Up First from NPR - Cluster Bombs For Ukraine, OK For Alzheimer's Drug, Progressive Pressure On Biden

Episode Date: July 7, 2023

Officials tell NPR the Biden administration plans to deliver controversial cluster munitions to Ukraine. The FDA gives full approval to a drug shown to slow Alzheimer's disease. And ahead of 2024, some progressive Democrats are pressing President Biden to move faster and do more on issues like climate and police reform.Want more comprehensive analysis of the most important news of the day, plus a little fun? Subscribe to the Up First newsletter.Up First is produced by Nina Kravinsky, Shelby Hawkins, Taylor Haney and Julie Depenbrock. Our editors are Michael Sullivan, Amina Kahn, Roberta Rampton, Alice Woelfle and Jan Johnson. Our technical director is Carleigh Strange with engineering support from Stacey Abbott.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

— Officials tell NPR the Biden administration is prepared to send cluster bombs to help fight the Russian troops that are entrenched in Ukraine. — We're asking, though, why do some of America's closest allies think that's a bad idea? — I'm Rob Schmitz, that's Michelle Martin, and this is Up First from NPR News. The FDA says a drug to treat Alzheimer's has its full approval. — It's not a home run, but it may slow down progression of the disease. What the green light for Lakembe could mean for hundreds of thousands of patients. Plus, President Biden's promises for big change met headwinds, but

progressive Democrats say he can still do more. The president's made a down payment, but he's got to fight like hell. What does that mean for 2024? Stay with us. We'll give you the news you need to start your day. Now Our Change will honour 100 years of the Royal Canadian Air Force and their dedicated service to communities at home and abroad. From the skies to Our Change, this $2 commemorative circulation coin marks their storied past and promising future. Find the limited edition Royal Canadian Air Force $2 coin today. The Biden administration is expected to announce today that it will send a new weapon to Ukraine,

cluster bombs. These cluster munitions have been around for decades and they've been effective in combat, but they're also controversial and many nations have pledged not to use them. We were wondering why this is happening now, so we're joined by NPR National Security Correspondent Greg Myrie in Ukraine's capital of Kyiv. Greg, thanks so much for being here. Sure thing, Michelle. So could you just give us a short explanation of what cluster munitions are, and why they're so controversial. So a cluster bomb can be dropped from a plane, though the Ukrainians would likely be firing them from the

ground in an artillery shell. And while the cluster bomb is in the air, it breaks open and releases dozens or even hundreds of little bomblets. And this can be very effective when used against troops spread out over a big area because there's not just one explosion. All these little bomblets are intended to explode over a vast space the size of a city block or so. However, some bomblets are duds. They don't detonate. They're small. They remain on the ground.

They can become embedded just below the surface. So years later, after a war is over, civilians can walk through these areas and step on the bomblets, causing them to explode and inflicting injury or death. For this reason, human rights groups say they shouldn't be used, really for the same reason they opposed landmines. But have they already been used in this war? Yes, they have. Russia has used them extensively in Ukraine to a lesser degree, according to research by Human Rights Watch. And more than 120 countries, including most NATO members, pledged not to use them under a 2008 convention. But Russia, Ukraine, and the U.S. are not part of that agreement. The U.S. has used them in the past.

I remember them as far back as the first U.S. war in Iraq in 1991. It looked like a really bad golfer had left dozens of big divots all over the course, and that instantly grabbed your attention because when you saw this, you knew some unexploded bomblets were lurking nearby. So why is this so important to Ukraine, and why now? Yeah, the main reason this seems to be happening now is Ukraine is pressing this major offensive and it's running low on artillery shells. Ukraine is trying to break through Russian lines in the east and the south where the Russian troops are deeply entrenched.

And the cluster munitions could be a very valuable weapon because you can hit a larger patch of territory with just one of these weapons compared to a conventional artillery shell. The U.S. has a large supply of them on the shelf, so it can presumably give them to Ukraine pretty quickly. And U.S. officials have told NPR that the dud rate has come down substantially. Mine clearing groups used to talk about rates of 20 percent or more. The U.S. says it'll only be sending those with a dud rate of around 2% or less. Some critics, though, do question the Pentagon's claim that the rate is really this low. Greg, before we let you go, can you give us a quick update on the status of Ukraine's offensive?

Yeah, the Ukrainian military gave a very specific answer this week, said Ukraine had retaken nine villages and 62 square miles since the offensive began a month ago. Now, these figures have very little changed over the last week or two, and it's much slower and more limited than many expected. That is NPR's Greg Myrie in Kiev. Greg, thank you. Sure thing, Michelle. For the first time, the Food and Drug Administration has given its full approval to a drug that is shown to slow down Alzheimer's disease. That means many more seniors will have access because Medicare will pay for it. NPR's John Hamilton covers brain science and is here with us to tell us more about it.

John, good morning. Good morning. So what do people need to know most about this drug? Well, for starters, it is called Lekembe. Its generic name is Lecanumab. It's administered by an intravenous infusion every other week. And when you give it to people in the early stages of Alzheimer's, it appears to slow down the loss of memory and thinking by about 27%.

That all sounds pretty good. But this effect is really pretty modest. And the question a lot of doctors have right now is whether this drug will really make a difference to most patients and their families. So I actually asked Dr. Sanjeev Vaishnavi. He's a neurologist at the University of Pennsylvania. Here's what he said about Lekembe. It's not a home run.

