmes, global innovation ​policy lead at Pfizer, praised the UK for trying to value new antibiotics partly based on how they would affect resistance rates in the future. The EU is planning to give drugmakers who bring a new antibiotic to market a voucher that can be used to extend the years of market exclusivity on another, presumably more profitable, drug, which it estimates will be worth about €440mn. Large drugmakers could use this for one of their own drugs, while smaller companies could sell the transferable voucher on. But much is riding on whether the US, the world’s largest pharmaceutical market, can push through its Pasteur Act, which would also establish a subscription-style model, with contracts valued between $750mn and $3bn. Holmes says it is the only incentive large enough to drive a significant change in where drugmakers spend on research and development. The act’s passage has not been smooth. It was originally introduced in 2020 and the budget has already been cut, from $11bn to $6bn. But after it was reintroduced in April this year, Mark McClellan, director of the Duke-Margolis Centre for Health Policy, is hopeful that the bipartisan bill could be tacked on to a bill on defence spending in the second half of this year. “We’re aiming for a multibillion-dollar programme here, which might seem like a lot, but it’s actually low compared to the current and projected costs of not having antibiotics around that can treat the most important resistant organisms that are around today,” he says. Yet even if western countries do find ways to fix their antibiotics markets, companies will still not be incentivised to launch novel antibiotics in developing countries. The problems of overreliance on broad spectrum antibiotics and a lack of diagnosis are likely to persist in regions without state of the art healthcare, and the resulting resistant superbugs are unlikely to respect national borders. Jayasree Iyer, chief executive of the Access to Medicines Foundation, says she wants to see global action that will help the countries that struggle with the highest need and the biggest drug resistance problems. She says antimicrobial resistance is a global problem that you cannot tackle country by country, arguing that an incentive like the UK’s subscription model is not significant enough for drugmakers to then prioritise India, Thailand or South Africa. “Everybody’s problem becomes nobody’s problem,” she says. “This has been on the political agenda for years now. Very little has been on the political agenda for this long.” The UK recently announced an investment of £210mn in labs, technologies and people to track resistant pathogens across Asia and Africa. But neither western governments nor companies are significantly investing in making new antibiotics available in these countries. An antimicrobial resistance expert at the World Health Organization says the agency is trying to promote a global approach. He warns that accessibility is becoming a problem, just like it was in the Covid-19 pandemic, when vaccine makers prioritised high-income countries, leaving developing countries behind. O’Neill, the author of the UK review, cautiously welcomes the progress that has been made in the field in the past six months, with “some slight amazement” after years of little momentum. He believes the expansion of the UK subscription scheme, the EU proposal, and especially the size of the potential Pasteur Act, could encourage venture capitalists to support early research again. But he called for more urgency. “It’s not like policymakers can sit around, trotting out these ideas and never following through,” he says. Otherwise, he warns, antimicrobial resistance may cause a crisis that will make Covid-19 look like a “garden party”. ©The Financial Times Limited 2023. All Rights Reserved. FT and Financial Times are trademarks of the Financial Times Ltd. Not to be redistributed, copied or modified in any way.

Sällsynta mineraler som behövs i batteriframställning är koncentrerade till ett fåtal länder, som nu flexar sina muskler för att ta hem en större del av vinsten. Några av dem har varit föremål för exploatering som går tillbaka till kolonialtiden. Detta är deras chans att ta tillbaka makten över sitt öde, skriver Financial Times. Samtidigt är mineralerna inte lika oersättliga som oljan. Dels är de mer utspridda över jordklotet, även om utvinningen i nuläget är koncentrerad till ett fåtal platser. Dels sker utvecklingen snabbt och nya kemiska sammansättningar, som exempelvis koboltfria batterier, kan hela tiden vända på efterfrågan. In the first part of a series, countries that produce the metals central to the energy transition want to rewrite the rules of mineral extraction. By Leslie Hook, Harry Dempsey and Ciara Nugent

Financial Times, 8 August 2023 The red-brown landscape of Tenke-Fungurume, one of the world’s largest copper and cobalt mines in the Democratic Republic of Congo, is covered by tens of thousands of dusty sacks. The bags stacked up by the roadside and piled next to buildings contain a stash of cobalt hydroxide powder equivalent to almost a tenth of the world’s annual consumption — and worth about half a billion dollars. The haphazard stockpiles of this bright green powder, a key ingredient in electric car batteries, point to how the DRC, the world’s largest producer of cobalt, is starting to flex its muscles when it comes to the metals needed for the energy transition. CMOC, the Chinese operator of the Tenke-Fungurume mine, agreed in April to pay $800mn to the government to settle a tax dispute which had seen the company slapped with an export ban for the previous 10 months. And now the DRC government is undertaking a sweeping review of all its mining joint ventures with foreign investors. “We’re not satisfied. None of these contracts create value for us,” says Guy Robert Lukama, head of the DRC’s state-owned mining company Gécamines. He would like to see more jobs, revenue and higher-value mineral activities captured by the DRC. This is the first in a two-part series on how the shift to renewables is transforming the economics and geopolitics of energy. Tomorrow: How China came to dominate clean energy technology At the entrance to his office, a cabinet display of highly mineralised rocks makes his point about the riches on offer. Lukama also advocates government intervention to keep cobalt prices high: “Excess of supply needs to be organised properly. Some export quotas will be useful,” he says.  The DRC is far from alone. As the world moves from an energy system built on fossil fuels to one powered by electricity and renewables, global demand for materials such as copper, cobalt, nickel and lithium is transforming the fortunes of the countries that produce them. The mining of certain metals is highly concentrated among just a few countries. For cobalt, the DRC accounts for 70 per cent of global mining. In nickel, the top three producers (Indonesia, the Philippines and Russia) account for two-thirds of the market. While for lithium, the top three producers (Australia, Chile and China) account for more than 90 per cent.  Demand is only going to grow in coming years. Under current plans, none of these key commodities will have enough operating mines by 2030 to build the infrastructure necessary to limit global warming to 1.5C above preindustrial levels, according to the International Energy Agency. By the end of this decade, the nascent lithium market needs to triple in size, while copper supply will be short by 2.4mn tonnes, it says.  The growing demand for these commodities is starting to shake up both the economics and the geopolitics of the energy world. The supply chains for some of these metals are becoming entangled in the rising tensions between the west and China, which dominates processing capacity for lithium, cobalt and rare earths and is considering restricting exports of some materials. Governments from Washington to Brussels to Tokyo are assessing where they can reliably source critical minerals without going through Beijing’s orbit. This shift is also transforming some smaller and historically under-developed countries into commodity superpowers. And their governments are now intent on rewriting the rules of mineral extraction. Many are trying to capture more of the value of their minerals, by moving more processing and value-added manufacturing domestically. Some are also attempting to control the supply, by nationalising mineral resources, introducing export controls, and even proposing cartels. Where once some of these resource-rich countries were victims of exploitation that can date back to colonial times, now they are becoming empowered to take back control of their fates. Just in the past 12 months, Zimbabwe and Namibia banned exports of raw lithium; Chile increased state control over lithium mining; while Mexico plunged its nascent lithium industry into uncertainty with a new review of mining concessions. Meanwhile, Indonesia added export controls on bauxite (a key ingredient in aluminium) to its pre-existing ban on exports of raw nickel ore. “Every government will seek a deal with the mining industry that’s a fair one, that is a winner for the country and the winner for the industry,” says Jakob Stausholm, chief executive of Rio Tinto, which has itself recently been to the negotiating table in Chile and in Mongolia. While he dismisses the idea that rising ‘nationalism’ is behind this, he does acknowledge there has been a change. “It’s probably going to be more and more difficult just to mine and extract and export; very often a nation wants to have some processing facilities associated with the mining.” The subtle shift in power towards the producers of sought-after battery metals is similar to other commodities shifts of the past, like the rise of coal during 19th century or the rise of tin during the 20th. But how far will producers go to take advantage of this moment? And how long can they make it last? The poster child for harnessing value from materials is Indonesia, which produces nearly half of the world’s nickel, a key ingredient in electric car batteries. Years of export controls on raw nickel have already succeeded in building an extensive domestic smelting industry, as well as battery plants, and several electric vehicle factories.  