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Biden Makes Lower Drug Prices a Centerpiece of His 2024 Campaign

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As he heads toward a re-election campaign next year, President Biden is betting that his success in pushing for policies intended to lower health care costs for millions of Americans will be rewarded by voters at the ballot box.

In speech after speech, Mr. Biden talks about capping the cost of insulin at $35, putting new limits on medical expenses for seniors, making some vaccines free and pushing to lower the prices of some of the most expensive drugs in the world.

At the White House, Mr. Biden and his advisers have already begun to elevate the issue as a centerpiece of his agenda. And at his campaign headquarters in Wilmington, Del., aides are preparing television ads, talking points and speeches arguing that Mr. Biden’s push for lower health care costs is a stark contrast with his Republican opponents.

“The president will have a very strong case to make,” said Senator Amy Klobuchar of Minnesota, a member of the president’s national campaign advisory board. “Not only will people want to keep the benefits they have seen, they are going to want to get the benefits that are coming their way.”

On Tuesday, the White House announced that the Biden administration will negotiate on behalf of Medicare recipients for lower prices on 10 popular — and expensive — drugs that are used to treat diabetes, heart disease and other chronic illnesses.

The move was made possible by passage last year of Mr. Biden’s Inflation Reduction Act, which for the first time allows Medicare to negotiate drug prices for older adults, a change that has been opposed by the pharmaceutical industry for decades.

Republicans also generally oppose giving the government the right to negotiate drug prices. But the candidates for the Republican presidential nomination have said little about the cost of medication, focusing instead on abortion, transgender medical issues and Covid lockdowns.

In his speeches, Mr. Biden rails against the industry and his Republican adversaries in Congress, all of whom voted against the law that included the prescription drug provisions. Aides say it is an effective message.

“Today is the start of a new deal for patients where Big Pharma doesn’t just get a blank check at your expense,” the president said at a White House event celebrating the change.

Since signing the law a year ago, Mr. Biden has repeatedly called it one of his proudest legislative victories. But his approval numbers have hardly budged. And while polls show that the new policy is widely popular among Americans who know about it, they also suggest that far fewer people are even aware that the change was made.

That is most likely because prices on just the first handful of drugs are not scheduled to actually drop until 2026 at the earliest, assuming Mr. Biden’s program survives legal challenges. Drug companies have filed numerous lawsuits against the administration that claim the law is unconstitutional. Court cases could drag on for years.

In its lawsuit against the administration, the Pharmaceutical Research and Manufacturers of America, an industry trade group, called the plan for negotiated prices “a government mandate disguised as negotiation.”

Even if Mr. Biden’s plan goes into effect, older adults who have made the choice to ration their drugs will have to continue doing so until more than a year after the 2024 presidential election.

Danny Cottrell, 67, a pharmacist who owns his retail pharmacy group in Brewton, Ala., said he regularly advised his Medicare patients on the ins and outs of the government’s prescription program. He welcomed Mr. Biden’s changes, but said it would be up to people like him to explain the complicated process.

“I got to remind them, this doesn’t start till 2026,” Mr. Cottrell said. “And then also remind them this thing will change several times between now and then.”

Neera Tanden, Mr. Biden’s top domestic policy adviser, said the White House was confident that the plan would survive the legal challenges.

“It is absurd to argue that negotiation is unconstitutional,” she said in an interview. “There’s nothing in the Constitution that says Medicare negotiating drug prices is unconstitutional.”

But more broadly, Ms. Tanden said that she and the president’s other advisers in the West Wing were determined to make the push for lower health care costs a central part of Mr. Biden’s message to Americans.

And next September, just weeks before Election Day, the administration will announce the results of the yearlong negotiations over the first 10 drugs.

“We plan to work extensively, to really remind folks of this issue,” Ms. Tanden said.

For the people leading Mr. Biden’s re-election campaign, the political benefits of focusing on lower health care costs are clear.

Some polls show that 80 percent of Americans support giving the government the ability to negotiate lower prices for Medicare, much the way it already does for veterans and members of the military.