It's not something that's going to stop the disease or reverse it, but it may slow down progression of the disease and may give people more meaningful or quality time with their families. How does this drug work? Right. So Lekembe is what's known as a monoclonal antibody. These are antibodies that are made in the lab and they're programmed to go after a specific target in the body. This drug is designed to find and remove a substance in the brain called amyloid beta. In people with Alzheimer's, amyloid beta tends to form these clumps and eventually these sticky plaques that build up between brain cells. Scientists think that somewhere along the way in this process, something damages brain cells and leads to dementia. They think Lekembe works by interfering with that process.

So the FDA has now given its full approval to this drug. Would you just tell us what exactly that means and why does that matter? So back in January, the FDA gave Lekembe something called an accelerated approval. It's a sort of a conditional approval that was based purely on its ability to remove amyloid from the brain. That meant doctors could actually prescribe the drug, but Medicare generally wouldn't pay for it because the drug had not shown that it had actually slowed down the disease. And by the way, this drug is expensive. It costs about $26,500 a year. So now this full approval means the FDA now believes the drug really does help patients, and it also means that Medicare will pay. That is critical because

Medicare covers people 65 and older, and in other words, we're talking about the vast majority of people with Alzheimer's. So does that mean that everybody who qualifies is now going to be able to get this drug, like, I don't know, tomorrow? Well, not exactly. I mean, even with full approval, many of these people still won't have access to Lekembe. This drug is only for people who are in the very early stages of Alzheimer's and have elevated levels of amyloid. So even with that restriction, though, this drug could potentially reach a million people or more. And unfortunately, it has side effects. What are the side effects you're talking about?

Lekembe can cause bleeding or swelling in the brain. That seems to be related to the process of removing amyloid, which can actually cause inflammation. So in other words, the process that is helping the brain can also cause damage. So when people first start taking this drug, they are required to get periodic brain scans to look for trouble. That is NPR's John Hamilton. John, thank you. Thank you. President Biden made some major promises to the more progressive wing of his party on his way to the White House. He said he'd forgive student loans and new drilling on federal lands and make two years of community college free for all. So far, his record on delivering on these promises has been mixed. And in the run-up to 2024, some progressive voters and activists want Biden to do more and do it faster.

Deepa Shivaram covers the White House for NPR and is with us once again to tell us more about this story. Good morning. Hey, Michelle. So let's start with student loans. The Supreme Court blocked Biden's debt relief plan last week. Obviously a disappointment for people who are counting on that, even maybe budgeting for that. But how are progressive voters responding to that? And I'm particularly interested in if they blame Biden or the court for their disappointment about all this.

Yeah, there's definitely a little bit of a sentiment among some progressive voters that Biden overpromised on forgiving student debt. You heard the president say that he knows people are disappointed, but he rejected that he gave people false hope, and he's trying to lay the blame on Republicans. But what has also stood out to progressive groups that I spoke with is that Biden bounced back with another plan immediately. It'll take longer, but they were happy that Biden didn't just throw his hands up on this issue, and they think he should apply that same strategy to some other issues as well. Here's Joseph G. Varghese. He's with a group called Our Revolution. It's a political organization which was started by supporters of Senator Bernie Sanders. It's a mixed bag. The president's made a down payment, but he's got to fight like hell in the remaining period of time to show voters

that he's doing everything in his power to deliver on the pocketbook issues that matter to him. So a mixed bag. Deepa, does that suggest that it's going to cut into support for the president in 2024? That is a matter of enthusiasm. I talked to Adam Green, who's the co-chair of the Progressive Change Campaign Committee. It's a group that backs lawmakers like Senator Elizabeth Warren. But he says Biden is doing something effective. And that's the strategy of drawing contrasts with his own agenda and the agenda of right-wing Republicans. It's very important that Joe Biden, on behalf of all Democrats, picks very high-intensity fights with Republicans on things like economics, abortion, and democracy. He really needs to make

clear what the battle lines are so that regular people who live busy lives say, oh, I actually care about that. It's worth my time to vote. And we already know that with abortion specifically, public opinion on the issue isn't in line with what Republicans are calling for. And that's a message that Biden will be taking to the trail in 2024. So say more about that. Where do progressive groups think Biden can still take more aggressive action? There's some unfinished business, things like child care, universal pre-K, that Biden's going to run on again. But climate action is a big issue where a lot of voters feel like Biden has backed out on what he promised in 2020. For example, the president campaigned on promises to end new drilling on federal lands in order to rein in emissions. But he approved a new venture in Alaska called

the Willow Project earlier this year. Millions of people petitioned against it. And climate activists see it as the total about face and a disappointment for people who voted for Biden based on his climate agenda. But I'll add here that Biden has already picked up a number of endorsements from environmental and conservation groups. And he's campaigning hard on his record on investing in clean energy projects. That is NPS Deepa Shivram. Deepa, thank you. Thank you. And that's Up First for Friday, July 7th. I'm Michelle Martin. And I'm Rob Schmitz. Up First is produced by Nina Kravinsky, Shelby Hawkins, Taylor Haney, and Julie Deppenbrock. Our editors are Michael Sullivan, Amina Khan, Roberta Ram Up First episode for Saturday, too.

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