After the country banned exports of raw nickel in 2014, it attracted more than $15bn of foreign investment in nickel processing, primarily from China. Today Indonesia has banned exports of everything from nickel ore to bauxite, with an export ban on copper concentrate coming into effect next year. Not everyone agrees with these policies. however: the EU has challenged them at the World Trade Organization and won an initial hearing. Indonesia is appealing against the verdict. But government officials say the country’s efforts to build domestic industry and encourage manufacturing are straight from the same playbook that western countries used a century ago. “This is not something we are doing out of the blue,” says Investment Minister Bahlil Lahadalia. “We are learning from our developed country counterparts, who in the past have resorted to these unorthodox policies.” He points to the way the UK banned exports of raw wool during the 16th century, to stimulate its domestic textile industry. Or the US, which used high import taxes during the 19th and 20th centuries to encourage more manufacturing to take place domestically. Lahadalia wants to take things one step further, by creating an Opec-style cartel to keep prices high for nickel and other battery materials. “Indonesia is studying the possibility to form a similar governance structure [to Opec] with regard to the minerals we have,” he says. Whether or not that happens, the rise of nickel has certainly given Indonesia a higher profile. When President Joko Widodo, or “Jokowi,” as he is typically known, visited the US last year, he met both President Joe Biden in Washington and Tesla CEO Elon Musk in an out-of-the way stopover in Boca Chica, Texas. Jokowi later said he encouraged Musk to build Tesla’s entire supply chain in the country, “from upstream to downstream.” Not every country will follow the same trajectory as Indonesia, however. A new report from the International Renewable Energy Association finds that metals producers will be able to wield influence in the short term, while production is concentrated and demand is growing, but they are unlikely to have the kind of lasting geopolitical power enjoyed by oil and gas producers. One challenge is that battery metals like lithium are well distributed around the globe — at least in terms of geological reserves, if not in actual mine production. Today’s high lithium prices are making it efficient to develop deposits that were previously too expensive to access, and fuelling the broader expansion of hard-rock lithium mining in places like China and Australia. An example of how mineral production can shift is lithium mining in South America. Chile is today the region’s dominant producer, but neighbouring Argentina, which has more business-friendly mining policies, could eventually overtake it. Argentina’s 23 provinces control their own natural resources, and have enthusiastically courted mining business. With roughly $9.6bn of lithium investment announced in the past three years, and 38 projects in the pipeline, officials say Argentina’s production should go up six-fold over the next five years. “Investment in lithium has never stopped and I think that has to do with the fact that we are open to private investment, and with uncertainty about the policies being rolled out in other countries,” says Fernanda Ávila, Argentina’s mining minister. Argentina’s position as an anomaly among South American lithium-holding countries has helped it attract investment, even as it has dried up in other sectors of the economy amid triple-digit inflation. While some politicians in South America’s “lithium triangle” — Chile, Argentina and Bolivia — have floated the idea of an Opec-style lithium cartel, Ávila is less than enthusiastic about the idea. Although “we have a very good relationship with our neighbouring countries”, she says, “that’s not a topic that’s on the agenda.” This is another reason why producing battery metals is different than producing oil: it is very hard to form a successful cartel. During the 20th century, several key commodities were controlled by cartels. Tin was managed through the International Tin Council from the 1950s to the 1980s — and Indonesia, Bolivia and the then Belgian Congo were all producer members. Likewise coffee producers banded together in a cartel during the 1960s and ‘70s; and natural rubber producers maintained a cartel until the 1990s. John Baffes, head of the Commodities Unit at the World Bank, who has studied these groups, says successful cartels have three characteristics: a small number of producers, who share a well-defined objective, over a short timetable. He thinks it will be difficult for battery metals producers to form cartels. “You may have some countries that come together, to create an environment that may be beneficial for them, such as keeping prices high,” says Baffes. “But that will be the seeds of failure, because more entities will come in, from outside of the group.” The speed at which battery technologies are evolving, and their ingredients changing, could also undercut efforts at cartelisation. Unlike oil, which is very hard to replace as a fuel source, battery metals have a much higher risk of substitution. The laboratories developing new battery chemistries are constantly evolving their formulas to use less of the metals that are expensive or hard to acquire. This is already starting to happen with cobalt, which carmakers are trying to reduce in their batteries due to its high cost, as well as concerns about human rights in the DRC. In a cautionary tale of how quickly the demand outlook can change, the use of cobalt-free batteries in China has surged from 18 per cent of the EV market in 2020, to 60 per cent this year, according to Rho Motion, an EV consultancy. Manganese-rich batteries are also on the horizon, which could further reduce cobalt use. “One of the consequences of the rise in non-cobalt batteries is that shortages previously forecast for cobalt for around 2024 and 2025 may not materialise,” says Andries Gerbens, a trader at Darton Commodities. “It may suggest cobalt prices remain lower.” The recent fall in prices of cobalt, nickel and lithium could damp efforts by producer countries to extract more rent and build up domestic manufacturing. After cobalt and lithium experienced a huge price rally in 2021 and 2022, driven primarily by demand from electric vehicle batteries, the market this year has been much calmer. A slowdown in China’s production of electric vehicles, combined with an increase in production, has brought cobalt hydroxide and lithium carbonate prices down 30 per cent and 40 per cent, respectively, during the first six months of the year, according to Benchmark Mineral Intelligence.  Veteran miners say this cycle has played out many times before. Resource nationalism tends to increase when commodity prices are high, or when elections are approaching, says Mick Davis, founder of Vision Blue Resources and former chief executive of Xstrata.  During these times, “[politicians] inevitably try to capture more of the rent than they initially envisioned and agreed,” says Davis. “The result always ends in tears. It means that the development of their mineral resources takes longer and longer to happen.” Yet while the cycle still allows producer countries to flex their powers, they are intent on seizing the moment however they can. Earlier this year Chile, the world’s second-largest lithium producer, announced a plan to semi-nationalise the industry: it will give greater control of two giant lithium mines in the Atacama Desert to a state mining company when the current contracts end in 2030 and 2043, with both those projects and all future ones becoming public-private partnerships. Chilean President Gabriel Boric said the plan to increase state control of lithium is the best chance Chile has to become a “developed economy” and to distribute wealth in a more just way. “No more ‘mining for the few’. We have to find a way to share the benefits of our country among all Chileans,” he said.  And many producers are succeeding in taking steps up the value chain, in a bid to create sustainable economic growth. In the DRC, the country’s second copper smelter is under way near the Kamoa-Kakula copper mine. Chile, meanwhile, is offering preferential prices on lithium carbonate to companies who set up value-added lithium projects in the country. The first taker is China’s BYD, one of the world’s largest electric vehicle manufacturers, which announced in April that it would build a lithium cathode factory in northern Chile, with 500 jobs expected in the investment phase. Argentina is set to open a small lithium ion battery factory — Latin America’s first — in September, with a larger plant to follow next year. Owned by state energy research company Y-TEC, the plant in the province of Buenos Aires will use lithium mined in Argentina by US firm Livent, to produce the equivalent of 400 EV batteries a year. Indonesia’s attempts to build out an electric vehicle industry are bearing fruit at an even larger scale. Earlier this year, Ford announced an investment in a multibillion-dollar nickel processing facility. This summer, Hyundai broke ground on a battery plant, its second manufacturing facility in the country. As the energy transition starts to recast the systems of power and wealth that dominated the 20th century, the new battery metals producers are just getting started. Many see this shift in the power dynamic as a welcome change. “It is absolutely essential that we rewrite the legacy of the mining industry, so that mineral rich countries can capture more of the economic value,” says Elizabeth Press, director of planning at Irena, and author of the report on critical minerals. “We see a greater awareness from both sides that things cannot continue as they were.” ©The Financial Times Limited 2023. All Rights Reserved. FT and Financial Times are trademarks of the Financial Times Ltd. Not to be redistributed, copied or modified in any way.