Campaign aides said talking about lower costs of drugs or limits on out-of-pocket medical expenses is one way to help Mr. Biden win support among seniors, who traditionally have voted for Republicans in greater numbers. That is especially important in battleground states like Michigan, Arizona, Georgia and Ohio, where increasing support among older adults will be critical in close contests.

The campaign’s early television ads have included numerous references to the president’s efforts to lower health care costs. A spokesman for the campaign said the issue of health care would be a central feature of a $25 million ad blitz focusing on what the president has done to lower costs overall and make economic progress.

Kate Bedingfield, who served as Mr. Biden’s communications director for the first two years of his presidency, said the issue had political benefits even when it came to appealing to people who do not benefit directly from the specific cost reductions.

“It draws a really clear contrast with the Republicans, who have stood in the way and continue to stand in the way of getting more done on this,” she said.

Representative Michael C. Burgess, Republican of Texas and a doctor, said Mr. Biden’s drug price negotiations were akin to government-imposed price controls that would lead to drug shortages.

“This administration’s approach goes beyond ‘negotiation,’” he said in a statement. “Instead, it holds pharmaceutical companies hostage, jeopardizing their future innovation and the well-being of American patients.”

Mr. Biden’s campaign aides said a debate with Republicans about the cost of medical care was one they were eager to have.

“MAGA Republicans running for president want to repeal the Inflation Reduction Act, which would deliver a massive win for Big Pharma and increase costs for the American people,” said Julie Chávez Rodríguez, the president’s campaign manager, referring to Republicans loyal to former President Donald J. Trump.

She said the choice in the election was between Mr. Biden and “a slate of candidates focused on extreme policies that put their wealthy donors first.”

Robert Jimison contributed reporting.

Canada Issues Travel Warning for L.G.B.T.Q. Citizens Visiting U.S.

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The Canadian government is warning L.G.B.T.Q. travelers to the United States that they may be affected by a series of recently enacted state laws that restrict transgender and other gay people.

Global Affairs Canada, the foreign affairs department, added a brief notice on Tuesday to a long list of travel warnings involving the United States that had already included cautions about gun violence and terrorism.

“Some states have enacted laws and policies that may affect 2SLGBTQI+ persons,” the notice reads. “Check relevant state and local laws.” (The beginning of the Canadian government’s acronym, “2S,” represents two-spirit, an Indigenous term for someone with a masculine and a feminine spirit.)

Jérémie Bérubé, a spokesman for the department, said in a statement that the change was made because “certain states in the U.S. have passed laws banning drag shows and restricting the transgender community from access to gender-affirming care and from participation in sporting events” since the beginning of this year. The warning did not name specific states.

He added that, like all travel advisories, this one had followed a “thorough analysis of various information sources, including consular trends observed by Canadian diplomats in the field.”

Mr. Bérubé did not respond to a question about whether any Canadian travelers had sought help from Canadian diplomats because of recent state legislation pertaining to L.G.B.T.Q. people.

Moves by state lawmakers, particularly in Florida, to curtail L.G.B.T.Q. rights have received prominent attention in the Canadian news media, as has a rise in hate crimes directed toward that community. The Human Rights Campaign has calculated that 520 pieces of legislation that would limit or remove the rights of L.G.B.T.Q. people have been introduced this year in state legislatures, with 70 of them enacted.

Helen Kennedy, the executive director of Egale Canada, an L.G.B.T.Q. rights group in Toronto, said that while her organization had not heard of Canadians being affected by the state measures, she anticipated that some would inevitably be caught up in them.

“We applaud our government for taking this step,” she said. “It sends a clear message that even our closest neighbor can potentially be a hostile force toward our community.”

There has been far less political momentum in Canada to roll back L.G.B.T.Q. rights, which have strong court protection.

For almost two years, the Atlantic province of New Brunswick had a policy that required teachers to use the preferred names and genders of schoolchildren. Premier Blaine Higgs has changed it to require that teachers obtain the permission of parents if the child is under 16. But the move has not had wide support. Several members of the Legislature, including some cabinet ministers, quit Mr. Higgs’s Progressive Conservative caucus in protest. Despite that backlash, other conservative politicians have suggested that they will follow New Brunswick’s lead.

