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News brief: Ukraine recaptures key territory, Xi-Putin meeting, insulin prices

STEVE INSKEEP, HOST:

Ukraine's military had a very good weekend.

A MARTINEZ, HOST:

Ukrainian forces reclaimed a lot of territory in the country's northeast. They're pushing forward in a swift-moving counteroffensive. Ukraine's ambassador to the U.S., Oksana Markarova, spoke with CBS.

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OKSANA MARKAROVA: We will advance. As we said before, we will not surrender. And we will liberate all Ukraine.

INSKEEP: NPR's Elissa Nadworny is in Kyiv.

Hey there.

ELISSA NADWORNY, BYLINE: Hello.

INSKEEP: How much have the battle lines been moving?

NADWORNY: So Ukrainian officials claim to have recaptured more than 1,200 square miles since the beginning of September. The Institute of the Study of War in D.C. is reporting that Ukraine has captured all of the Kharkiv region. That's in the country's northeast.

INSKEEP: Sure.

NADWORNY: Now, over the weekend, we've been driving around all across Ukraine and in the east, and people are just glued to their phones - I mean, watching towns get taken; what's going to be the next town? There's just been so much movement. Ukrainian forces have made it to the towns of Izium, Balakliya and Kupiansk, all of which are strategic places that have been controlled by Russia for the last six months. And given the videos and photos we've seen, Russian forces left in a hurry, leaving valuable weapons behind.

INSKEEP: I was surprised over the weekend to realize that even the Russian authorities are acknowledging that things have not been moving in their direction.

NADWORNY: Yeah. Russia's Ministry of Defense and the Kremlin haven't said anything official, but Russian military maps show that the front line in the east has moved significantly, and not in the Russian's favor. Over the weekend, Russia's Defense Ministry spokesman, Igor Konashenkov, confirmed that forces withdrew from Balakliya and Izium.

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IGOR KONASHENKOV: (Speaking Russian).

NADWORNY: He didn't call it a retreat. He called it a regrouping in order to scale up efforts further southeast. But, you know, on Sunday, the Russian missiles - they were going wild. They hit civilian infrastructure in cities like Kharkiv and Sumy. Folks here are calling it a retaliation for the counteroffensive. In many places, power that was struck out has actually already been restored.

INSKEEP: Yeah. Of course that does raise the reality that the Russians still have a lot of firepower. So how much does it seem that the war has shifted here, really?

NADWORNY: Well, there - it's a big shift because Izium, Kupiansk - these are transportation and supply hubs for the Russian forces. So they're a base from which they could launch attacks on the Donbas and Donetsk regions. So it's a big strategic loss for Russia. But there is still a counteroffensive happening in the south. That's where Russian forces are dug in, near Kherson and the Black Sea. And it's been more of a slog there. There hasn't been as much traction.

INSKEEP: Elissa, you mentioned driving around across the country over the weekend and not very far from the front lines. What did you see and hear?

NADWORNY: Well, we were in Sloviansk - that's about an hour southeast of Izium - visiting with people who are housebound. And there were a ton of explosions. There was a lot of action. There was mixed emotions 'cause there's excitement about the Ukrainian gains. But there's also a real sense of fatigue and fear.

ANNA: (Non-English language spoken).

NADWORNY: That's Anna. She's 85 and bedridden. She didn't share her last name for fear of safety. She's saying, I don't sleep. There's no heat. She's afraid of dying here alone. And I think it's a good reminder that this offensive may have caught the Russians by surprise, but it doesn't mean the war is anywhere near over.

INSKEEP: No. And here is another indication of that. There's still trouble at a nuclear power plant in southern Ukraine that is still controlled by the Russians, still near the fighting. What's happening there now?

NADWORNY: So the plant is going to power down the last remaining reactor. This is a safety precaution. Power lines have been restored to the Zaporizhzhia power plant, which means it's connected to the grid. But they've got to cool this stuff down still. So if it gets knocked off the grid, they can rely on generators, but they only have so long. And with limited amount of fuel and the active fighting, it's not going to be an easy resupply. So it's an ongoing situation.

INSKEEP: NPR's Elissa Nadworny. Thanks so much.

NADWORNY: You bet.

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INSKEEP: The leader of China, Xi Jinping, is preparing to make his first trip out of his country in over two years.

MARTINEZ: He's been operating within a strict COVID bubble. But by midweek, he expects to be in Central Asia. His meetings include a regional security forum, also attended by Central Asia's other big neighbor, Vladimir Putin, the president of Russia.

INSKEEP: NPR's Emily Feng covers China. Good morning, Emily.

EMILY FENG, BYLINE: Good morning, Steve.

INSKEEP: What makes this trip worth it for China's president?

FENG: Well, Xi just hasn't met many other world leaders since early 2020 because of the country's strict zero-COVID policies. So he's been doing everything remotely, and that is going to have a cost, however immeasurable, on China's diplomacy to the rest of the world. But you know who's been really, really busy all over the world? - the U.S. U.S. diplomats have been intensifying competition with China. And China is losing out, particularly on the issue of Taiwan, which is this island that China claims control over, but which is strengthening ties with the U.S. In August, House Speaker Nancy Pelosi visited Taiwan.

And then since there's been this stream of American governors, senators and representatives who've also paid visits, the last of which was just this past week - so there's pressure for Chinese leaders to venture out again. And this week is also one of the last possible weeks Xi Jinping could have globetrotted because he's got to head back soon and kick off the Communist Party Congress in mid-October, where he's expected to formalize his third term in power.