Värmeböljor skapar problem för företag världen över. Turistnäringen lider särskilt mycket, som när Greklands Akropolis tvingades stänga på grund av extremvärmen. Byggsektorn, industrier, jordbruk och transport påverkas också, med minskad produktivitet och högre kostnader. Effektiviteten i arbetsstyrkan sjunker med stigande temperaturer och infrastrukturen slits snabbare. Det förändrade klimatet har redan kostat världsekonomin enorma summor. Nu måste näringslivet anpassa sig till de nya förutsättningarna, skriver Financial Times. As record-breaking heatwaves become the new normal, a range of industries brace themselves for changes to the way they do business. By Attracta Mooney, Camilla Hodgson and Ian Smith in London and Aime Williams in Washington

Financial Times, 21 July 2023 The Acropolis has stood above the city of Athens for centuries, its ancient walls and pillars withstanding war, siege and conquest. But as temperatures crested 40C across southern Europe this month, Greece’s top tourist attraction briefly fell victim to extreme heat. Officials shut the site for several hours during the hottest parts of the day, after holidaymakers queueing to enter required medical attention. The Cerberus heatwave — named after the three-headed dog who guarded the gates to hell in Greek mythology — has shone a spotlight on just how vulnerable the Mediterranean’s huge tourism industry is to the heatwaves that are becoming increasingly common in Europe. But the economic impact of what experts warn could be a new era of record-breaking heat goes far beyond tourism. Industries ranging from construction, to manufacturing, agriculture, transport and insurance are all bracing for changes to the way they do business as high-temperature days become more routine because of climate change. Scientists are clear that extreme weather events, including heatwaves, will become more frequent and intense with every fraction of a degree of warming. In July, with average temperatures already at least 1.1C hotter globally than pre-industrial levels, swaths of the US, Europe and Asia sweltered under “heat domes.” Record highs were reached from China to Italy. Business leaders and policymakers are now counting the cost of shuttered companies and decreased productivity. A study published by academics at Dartmouth last year found that heatwaves, brought on by human-caused climate change, cost the global economy an estimated $16tn over a 21-year period from the 1990s. Extreme heat is “pulling down our growth,” says Kathy Baughman McLeod, director of the Adrienne Arsht-Rockefeller Foundation Resilience Center at the Atlantic Council, and “dragging down our economies . . . the runways are buckling, metros are closing, restaurants have to shut down because the kitchen staff are too hot.” But those costs are likely to spiral in coming decades as economies reorient themselves for peak seasons of ever more extreme heat, to mitigate against the risks and disruption they will bring. “Extreme heat is one of the very serious consequences of climate change,” says Dan Jørgensen, Denmark’s climate minister. “The very tragic news is that this is probably only going to get worse.” One of the main reasons that extreme heat poses an economic threat is because it makes it harder to work. High temperatures go hand in hand with low productivity. In hot conditions, human beings typically “work slower, we take on more risk, our cognitive function decreases”, says Laura Kent of the Institution of Mechanical Engineers, a professional association which recently produced a report on how industry will need to adapt to extreme heat. A study by the International Labour Organization, the UN agency for workers, projected that by 2030, the equivalent of more than 2 per cent of total working hours worldwide would be lost every year, either because it is too hot to work or because workers have to work at a slower pace.  Around 200mn people in cities today are at risk from extreme heat, a number that is expected to grow eightfold by 2050, according to Sachin Boite, director of climate resilience at the C40 network of mayors pushing for environmental action. Yet few countries have a maximum temperature for when work must stop. In the UK, for example, where extreme heat has not historically been a problem, there is only a recommended threshold for stopping work in cold, not hot, temperatures. The poorest and least able to cope are often hit hardest by extreme heat — with productivity losses often concentrated in jobs where wages tend to be lower than average.  Outdoor workers — especially those in agriculture or construction — are particularly at risk of death, injuries, sickness and reduced productivity because of heat exposure, according to the ILO. Between 1992 and 2016, 285 construction workers in the US died from heat-related causes, about a third of all the country’s occupational deaths from heat exposure, according to academic research. But those working inside are at increasing risk as intense heatwaves become more frequent, including the world’s 66mn textile workers, who often work inside factories and workshops without air conditioning. Many are situated in the global south, where peak temperatures are even more extreme and dangerous.  After British Columbia in Canada suffered a devastating heatwave in 2021, heat-related workplace injuries requiring compensation increased by 180 per cent when compared to the previous three-year average, according to research. More than a third of those came from indoor workers, compared to 20 per cent on average. The impact of extreme heat on workers has become “an issue of human rights,” says Italy-based environmental economist Shouro Dasgupta, and one that calls for stronger labour protection policies. “The right to a safe and healthy working environment is a human right [that] is being eroded,” he adds. “Governments will need to step in.” Beyond the consequences of extreme heat on their employees, industries are being forced to rethink more existential issues, such as where their businesses are based and how they operate. The construction industry is one area that might require a radical reinvention, says Daisie Rees-Evans, who works on policy at the Chartered Institute of Building, a professional body. “Not only do extreme weather conditions impact construction work on sites but it actually impacts material,” she says.  Steel can warp in hot conditions, while concrete becomes difficult to work with and sets much more quickly — leaving it more prone to cracking and affecting its strength and durability. There is also the risk concrete will spoil before it can be poured.  All of this adds up to additional costs for the sector, says Rees-Evans. Companies faced with having to reorder materials such as steel that warped often find themselves battling with other companies who also need to repurchase goods, driving up prices in the process. Any delays to projects can also come with additional costs, including fines levied for exceeding the agreed completion date, she adds.  Manufacturing is another sector that faces significant changes. Factories and warehouses “are just not designed for the temperatures we are seeing now and expected to see,” says Kent of the mechanical engineers’ association.  This means that equipment might not work as effectively or wears out more quickly, which comes with higher operational costs. “A vast majority of our industry rely on some sort of heating or cooling process,” she says. “If you are heating or need to cool down to a certain temperature and the ambient temperature is already hotter, that difference is harder to overcome.” At the same time, the availability of water can come under intense pressure during periods of higher heat — a huge problem for the industrial sector, which needs water for functions from cooling and transportation.  Along the Rhine, one of Europe’s most important waterways, companies have faced disruptions due to low water levels for three out of the past five years, including in 2018 when barges struggled to travel, hitting fuel and chemical supplies.  “For the longest time, we have put industries next to rivers,” says Johanna Lehne, programme lead at climate consultancy E3G, but companies are now faced with questions about where they should be based and what they are able to produce.  Then there is the risk to infrastructure. Heat stress is “going to shorten lifespans”, says David Carlin of the UN Environment Programme Finance Initiative. That affects everything from train tracks to roads and airports. “Not only do you have potential infrastructural damages like bridge collapses, but you also have the need to replace these things faster, which is increasing costs.” For agriculture, extreme heat can result in decreasing crop yields, fuelling rising prices and food insecurity in the process. Research from Arsht-Rock found corn, the most widely produced US crop, is losing about $720mn in revenue annually because of extreme heat, which will increase to a projected $1.7bn by 2030.  