While the overall threat assessment for travel to the United States remains at the lowest level, the country now joins many others that the Canadian government warns L.G.B.T.Q. travelers about, most in language far stronger than the advice for the United States. The new advisory includes a link to a page of general safety guidance for the community regarding international travel.

Florida and some of the other states that have enacted anti-L.G.B.T.Q. laws and policies are popular tourist destinations for Canadians. Ms. Kennedy said that the legislation was increasingly causing L.G.B.T.Q. Canadians making travel plans to ask, “Is this the best place to spend my money?”

Narcan Available for Over-the-Counter Purchase: What to Know

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Narcan, the first opioid overdose reversal medication approved for over-the-counter purchase, is being shipped to drugstore and grocery chains nationwide, its manufacturer said Wednesday. Big-box outlets like Walgreens, CVS, Walmart and Rite Aid said they expected Narcan to be available online and on many store shelves early next week.

Public health experts have long called for greater accessibility to the drug, which they describe as a critical weapon against rising overdose rates. There were more than 100,000 opioid overdose fatalities in each of the last two years in the United States.

Narcan is already a staple for emergency personnel and street outreach teams. Now scientists and health officials are hoping Narcan will eventually become commonplace in public libraries, subways, dorms, corner delis and street vending machines.

They also predict it may become a fixture in medicine cabinets, as more people realize that illicit party drugs like cocaine and counterfeit Xanax pills may be tainted with deadly fentanyl, an opioid.

Here’s what you need to know about buying this lifesaving medication.

Narcan is a nasal-spray version of the drug naloxone, which blocks an opioid’s effects on the brain, rescuing a person overcome by drugs like fentanyl, heroin or oxycodone.

An individual may be overdosing if his or her breathing is slowed or stopped, and the pupils of the eyes narrow to a pinpoint. Naloxone is generally considered so safe that experts say that, when confronted with a possible overdose, it is better to risk using it than to hesitate.

Each carton contains two palm-size plunger devices, each filled with four milligrams of naloxone. The rescuer inserts the spray tip into the patient’s nostril and depresses the plunger.

Usually one dose is sufficient to reverse an overdose within two to three minutes. But addiction specialists have reported that in areas where the fentanyl supply is quite potent, a second dose may be needed.

The cost is likely to dictate the extent of Narcan’s uptake. The manufacturer, Emergent BioSolutions, suggests $44.99 as the price of the two-dose box.

“People with some money and motivation will seek this product out, which is fantastic,” said Brendan Solaner, an addiction policy expert at Johns Hopkins Bloomberg School of Public Health. “That may include concerned family members.”

But those who will need Narcan the most may not be able to afford it, he added, saying that “this includes people who are unhoused or financially insecure and are at greatest risk of overdose.”

When Narcan was available only by prescription, public and private insurance readily covered it. But those plans typically restrict coverage of over-the-counter drugs.

Some state Medicaid programs have already announced that they will cover Narcan when it becomes available over the counter. Those states include Missouri, California, Massachusetts, Washington, Rhode Island and Oregon.

Emergent said that prices would be lower for bulk sales to public interest groups and state health departments, which will in turn distribute Narcan to local outreach organizations and clinics.

Retailers often put pricier products or those that are likely to be stolen behind a counter or in a locked case. But behavioral health experts say that customers may be reluctant to ask store workers for Narcan, fearing raised eyebrows and dismissive comments — marks of the pervasive stigma surrounding drug use and addiction.

Through a spokeswoman, Rite Aid said Narcan would be available at its pharmacy counter and in pain care aisles. Many stores, including CVS, will also have it by the front register. Rite Aid, Walgreens, Walmart and CVS also said that Narcan could be purchased next week through their online sites, offering greater privacy.

“Stigma will always be there, but I think there’s been a sea change in how the public perceives naloxone over the last decade, and many more people are willing to carry it,” Dr. Solaner said.

Although Narcan is the first overdose reversal medicine to be sold over the counter, the field is likely to be crowded soon with less expensive competitors.