INSKEEP: Which, of course, is itself a big change. Now, looking at a map here - Central Asia, of course, is a group of countries, many of which used to be part of the old Soviet Union, which is right there. They also border China. So what draws China's leader exactly there?

FENG: Xi Jinping is looking to project stability in the region because after Russia invaded Ukraine, that really frightened some of these post-Soviet republics in Central Asia.

Jakub Jakobowski is a senior fellow on China at the Center for Eastern Studies, a Polish state think tank. And I also asked him, why Kazakhstan?

JAKUB JAKOBOWSKI: I think Kazakhstan basically wants to maintain the status quo. It sees Russia as an actor that has changed. Russia is turning from a security provider in a authoritarian sense, a stability provider, into an aggressive country that can actually destabilize the region.

FENG: And so now Central Asia is looking to China. Also, Central Asia is key to China's security. Kazakhstan borders Xinjiang, this region in China where the United Nations says China may have committed crimes against humanity by arresting and detaining Uyghurs, Kazakhs and other ethnic groups. China says it's battling terrorism there. And that's also one of the reasons why Xi heads to Uzbekistan on Thursday for a meeting of the Shanghai Cooperation Organization, which is a security block.

INSKEEP: And, of course, Vladimir Putin will be at the table there. I would imagine they might have a little conversation on the side.

FENG: Yep. They most definitely will be talking about Russia's war in Ukraine. Remember back to February. Putin actually traveled to Xi in Beijing then. He was one of the few world leaders to attend the opening ceremony of the Winter Olympics in China. The two countries signed a no-limits partnership, and then weeks later, Russia invaded Ukraine. So far, China has not wavered in its support of Russia, but that partnership is way more complicated now, given the success Ukrainian forces have had this weekend pushing out Russian forces in the northeast. And so this means this meeting is going to be really important for Putin. He need to convince China he's a reliable partner, one that will not fail and embarrass Xi Jinping.

INSKEEP: Emily, thanks so much.

FENG: Thanks, Steve.

INSKEEP: That's NPR's Emily Feng.

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INSKEEP: When it comes to out-of-control prescription drug prices, insulin is the poster child.

MARTINEZ: Leading manufacturers have increased prices by more than 600% over the last 20 years. Insulin has become so expensive, many diabetes patients ration the drug.

INSKEEP: Although some states are now trying to address the problem. And NPR's Allison Aubrey is covering that. Allison, good morning.

ALLISON AUBREY, BYLINE: Good morning, Steve.

INSKEEP: I guess we need to start, actually, at the federal level because Congress passed this measure they called the Inflation Reduction Act, which is supposed to include prescription drug reforms. Does that help people with insulin?

AUBREY: Well, it will help Medicare patients. There will be a new cap on out-of-pocket costs for them. But as for the other 80% of Americans, there are many families still struggling to afford insulin. I spoke to Clayton McCook. He lives in Edmond, Okla. His 14-year-old daughter Lily has Type 1 diabetes. And due to their very high-deductible health plan, they pay thousands of dollars out of pocket each year. He says he's angry that pharmaceutical companies price insulin at $300 a vial when it only costs about $6 to make.

CLAYTON MCCOOK: I could go to Canada right now and get my daughter's insulin - the same exact drug - for $35 to $40 a vial because the Canadian government says, this is it. This is the most you can charge. And they're still making a profit at that price. They're still making a handsome profit. This is a very visceral thing for me. Without insulin, my daughter will die.

AUBREY: And McCook says if there's not more action in Washington, D.C., to fix what he says is a broken system, he points to momentum at the state level.

INSKEEP: What's happening at the state level?

AUBREY: Well, about 20 states have passed laws or programs to limit the amount patients pay for insulin. I'd say the boldest initiative is in California. Instead of buying insulin from big pharmaceutical companies such as Eli Lilly, Novo Nordisk, they want to make their own insulin. Governor Gavin Newsom has said nothing epitomizes market failures as much as the cost of insulin.

I spoke to Dr. Mark Ghaly. He's secretary of health and human services for the state of California.

MARK GHALY: The cost of actually creating the insulin is not nearly as much as what people are paying for it. California is looking at, what approach can we take to make sure what people pay for it is as close to the actual cost of creating it as possible?

AUBREY: Earlier this summer, state lawmakers approved $100 million for this project. The idea is to kind of produce biosimilar - as they're called - insulin products akin to generic versions of the existing drugs.

INSKEEP: Is this doing something that is proven and practical that anyone can do?

AUBREY: Well, it hasn't been done yet. But Californians are not the first to be thinking about this. Civica Rx is a nonprofit generic drug company. It started back in 2018. They're already in the process of developing three insulin products that will cost no more than $30 a vial.

I spoke to Civica Rx's Allan Coukell.

ALLAN COUKELL: Our timeline is to bring the first of those three insulins to market in 2024. And we're working with the FDA now as we move through the development process.

AUBREY: The FDA would need to authorize these insulin products, and he's optimistic this will happen, which could usher in much cheaper insulin for millions of Americans.

INSKEEP: Allison, thanks.

AUBREY: Thank you, Steve.

INSKEEP: That's NPR's Allison Aubrey. Transcript provided by NPR, Copyright NPR.

A Martínez is one of the hosts of Morning Edition and Up First. He came to NPR in 2021 and is based out of NPR West.
Steve Inskeep is a host of NPR's Morning Edition, as well as NPR's morning news podcast Up First.