As work becomes riskier in a range of sectors, insurance costs will rise. Climate change “will significantly shape how the sector will choose to manage and absorb risks,” says Mohammad Khan, general insurance leader for consultancy PwC’s UK arm. According to data from reinsurer Swiss Re, heat-related catastrophe losses for insurers, such as crop failures from drought or wildfire damage to properties, amounted to $46.4bn in the five years to 2022, up from $29.4bn in the previous five years. In California, one of the areas most affected by wildfires, some big US insurers have pulled back. Allstate cited the growing bill from wildfires as among the reasons it paused selling new home insurance policies in California last year. State Farm, another big home insurer, warned of “rapidly growing catastrophe exposure” when it did the same earlier this year. That has fed a growing debate about the affordability of insurance for both individuals and companies as climate change effects intensify, with more people falling into public safety nets.  A couple of generations down the line, humans will have to find new ways to adapt their societies as temperatures rise ever higher. Climate pledges made by countries put the world on track for temperature rises of between 2.4C and 2.6C by 2100. This is far ahead of the 1.5C threshold after which scientists have warned of potentially irreversible changes to the planet and devastating consequences for citizens.  “This [extreme heat] is not going to go away anytime soon. It’s going to be more frequent, it’s going to be more intense, it’s going to be longer as well,” says Carolina Cecilio, policy adviser at E3G.  Some countries are waking up to the issue. Greece appointed its first chief heat officer in 2021, while Spain said earlier this year it would ban outdoor work during periods of extreme heat. Companies are introducing measures such as using “misting” on animals and employees to keep cool. Others are switching working hours, trying to do more at night or during the early hours of the morning — although this can be met with objections from local governments and residents.  As the world warms, so-called passive cooling is likely to become more important for economies, says Kent.  Many of the materials that buildings and roads are made from — such as tar and concrete — absorb and retain energy from the sun’s rays, warming their surroundings, while factories and warehouses are often found in industrial parks that lack green spaces and allow heat to build up. Cost effective solutions included “cool roofs” that are painted white to reflect the heat, or adding shade through the use of “overhang” on buildings or increased tree cover. Rees-Evans says construction firms are starting to use AI to factor forecasted weather into a project’s running order. This would allow them, for example, to hold off ordering steel if they expected a prolonged period of hot weather was on the cards.  Internationally, adaptation is expected to be high on the agenda of the international COP28 climate negotiations. Politicians are increasingly looking at how money can be raised to help countries, especially those in the global south, deal with extreme temperatures because of climate change.  But Baughman McLeod says businesses and policymakers needed to act now to prepare for extreme heat. A big rethink of our economies may be needed, she says, as countries that depend on tourism see visits plummet during peak seasons, or companies can no longer do business for key months of the year. “There is not a solution for every place, but there is a solution for every person.” ©The Financial Times Limited 2023. All Rights Reserved. FT and Financial Times are trademarks of the Financial Times Ltd. Not to be redistributed, copied or modified in any way.

Den svenska startupen Bioarctic har väckt liv i hoppet om att hitta en behandling mot Alzheimers, ett årtionde efter att flera läkemedelsjättar gett upp. Under ledning av Gunilla Osswald, som tidigare gjort karriär på Astra Zeneca, har Bioarctic utvecklat en medicin som för närvarande granskas av den amerikanska läkemedelsmyndigheten FDA. Om bolaget får ett fullständigt godkännande ger det hopp till miljontals människor som drabbats av Alzheimers. Bioarctics genombrott belyser också de risker och belöningar som neurovetenskaplig forskning innebär för läkemedelsföretag, skriver Financial Times. – Vi är inte rädda för konkurrens [...] Marknaden är enorm, säger Osswald. A decade ago a large part of Big Pharma gave up on one of humanity’s cruellest diseases. But then a new treatment showed promise. By Hannah Kuchler in Stockholm and Jamie Smyth in New York

Financial Times, 03 July 2023 Gunilla Osswald speaks quietly as she describes her last act at AstraZeneca. After 28 years of trying to create treatments for patients with brain disorders, in 2012 she was handed the “sad” task of closing a large Swedish research and development site and making 1,300 people redundant.  A decade ago, the Anglo-Swedish drugmaker was cutting its investment in neuroscience. It was not the only one. GSK, Pfizer and Bristol Myers Squibb were among other big pharmaceutical companies that stopped trying to find treatments for some of humanity’s most inscrutable diseases. At the time, Alzheimer’s research was considered a costly, hopeless cause and investors preferred companies to chase larger rewards in areas such as cancer. Peering over a conference table in Stockholm, Osswald admits neuroscience is risky for drugmakers. “It’s a difficult area. But the benefit can be so huge when you have something which is successful,” she says.  After AstraZeneca closed its site, Osswald did not give up. Instead, she became the leader of a start-up of just 20 people devoted to tackling Alzheimer’s, called BioArctic, and brought in others from AstraZeneca. Their aim was to create a drug that would become the first to significantly slow the progression of the disease. On that front, they have made progress. This week, the Food and Drug Administration, the US regulator, will decide whether to fully approve BioArctic’s first commercially available drug candidate, lecanemab, created with the Japanese drugmaker Eisai and US biotech Biogen. The FDA already granted emergency approval in January, based on data that showed lecanemab slowed the rate of cognitive decline in early-stage Alzheimer’s patients by 27 per cent, a moderate but statistically significant result. Full approval should vastly increase the number of patients able to access the drug in the months ahead; it is the first time people with Alzheimer’s will be able to take something to slow the progression of their disease. “It is really a big step forward,” says Osswald, explaining that before this, drugs could only alleviate some symptoms, not tackle the causes of the condition.  Not everyone agrees. Some researchers and clinicians are concerned that the reduction in the rate of cognitive decline seen during the late-stage drug trial is not “clinically meaningful” because many patients would not feel much of an impact. They worry that the benefits do not outweigh the risks: the trial showed the drug can cause swelling and bleeding in the brain. Patients will have to be carefully monitored when they first take the drug, which is administered intravenously. Since the trial of 1,795 ended, at least three Alzheimer’s patients have died from brain bleeds after taking lecanemab, including two people who were also taking blood-thinning medicines. Eisai said the drug could not be directly linked to the deaths.  About 55mn people worldwide have dementia, of which up to 70 per cent suffer from Alzheimer’s — a disease that erases memories and the ability to communicate and live independently. In the UK, the Alzheimer’s Association estimates it already costs the government £25bn a year. The disease is distressing for patients and their families, and expensive for overstretched health systems in countries with ageing populations. Osswald weighs her words carefully, wary of overpromising to desperate patients. “It’s not a cure. But it hopefully can help them to get a longer time when they are fairly healthy,” she says. Lecanemab is not the only new Alzheimer’s drug with potential. BioArctic’s results last autumn were rapidly followed by those from another promising trial for a drug, donanemab, from Eli Lilly. If they are both approved, the drugs may eventually save on healthcare costs by keeping people healthier for longer. But they will create huge upfront bills. Lecanemab will have an official US price of $26,500 a year, though insurers will negotiate rebates that make it cheaper. Medicare, the US government-backed insurance for seniors, has pledged to pay for it if approved. In Europe, the regulator is expected to make a decision in the first quarter of next year. Lecanemab has given hope to large pharmaceutical companies, such as Bristol Myers Squibb and GSK, which are piling back into neuroscience, partnering with start-ups, or looking to see if they can revive failed drug candidates. There are now more clinical trials for Alzheimer’s drugs than ever before, with drugmakers increasing the number they sponsor by almost 8 per cent in the past year, according to research from the University of Nevada. AstraZeneca says it still has a small neuroscience group with a number of products in trials, including one for Alzheimer’s in an early study. After a transformation in oncology treatments over the past decade — mortality rates are falling across many types of cancer — scientists are speculating that Alzheimer’s could also be tackled with medicines targeted to sub groups of patients.  