A generic naloxone spray by Teva Pharmaceuticals is still available by prescription, which means that public and private insurance policies typically cover it. Pharmacists in most states rely on a “standing order” for the spray, which means they don’t need a physician’s prescription to dispense it. For a person with Medicaid or commercial insurance, generic naloxone could well be less than $10.

CVS is encouraging customers to ask for Narcan at the pharmacy counter “so our pharmacy teams can check a patient’s insurance plan for potential savings on prescription naloxone products,” a spokesman said.

Earlier this summer, the Food and Drug Administration gave over-the-counter approval to RiVive, a naloxone spray expected in early 2024. RiVive, manufactured by Harm Reduction Therapeutics, is intended as a low-cost product largely for outreach groups.

Other forms of naloxone, including some with higher concentrations and some that are loaded in syringes, are already available by prescription.

Trump’s ‘Lunatic’ Attack On Biden Gets Turned Right Back Against Him

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Donald Trump is getting the treatment on social media for an attack on President Joe Biden that his critics say sounds a lot like projection.

The former president has been posting videos of himself ranting against everyone from former President Jimmy Carter to special counsel Jack Smith.

But Trump has saved some of his deepest vitriol for Biden, this week accusing him of being both bribed and blackmailed, claiming he will start World War III, and vowing to make the entire Biden family “pay a price.”

“I think that crooked Joe Biden is not only dumb and incompetent, I believe he that has gone mad, a stark raving lunatic,” Trump said in another clip, in which he also called the president a “mental catastrophe.”

That rant was initially posted on Aug. 17, but took off on Tuesday when the ex-president shared it again on his Truth Social website, and then got passed around on X ― aka Twitter ― via attorney Ron Filipkowski:

Critics fired back:

Life at a Grand Slam: What You Don’t See on TV at the U.S. Open

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When Mackenzie McDonald dueled Félix Auger-Aliassime for three and a half hours in the opening round of the U.S. Open, fans were only seeing a glimpse of the time McDonald put in toward his surprise win on Monday.

For both players, and hundreds of others at the sprawling tournament, a match day extends well beyond a warm-up and the contest itself. The preparation, of course, takes weeks and months, with the grueling men’s and women’s professional tennis tours pushing players to seek higher rankings to gain a more favorable path at the Grand Slam tournaments.

And once they arrive in Queens, a new series of obstacles emerges as players adapt to the feel of the courts, the ambience of New York and the demands of one of the world’s biggest sporting events.

For McDonald, the 28-year-old American who broke into the top 50 of the singles rankings in 2022 and upset Rafael Nadal in the second round of this year’s Australian Open, the preparation for the U.S. Open began on Aug. 22 when he arrived in New York. McDonald, who is scheduled to play Borna Gojo of Croatia in the second round on Wednesday, said he trained hard for his first few days, then tapered a bit to recover before his four-set duel against Auger-Aliassime.

Those practices, along with the travel, can become repetitive. Jessica Pegula, the American ranked third in women’s singles, last week compared the routine on tour to “Groundhog Day,” the 1993 film in which a man relives one day again and again. McDonald echoed that sentiment.

“Things can get monotonous week after week, locker room after locker room, hotel after hotel,” McDonald said. “It’s good to have those small goals or little things that drive you that make you believe that you can get better.”

Two days before his opening match, McDonald couldn’t focus solely on his play. Before practicing on Saturday, he had to stop by a fan event put on by Wilson, his racket sponsor.

His day began at about 8:45 a.m. as he made his way down to the lobby of his hotel in Manhattan’s Murray Hill neighborhood. A driver and S.U.V. were already waiting for him, his girlfriend and his trainer as they walked out of the hotel.

On a normal day, the drive from the east side of Manhattan to Billie Jean King National Tennis Center in Flushing Meadows Corona Park can take up to an hour in heavy traffic.

“It’s never easy,” McDonald said of the commute to Queens. “Day after day, it definitely adds up.”

But on a Saturday morning, with little traffic and an assertive driver familiar with shortcuts, the ride was a brisk 21 minutes 16 seconds.