While it is far from a perfect drug, lecanemab is the culmination of decades of research and many failed candidates — a prolonged and frustrating process of trial and error that is beginning to bear fruit. John Hardy, a professor of neurology at University College London, says academics and companies finally understand what a potential drug has to do to tackle the disease. “We’re not operating in the dark anymore,” he says. BioArctic’s co-founder, a doctor-turned-scientist called Lars Lannfelt, travelled to the end of the earth to find the clue that led to his drug breakthrough. In the 1990s Lannfelt made a name for himself in dementia research when he discovered in Alzheimer’s patients a mutation in the gene that produces a protein called amyloid beta. A build-up of amyloid in the form of sticky plaques in the brain is generally considered to be the cause of Alzheimer’s. (Not all researchers agree with the “amyloid hypothesis”. Numerous therapies aimed at reducing plaques in patients’ brains have failed in trials, sowing doubts and entrenching division.) Lannfelt made his discovery — christened “the Swedish mutation” — after long and slippery drives to faraway communities in his Volvo, which, he laments, lacked power steering. In his search for a drug to treat the disease, he went even further, flying to Umeå in Northern Sweden and driving a rental car to a remote community of people who, due to their own genetic mutation, were suffering disproportionately from Alzheimer’s. They experienced “exaggerated forms of the disease” — developing symptoms at a younger age than average and experience a faster decline. It was therefore easier to witness what was happening in the brain using blood tests and scans. “My idea was, if we don’t understand the mutation cases, we will never understand the more common forms. You start off with what is simple,” Lannfelt says.  Lannfelt discovered that patients in the Arctic community had the symptoms of Alzheimer’s but they didn’t have the sticky plaques in their brains. Rather, they had a build-up of amyloid beta in a soluble form called protofibrils. Lannfelt came to believe that it was the protofibrils that initially cause the disease. Unlike the plaques, soluble protofibrils can move around the brain, gumming up neurons and eventually causing the cells to die. Protofibrils, he thought, would also be a safer target for a drug. Amyloid beta exists in many forms in the body. Protofibrils are only in the brain. Drugs designed to target amyloid beta generally could therefore latch on in unintended places, causing severe side effects. In 2003, Lannfelt and his BioArctic colleagues first approached Eisai, a much bigger company with experience in clinical trials with Alzheimer’s patients. Unlike many pharmaceutical companies at the time, Eisai was similarly determined to find a drug for the disease. Haruo Naito, chief executive, was leading the company’s discovery lab when Eisai developed its first therapy for symptoms of Alzheimer’s, and he stayed in contact with patients and their families. Alexander Scott, executive vice-president of integrity, says Naito understood the “tremendous unmet need” for patients.  In 2007, the Japanese drugmaker took the license for lecanemab and in 2014 Eisai signed up Biogen to jointly develop and commercialise the drug.  Lannfelt, now 74, has been studying Alzheimer’s since 1992. He was convinced BioArctic’s new approach would work, yet it worked better than he expected. In the study, the patients taking the drug declined 27 per cent more slowly than those who received a placebo, as measured on a cognitive and functional scale. Study participants, considered early-stage, had probably had the amyloid building up in their brains for 20 to 25 years. But scans showed a significant removal in just 18 months. “I was surprised the effect was so strong,” Lannfelt says. Investors were also surprised. BioArctic’s stock shot up more than 240 per cent on the day the initial results were published. When approved, analysts at Swedish bank Carnegie forecast sales will peak at $13bn in 2035, giving BioArctic a $1.1bn royalty that year. In total, it stands to receive billions, much of which it plans to invest in the hunt for more effective drugs. This is a marked difference from the last Alzheimer’s drug heralded as a breakthrough. Medicare refused to pay for Biogen and Eisai’s aduhelm, after a controversial US accelerated approval in 2021. Aduhelm did not work as well, and scientists debated the validity of its trials, after one failed. It was initially priced far higher, at $56,000 a year, though it was later cut to $26,500. Now there are two drugs with more solid prospects. An exception to Big Pharma’s initial exodus from neuroscience was Indianapolis-based Eli Lilly, which persisted despite having other Alzheimer’s drugs fail. Ron DeMattos, senior vice-president and chief scientific officer of neurobiologics at Lilly, says the decision to pursue an amyloid-reducing drug was a “leap of faith”. Unlike BioArctic, Lilly targeted the solid form of amyloid beta, the plaques. Its molecule proved successful: donanemab slowed the progression of the disease by 35 per cent in 1,182 patients — a narrower group than in the lecanemab trials. The trial also showed side effects of brain swelling and bleeding. But its full trial results have not yet been published. “I believe the field can now move past all this back and forth, amyloid hypothesis, or not amyloid hypothesis,” DeMattos says. “The real question is how do we drive further benefit for patients? How do we continue on this line of success to improve those margins that make patients better over time.” Hardy, the neurology professor at UCL, says the real problem with the previous drugs targeting beta amyloid was that they didn’t remove enough of it. “To me, the two [new] drugs look pretty similar, they both remove amyloid, and they both have similar clinical effects,” he says.  But at the same institution, Rob Howard, a professor of old age psychiatry, disagrees. He accepts amyloid beta is connected with Alzheimer’s, but doubts if it drives its progression. He believes there was poor correlation between how much amyloid was cleared and how much clinical benefit there was in patients in the lecanemab trial. Since the successful trial results of lecanemab and donanemab, there has been a real uptick in interest from Big Pharma looking to acquire neuroscience biotechs, says Philip Scheltens, who leads the €260mn LSP Dementia Fund. “We are now in an interesting position because Big Pharma suddenly gains interest again, but doesn’t have a pipeline,” he says.  Dementia is still far less understood than cancer, despite having a similar number of patients, partly because it receives less funding, Scheltens says. Some 4.8mn papers about cancer have been published on the online database PubMed, compared to 264,000 on dementia.  Aware that global Big Pharma is now paying attention to the tiny company in Stockholm, Osswald is tight-lipped about what else BioArctic is working on for Alzheimer’s. But the company is inspired by a transformation in oncology. Anders Martin-Löf, chief financial officer, says oncology was the “big thing” of the past 10 years, with more targeted drugs, often combined for better impact.  “We’re at the starting point now in neuro. And I think we’re looking for a golden era that is about to start,” he says.  Even if amyloid build-up is the first sign of Alzheimer’s, there are other targets to tackle, like the tangles of proteins called tau that accumulate in patients’ brains. Eisai is already testing lecanemab combined with a drug to target tau. As tests become more accurate and we understand more about what is happening inside individuals, drugs may become targeted to specific groups, like in cancer where many tumours are sequenced to discover which mutations are driving them, and then specific drugs are prescribed. Some believe Alzheimer’s may not even end up being a single disease.  BioArctic is also looking at ways to target beta amyloid more effectively. Its moonshot project is a “brain transporter” designed to get more drug into the brain. At the moment, only about 1 per cent of a drug can cross the strict blood-brain barrier, so patients must receive large doses and risk side effects. By hijacking the system that delivers iron into the brain, it hopes that it can access the 600km of blood vessels inside the organ. Zoe Karamanoli, an analyst at RBC Capital Markets, who covers BioArctic, says brain transporter has “huge potential” — but is still really risky at this stage. She says BioArctic’s cash windfall from the lecanemab royalties will help the company — but it is not enough to guarantee a second success. “Definitely having something that has worked and is approved in such a difficult field helps them. But don’t get carried away and assume everything will work,” she warns.  Lecanemab is already in phase 3 trials for a population with less amyloid in their brains and who do not yet have symptoms. Other companies are also looking to go earlier. Last week AC Immune received an FDA breakthrough designation — a fast track through the regulatory process — for an “Alzheimer’s vaccine”, which it hopes will stimulate the immune system to tackle the build-up of proteins itself. In a fortunate coincidence, in 2020 Swedish scientists created a blood test that can detect the early stages of build-ups in the brain, before anyone would seek treatment. The test can detect the disease five to 10 years before patients show a clear impairment.  Some experts believe the current drugs have too serious side effects to treat asymptomatic people, though others hope that with less amyloid stuck to blood vessels, there could be fewer side effects.  Eisai’s Scott, whose own parents died from Alzheimer’s, compared taking drugs to prevent the disease to the “pretty radical procedures” that some are prepared to undertake to reduce the risk of cancer. “People will get double mastectomies, if they have a family history, as Angelina Jolie showed us,” he says.  If lecanemab is used preventively, BioArctic could make billions more. Osswald has ambitions to grow BioArctic into a standalone pharma company, which conducts large trials and sells its own drugs globally. But she does not want it to be the next AstraZeneca which, she found, could get bogged down in bureaucracy. BioArctic has just 85 staff in an office and labs spread over a couple of floors in Stockholm. Nor is she wary of competition as other Big Pharma companies rejoin the race for better treatments for Alzheimer’s. “We’re not afraid of competition. I think that is helpful for patients,” she says. “The market is enormous.”

Den brittiska befolkningen röstade för att lämna EU. Men allteftersom nackdelarna har blivit allt mer uppenbara har opinionen svängt, skriver The Economist. Trots det är det ingen som förespråkar att Storbritannien ska be om att få gå med igen. By The Economist 7th month, 2023 edition Don’t expect anyone to talk of rejoining the EU. Politics is routinely dominated by the short run: in-party scraps; looming by-elections. But quietly shifting and longer-term trends risk being neglected. One such is the rise of disillusion with Brexit. Polls from YouGov, Ipsos and NatCen Social Research all find that sizeable majorities of Britons now regret the decision to leave the European Union. The latest numbers show a margin as wide as 60-40% for those wishing that Britain had remained in the EU, compared with the 52-48% vote to leave in June 2016. Had all of those with an opinion on Brexit voted seven years ago, the result would have been even closer. Still, the numbers suggest a steady shift. What explains it? Several factors, according to Sir John Curtice, of NatCen, who spoke at a recent conference of the UK in a Changing Europe think-tank. Demography is one: older people mostly backed leave while younger ones preferred remain, so the passage of time tilts against Brexit. Those who did not vote in 2016 now break strongly against leaving the EU. Remain supporters are almost all still convinced they were right. But the most significant change is that as many as 20% of those who backed leave in 2016 now say they would support remain instead. Why? The obvious answer is disappointment with the outcome. Voters’ concerns have moved beyond Europe to focus on more short-term worries—the high cost of living, falling real wages, struggling public services and high immigration. Brexiteers like to argue that such ills were largely caused by covid-19 and the war in Ukraine. A few also argue, like Marxists of yore, that true Brexit has never been properly tried. Yet leaving the EU has clearly made at least some problems worse. Britain was one of the last G7 economies to recover to its pre-covid level of output; growth remains nugatory; most economists reckon extra barriers to trade have had damaging economic effects; inflation and interest rates are higher than in most other European countries; net migration is running at its highest level ever. Most of the specific promises made by the Vote Leave campaign in 2016 have proved illusory, too. This goes beyond the notorious red-bus pledge of £350m ($445m) extra a week for the nhs. The campaign claimed that trade with the EU would go on much as before, red tape would be swiftly shredded and big new free-trade deals with America and others would be simple to deliver. The broadest promise, that there would be no downside to Brexit but only considerable upside, looks empty. When Nigel Farage, the former leader of the UK Independence Party, admits (as he did in May) that “Brexit has failed” and Sir Jacob Rees-Mogg, a Tory Brexiteer, is laughed at for citing the benefits of Brexit, rising disillusion seems less surprising. This does not mean that there is growing demand to rejoin the eu. Europe is falling down the list of voters’ priorities and almost nobody wants to reopen such a bitterly divisive issue. Yet there is scope to soften the hard Brexit agreed to by Boris Johnson in December 2020. In February Rishi Sunak, the prime minister, won kudos for negotiating the Windsor framework. That resolved many practical problems over the border in the Irish Sea created by Mr Johnson’s decision to take Great Britain out of the EU’s single market and customs union but leave Northern Ireland in both. This week Britain and the eu signed a memorandum of understanding on regulatory co-operation over financial services, though it will do little to open up the EU market to London-based firms. As the chances of a Labour government after the next election rise, so do hopes that it may further improve relations with the eu. Sir Keir Starmer, Labour’s leader, insists he will not rejoin the single market or customs union. David Lammy, the shadow foreign secretary, suggests the eu would not agree anyway unless the Tories changed their stance. But he also told a recent meeting of the EU-UK forum, a talking-shop in Brussels, that better relations with the EU were his “number one priority”. Labour figures have floated various ideas. These include more formal security and defence co-operation; a veterinary agreement to facilitate trade in food; full association with the EU’s Horizon and Copernicus scientific-research programmes; a mobility deal to reduce visa hassles for travelling musicians and others; and an enhanced agreement on financial and other services. Three more suggestions for how thicker relations with the EU might be added to Mr Johnson’s notably thin trade and co-operation agreement (TCA) have appeared. In April the House of Lords EU committee published a report on how to improve ties in the political, diplomatic, security, climate-change and mobility fields. In May the uk trade and business commission, co-convened by Hilary Benn, former Labour chairman of the House of Commons Brexit committee, came up with 114 ideas for mitigating the damage to trade. And in late June the Tony Blair Institute, a think-tank, put forward its own shopping list of proposals for closer relations with the EU. The biggest obstacle lies in persuading the EU to agree to any such ideas. At the meeting of the EU-UK forum, Maros Sefcovic of the European Commission suggested that trade barriers were likely to get worse not better, and saw little hope for big changes during a five-year review of the TCA that is due in 2025-26. The commission thinks the review should be mainly about implementing the 2021 deal, not expanding it. The EU likes the existing arrangement, as it helps goods exports but does little for services, Britain’s strength. It is also wary of a non-member cherry-picking the benefits of its single market without signing up to associated obligations. There are two political lessons to draw from Brexit disillusion. One: it is no longer possible for the Tories to persuade voters who backed them in 2019 not to switch to Labour for fear of losing the advantages of Brexit—for these are so difficult to discern. The other: whoever wins the next election, the trend will be towards closer relations with the EU, not moving further away. The process may take longer than anti-Brexiteers hope, and it will always be a mistake to take eu assent to future changes for granted. Yet Brussels and national capitals will surely feel under strong pressure to be nicer to Britain, especially if Labour wins. The eventual destination is uncertain; but the direction of travel now looks settled. © 2023 The Economist Newspaper Limited. All rights reserved.