The quick ride afforded McDonald some extra time to drop off his bags before heading to the Wilson event, where he spent about half an hour volleying with children, then posed for pictures and videos.

With that commitment filled, McDonald could focus on more intense tennis for the rest of his day, starting by working with a physiotherapist and finding time to eat, and following that with two hours of practice.

McDonald’s first hour of practice was scheduled at noon against Marcos Giron, another American player, on Court 4 near Arthur Ashe Stadium. As McDonald and Giron hit back and forth and played out points, dozens of fans stopped by to watch them. As their practice drew to a close, several of those fans began to gather courtside in hopes of an autograph or a picture. But McDonald had no time.

After shaking hands with Giron and his trainer, McDonald quickly grabbed his bags, and scurried off for his next practice on a court on the opposite end of the tennis center, nearly half a mile away.

To avoid having players walk that distance through a sea of fans, the U.S. Open has vans that shuttle them and their trainers out to the farthest practice courts. McDonald and his trainer hopped in a van, but the driver wanted to stay a few more minutes to see if any other players would come.

Already behind schedule, McDonald politely asked the driver if they could leave without waiting. In the early rounds of the tournament, when hundreds of players need to practice, court time is precious.

“They definitely show the glamour of the sport on TV,” McDonald said. “It is all the behind the scenes, it is the day to day and the around-the-year tournaments that we play that really get us to these moments.”

By the time McDonald arrived to his next practice court, it was just after 2 p.m., and the sun was beaming down with temperatures in the 80s. He trained for another hour before finally cooling down and heading back to his hotel to rest.

On Sunday, McDonald wanted to scale back his workload to only an hour of tennis, so he could be fresher for his match the next day. He still did not know his exact playing time, but because it would likely be in the afternoon, McDonald said he hoped to have an afternoon court slot on Sunday.

He was scheduled for 4 p.m. against Lloyd Harris of South Africa on Court 5, where McDonald was scheduled to play the next day.

“Way more of a chiller day for me,” McDonald said, adding that the rest of his Sunday would be spent resting, hydrating and taking “my mind off of tennis for a bit.”

But even when he’s not training, McDonald said there’s other preparation that goes into playing a match, including creating a game plan and looking over analytics.

“The mental preparation for my match on Monday started once that draw came out,” he said.

Before McDonald’s match on Monday, there were three others scheduled on Court 5, starting at 11 a.m. Being scheduled later in the day often leaves players trying to figure out how long each of those matches will last so they can plan an ideal time to leave their hotel.

But trying to make those predictions can be a gamble when rain or a lengthy five-set men’s match can delay another match’s start time. At majors, McDonald said that he likes to arrive four hours before a match to be treated by a physiotherapist, hit with a partner for half an hour, have lunch and then prepare his sports drinks and rackets.

“There’s definitely a lot of little nuances that go in part of each day that you’re really submerged in,” he said. “Everything’s invested toward what’s going to prepare me best to play this match today.”

McDonald and Auger-Aliassime finally took Court 5 around 5:45 p.m., and after a quick warm-up, it was 5:51 p.m. when the umpire, Jaume Campistol, said: “Ready? Play.”

From the beginning, it looked like the match was going to be a long duel. It took an hour and nine minutes for McDonald to win the first set on a tiebreaker.

Auger-Aliassime took the second set, but after that McDonald settled in. As McDonald and Auger-Aliassime played on, cheers from Arthur Ashe Stadium overflowed out of the venue, and they could be heard on Court 5. At one point in the fourth set, Auger-Aliassime appeared to complain to the chair umpire about the noise coming from Ashe.

Eventually, after more than three hours on the court, McDonald prevailed, winning the last five points of the fourth set to win, 7-6 (5), 4-6, 6-1, 6-1, and advance to the second round.

Before his win, McDonald said that each incremental victory is what motivates him on tour. The drive to advance, he said, pushes him through long practices, commutes and extensive travel.

“I want to win a title so bad,” said McDonald, who has made one singles final in his career, losing to Jannik Sinner of Italy at the 2021 Citi Open in Washington, D.C. “I always find that each week, your opportunity each week, can be that week that can shift things, and I think that dream is what we’re all chasing.”