Allt fler unga i västvärlden diagnosticeras med cancer. Och forskarna har inget bra svar på varför, skriver Financial Times. Paddy Scott var bara 34 år när han fick diagnosen tjocktarmscancer som spridit sig till levern. Ledande epidemiologer menar att utvecklingen är så pass tydlig och omfattande att det går att tala om en epidemi, enligt tidningen. Increasing numbers of younger people in the developed world are being diagnosed with the disease. Scientists are not sure why By Sarah Neville and Amy Borrett June 18, 2023 When Paddy Scott developed agonising stomach pains in 2017, the possibility of cancer never entered his head. The British expedition photographer and film-maker, whose work often took him into rugged or dangerous terrain, was just 34 years old and prided himself on his physical fitness.  After his GP referred Scott to hospital for a colonoscopy, the clinician who administered it asked if he would take part in a trial of a new blood test designed to detect tumours. The invitation struck him as strange. “I remember thinking, yes but I’ll be the kind of ‘control’ that doesn’t have it,” Scott says. Later he received the devastating news that he had advanced bowel cancer which had spread to his liver. Scott’s experience is not the anomaly it once was. The past 30 years have seen an upsurge in cases of so-called “early onset” cancer in the under-50s. So marked is the increase, leading epidemiologists have suggested it should be called an epidemic. Financial Times analysis of data from the Institute for Health Metrics and Evaluation at the University of Washington School of Medicine shows that over the past three decades cancer rates in the G20 group of industrialised nations have increased faster for 25- to 29-year-olds than any other age group — by 22 per cent between 1990 and 2019. Rates for 20- to 34-year-olds in these countries are now at their highest level in 30 years. In contrast, cases in older age groups — those over 75 — have declined from their peak around the year 2005. During more than six years of gruelling treatment courtesy of the UK’s taxpayer-funded NHS, Scott has observed this shift. “I always used to be known around the ward because I was the youngest there. But the other day I was sitting in chemo with a guy who must have been late 20s. It does seem like it’s increasing quite dramatically [in younger people],” he says. Researchers have no definitive explanation for why people in the prime of life seem to be markedly more vulnerable to the disease than their counterparts in earlier generations. There may be clues in the types of cancer afflicting the young, researchers believe. Among 15- to 39-year-olds, cases of colorectal cancer increased 70 per cent in G20 nations between 1990 and 2019, compared to a 24 per cent increase in all cancers, the FT’s research found. Analysis produced by the American Cancer Society based on national data on cancer incidence and mortality suggests that this year 13 per cent of colorectal cancer cases and 7 per cent of deaths will be in people under 50.  Michelle Mitchell, chief executive of Cancer Research UK, or CRUK, cautions that age remains the biggest predictor of cancer risk, with around 90 per cent of all cancers affecting over-50s and half afflicting those over 75. But the increase in younger age groups is nevertheless “an important change. We need to understand that change,” she says. CRUK has launched a joint research initiative with the US National Cancer Institute to learn more about the causes of early onset cancer. The trend has economic, clinical and social implications. For cancer doctors on the frontline, the rise in such cases is becoming an inescapable and worrying aspect of their practice. Shahnawaz Rasheed, the surgeon in charge of Scott’s treatment at the Royal Marsden, a renowned London cancer hospital recalls a two-week period a couple of years ago when he operated on four women under 40. Another recent patient was a super-fit, international sportswoman in her 30s. Diagnoses in young adults hit clinicians like Rasheed hard, deepening his resolve to find answers. “These are people who should just be getting on with their lives . . . building careers, bringing up children,” he says. “It breaks my heart.” Scientists searching for insights are increasingly convinced that changes to nutrition and ways of living that began in the middle of the last century hold at least part of the key to the puzzle. Dr Frank Sinicrope, an oncologist and gastroenterologist at the Mayo Clinic in the US with a particular interest in early onset colorectal cancer, says incidence of the disease has been markedly increasing among people born in, or after, the 1960s. The increase in younger people coming to him for treatment in recent years has been “quite alarming” he says. The diet and lifestyle to which children are exposed in early life is likely to be a factor in the rise, he says, pointing to childhood obesity which has “become more prevalent and more problematic over the past 30 years”. However, no single factor can explain it, Sinicrope adds.  As they explore a connection with diet, researchers are homing in on the possibility that changes to the microbiome — the roughly 100tn microbes that live inside us, mostly in the gut — are increasing susceptibility to cancer. The microbiome is thought to play a key role in overall health, including digestion and regulation of the immune system, as well as protecting against disease-causing bacteria and aiding the production of vital vitamins. The consumption of food high in saturated fat and sugar is believed to alter the composition of the microbiome in ways that can harm an individual’s health. While these changes affect people of all ages, researchers believe it is highly significant that cases of early onset cancer started to rise from around 1990. People born in the 1960s belonged to the first generation exposed from infancy to modernised diets, and lifestyle and environmental changes, that started to become the rich-world norm in the 1950s.  Cancer often develops over decades — people can harbour slow-growing tumours for years — so for those diagnosed in their twenties, thirties and forties “some of the risk factor exposures may have happened when they were a baby or even in utero”, says Prof Shuji Ogino, an epidemiologist at the Harvard TH Chan School of Public Health who is part of the CRUK/NCI research initiative. The fact that the biggest increases in cancer in the young have been in gastrointestinal varieties — colorectal as well as in the oesophagus, stomach, pancreas, bile duct, liver and gallbladder — bolsters the case for a link with diet. Some other cancer types increasingly seen in younger people, such as breast, kidney and endometrial cancers, plus the blood cancer myeloma, may be affected both by obesity and the condition of the microbiome even though they lack an obvious link to the digestive system, Ogino says. Additionally, antibiotic use and medications more generally can affect an individual’s microbiome, sometimes referred to as their “bacterial fingerprint”. Ogino points out that during the second half of the 20th century the range of medicines available to treat multiple conditions substantially increased. New anti-obesity medicines are a recent example. “The effect really remains unknown what they all do in the long term,” Ogino says. The link to the microbiome is still circumstantial, he emphasises. He points to other changes that occurred from the 1950s onwards: more sedentary lifestyles, changes to sleep patterns and repeated exposure to bright light at night that can affect circadian rhythms and metabolism. “All these changes are happening in a really parallel way so it’s hard to tease out the culprit. There are likely multiple culprits which work together,” he says.  The rise in cases in wealthy western countries now looks set to find a belated, but resounding, echo in poorer countries where these societal changes happened decades later than in the US or the UK. The FT’s research shows that between 1990 and 2019, cancer rates for 15- to 39-year-olds increased significantly faster in upper-middle income countries, such as Brazil, Russia, China and South Africa, compared to high-income countries: by 53 per cent compared to 19 per cent.  