And after he beat Auger-Aliassime, the routine of mental and physical preparation began again for Round 2.

Biden Administration Unveils First Drugs for Medicare Price Negotiations

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The Biden administration on Tuesday unveiled a long-awaited list of the first 10 medicines that will be subject to price negotiations with Medicare, kicking off a landmark program to reduce drug spending that is being fought by the pharmaceutical industry in court.

The medications — which treat diabetes, cancer and other conditions — are taken by millions of older Americans and cost Medicare billions of dollars annually. The Centers for Medicare & Medicaid Services selected the drugs through a process that prioritized ones that account for the highest Medicare spending, have been on the market for years and do not yet face competition from rivals. Additional medications will be selected for price negotiations in the coming years.

1. Eliquis, for preventing strokes and blood clots, from Bristol Myers Squibb and Pfizer

2. Jardiance, for diabetes and heart failure, from Boehringer Ingelheim and Eli Lilly

3. Xarelto, for preventing strokes and blood clots, from Johnson & Johnson

4. Januvia, for diabetes, from Merck

5. Farxiga, for diabetes, heart failure and chronic kidney disease, from AstraZeneca

6. Entresto, for heart failure, from Novartis

7. Enbrel, for arthritis and other autoimmune conditions, from Amgen

8. Imbruvica, for blood cancers, from AbbVie and Johnson & Johnson

9. Stelara, for Crohn’s disease, from Johnson & Johnson

10. Fiasp and NovoLog insulin products, for diabetes, from Novo Nordisk

Ukraine Steps Up Evacuation Calls as Russia Attacks in Northeast

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Yevgeny V. Prigozhin, the Russian mercenary chief who died in a plane crash last week, has been buried in a private ceremony in St. Petersburg, his press service said on Tuesday, ending days of speculation over how he would be laid to rest.

The announcement on the Telegram messaging app came as a surprise. Hours earlier, the Kremlin said it had no information about Mr. Prigozhin’s funeral except that President Vladimir V. Putin would not attend.

Mr. Prigozhin’s funeral “took place in a private format,” his press service said. “Those wishing to say goodbye can visit the Porokhovskoye cemetery” in St. Petersburg.

On Tuesday afternoon, the Porokhovskoye cemetery was being heavily guarded by Russian police, riot police, and national guardsmen, who did not allow people to enter, suggesting the lengths the state has gone to to keep the public mourning for Mr. Prigozhin at a minimum.

Details about Mr. Prigozhin’s funeral, including the date and whether members of the public would be allowed to attend, were unclear for days. Rumors had swirled about ceremonies at other cemeteries, though Porokhovskoye had not been mentioned, and police had cordoned off some of them and set up metal detectors at the Serafimovsky Cemetery, where Mr. Putin’s parents are buried.

Police officers at Mr. Prigozhin’s grave.Credit…Nanna Heitmann for The New York Times

The secrecy reflected the sensitivities surrounding Mr. Prigozhin, a longtime ally of Mr. Putin who launched a failed mutiny against Moscow’s military leadership in June. He was killed along with nine others, including top leaders of his Wagner private military company, in the crash of a private jet northwest of Moscow last Wednesday.

Mr. Prigozhin had received the Hero of Russia designation, one of the Russian military’s top honors, which generally accords special burials, including an honor guard and a military band.

The confusion was in line with the murky details about the crash. Its cause remains unclear, but U.S. and Western officials believe it was prompted by an explosion on board. Many Western officials have said they think it is likely that Mr. Putin may have played a role in having Mr. Prigozhin killed as retribution for the mercenary chief’s short-lived mutiny in June.

After the crash, Russian authorities released the plane’s flight manifest, showing the names of the 10 people who were supposed to be on board, and said that all aboard had been killed. That left room for days of speculation about whether Mr. Prigozhin was really on the plane.

The deaths were not officially confirmed until Sunday, when Russian investigators said that genetic testing showed that the victims of the crash matched the names on the manifest.