Valerie McCormack, an epidemiologist who has studied disease patterns in cancer in low and middle income countries, where infectious diseases have long posed the biggest health burden, suggests a number of factors could be increasing rates of non-communicable diseases, including cancer, in the Brics and other developing nations. Women in these countries are having fewer children overall, and at later ages, meaning they spend a shorter period of their lives breastfeeding compared with previous generations. Having a larger family — typically leading to an extended period of breastfeeding — and giving birth for the first time at a young age are factors known to confer protection against breast cancer. “These changes do have many benefits for women, but they do place them at greater risk of breast cancer,” says McCormack, who is deputy branch head for environment and lifestyle epidemiology at the International Agency for Research on Cancer, part of the World Health Organization. Similarly, an increase in smoking and alcohol use evident in some developing countries, mostly in men, is “narrowing the gap in cancer risk” between rich and poorer nations, while the adoption of a more westernised diet, obesity and lower physical activity were implicated in the growth of colorectal cancer cases, McCormack adds. But she cautions: “These are epidemiological and lifestyle transitions which will be contributing to increasing rates of specific cancers” — but they are unlikely to tell the full story. “Some of the rises are so very recent that the research hasn’t been done to exactly pinpoint all of the driving factors,” she says. The rise in early onset cancer is not simply a concern for health systems. It is a problem for economies too. Those who survive the disease are at greater risk of long-term conditions such as infertility, cardiovascular disease and secondary cancers, researchers say, threatening more costly healthcare burdens in future. Simiao Chen, head of the research unit for population health and economics at the Heidelberg Institute of Global Health and an adjunct professor at Peking Union Medical College, led a team which earlier this year calculated that the estimated global cost of cancer from 2020 to 2050 would be $25.2tn at constant 2017 prices. This, the researchers concluded, was “equivalent to an annual tax of 0.55 per cent on global gross domestic product”. “If the trend is getting younger then the economic burden will be much heavier because we are losing people in the working age population who can contribute to economic growth,” Chen says. Cancer survivors might not be able to recapture their previous productivity levels, she suggests. “So it will reduce the quantity and the quality of labour”, she adds. Recognising that early onset cancers are becoming more common, some clinicians would like to see a reduction in the age of eligibility for screening programmes, most of which take effect only in later middle age.  In England, for example, home bowel cancer testing kits are sent out when patients reach 60. Last month, the US Preventive Services Task Force, an independent body made up of national experts, suggested that the age for breast screening should be lowered to 40. In 2021, the same group argued that colorectal screening should begin at 45. As health systems around the world struggle with a mismatch between demand and resources made worse by the pandemic, mounting a compelling case for the necessary expenditure may prove harder. A “national dialogue” about priorities may be needed given the rising proportions of under-50s developing cancer, Rasheed, the Royal Marsden surgeon, says. Some scientists say they have identified differences in the molecular structure of cancers in younger people, pointing to the potential need for specific treatments aimed at this group. Tomotaka Ugai, an instructor at Harvard Medical School who led a study into rising rates of early onset cancer which drew international attention to the trend in 2021, says that for many cancer types such as breast, colorectal, endometrial, multiple myeloma, pancreatic and prostate, “early onset cancers have more aggressive clinical features”. A related question is whether the causes of early onset cases are different to those diagnosed at older ages. Ugai says: “We assume that many risk factors overlap between early onset and later onset, but we don’t know if risk factors completely overlap . . . so we need to conduct more research.”  Some clinicians believe that equally important is the fact that cancers have often reached a more advanced stage in a younger person before they are diagnosed. They believe doctors need to be on the alert for cancer in a 20- or 30-something, recognising this can no longer be considered an outlandish prospect.  Rasheed, who regularly lectures to GPs about the importance of spotting cancer “red-flag” signs early, says studies have shown that younger people “may have been seen by five or six clinicians, before being referred for specialist investigations, diagnosis and treatment”. The same symptoms in someone 30 years older would have probably rung immediate alarm bells. The delayed diagnoses may also reflect a lack of awareness among younger people of the symptoms they should look out for, he suggests. “I’ve heard and seen a lot of horror stories about younger people who, by the time they come in [to hospital] have got quite locally advanced or metastatic disease. And there may have been a window [to find and treat the cancer] earlier,” he says. Scott recalls that, after his GP referred him to a central London hospital for tests, “apparently they said to her, ‘This isn’t urgent, he’s 34, he’s clearly in very good health’. She pushed and pushed and eventually managed to get me in.” The question preoccupying researchers and clinicians is whether the rise in cases over the past few decades represents the tip of a much larger epidemiological iceberg. In their research paper, Ugai and his fellow researchers warned of the possibility that those who are currently children, adolescents and young adults might have higher risks of cancer throughout their lives compared to older generations.  And it may not stop at cancer. The same risk factors may predispose them to conditions such as diabetes and inflammatory bowel disease, the scientists said, suggesting a permanently higher chronic disease burden in the future unless action is taken to spur healthier ways of living and eating, and to reform the way that food is produced and distributed. While the prevalence of smoking, a key cause of cancer, has decreased in many parts of the world over the past few decades, obesity, physical inactivity and other risk factors have increased, Ugai notes. “So there is a trade off but we can speculate that [early onset cancer] cases will continue to grow for the foreseeable future,” he says. For younger people like Scott who were previously healthy and fit, cancer can seem like the ultimate misfortune, the shortest of straws. As he copes with his diagnosis, Scott resists asking “why me?” He has started a masters degree in environmental politics and policy and became a father 11 months ago when his partner, Hen, gave birth to their son, Osprey. But he inevitably reflects on what might have been. “I’d spent 10 years trying to break into wildlife film-making. And then just as I started [cancer] treatment, I started getting job offers and had to turn them down. “I can’t help but think, ‘What would my life be like if I didn’t have to be going through all this?’” Copyright The Financial Times Limited 2023 © 2023 The Financial Times Ltd. All rights reserved. Please do not copy and paste FT articles and redistribute by email or post to the web. ©The Financial Times Limited 2023. All Rights Reserved. FT and Financial Times are trademarks of the Financial Times Ltd. Not to be redistributed, copied or modified in any way.

Vodafone och mobiloperatören har kommit överens om ett avtal om att slå samman sina brittiska telekomnät. Går fusionen igenom kommer bolagen bilda Storbritanniens största mobiloperatör, det uppger The Guardian.