Video

People paid tribute to Yevgeny V. Prigozhin, the Russian mercenary chief, and Dmitri Utkin, a longtime lieutenant.CreditCredit…Nanna Heitmann for The New York Times

Wagner’s logistics chief, Valery Chekalov, who was also on the plane, was buried Tuesday morning in Northern Cemetery in St. Petersburg, in a ceremony that was not publicized in advance. Several hundred people came to pay their respects.

Some analysts speculated that the Russian authorities were seeking to avoid a public outpouring of support for Mr. Prigozhin and his top lieutenants.

“It seems that the authorities, as expected, want to avoid a spontaneous rally in memory of the top leadership of Wagner and to do so, have imposed a fog around the burial place,” Farida Rustamova, an independent journalist, wrote on the Telegram messaging app.

Valeriya Safronova, Nanna Heitmann and Jesus Jiménez contributed reporting.

— Valerie Hopkins reporting from St. Petersburg, Russia

U.K. Flights to Be Disrupted for Days After Air Traffic Control Glitch

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Flights in and out of Britain will be disrupted for days, the U.K. government said on Tuesday, after a technical issue with the country’s air traffic control system left thousands of passengers stranded abroad or facing severe delays.

Around 280 flights were canceled on Tuesday, about 5 percent of the total scheduled to leave or arrive in Britain, according to Cirium, an aviation analytics company, compounding travel woes for British holidaymakers after more than a thousand flights were canceled the day before.

The trouble came at a particularly busy time for travelers in Britain, many of whom were returning home from summer vacation or long weekends because Monday was a public holiday in the country.

“The timing was not at all helpful for people,” Mark Harper, the government minister responsible for transport policy, told the BBC on Tuesday morning. “It’s disrupted thousands of people. Lots of flights were canceled yesterday because of the imperative to keep the system working safely, and it is going to take some days to get completely everybody back to where they should be.”

He added that the government’s technical experts had concluded that the episode was not a cyberattack.

Britain’s National Air Traffic Service, which runs air traffic control, said on Monday that a failure of the automatic system that processes plane routes meant that, for several hours, flight plans had to be entered manually.

When air traffic control issues arise, the priority is to safely land planes that are already in the air, experts said, forcing hundreds of flights to be temporarily grounded or canceled. They added that the delays continued on Tuesday in part because aircraft and crews were out of position.

Juliet Kennedy, the operations director of the air traffic service, apologized in a video on Monday night, and added that “it will take some time for flights to return to normal.” She said the company would thoroughly investigate what had caused the glitch.

In a statement issued late Tuesday, the agency said its initial investigation found the problem related to “some of the flight data we received.” It said its findings would be made public.

Passengers have been urged to check the status of their flight with their airline before traveling to the airport.

How the War in Ukraine Turned Tennis Into a Battlefield

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Before becoming a soldier, Stakhovsky was a pro tennis player, and a very successful one: He was ranked as high as 31 in the world and had more than $5 million in career winnings. He is best remembered for beating Roger Federer at Wimbledon in 2013. I was there and watched slack-jawed as Stakhovsky, playing serve-and-volley tennis, a style that had become virtually obsolete, took out the then-seven-time champion on Centre Court. In the news conference that followed, the Ukrainian joked, “I can definitely tell my grandchildren that, yeah, I kicked the butt of Roger Federer.” He lost his next match, but the win over Federer ensured him a permanent place in tennis trivia. That he is now a combatant in war is hard to believe, and as I walked around Wimbledon this year, I found myself thinking about Stakhovsky and his journey from tennis whites to military fatigues.

In early August, while he was off-duty in Kyiv, I spoke with Stakhovsky by video. He told me that he was vacationing in Dubai with his family when the war started. The city was hosting a men’s tournament that week, and he said he was with two Russian players, Rublev and Karen Khachanov, the night before. Stakhovsky had just retired from tennis and was residing in Budapest; he had not lived in Ukraine since he was 12. But with his country under attack, he felt obliged to join the war effort. He left Dubai and arrived in Kyiv on Feb. 28, four days after the Russians invaded. “I did not have any other option,” he said. “I could not imagine sitting outside of Ukraine and screaming for other people to help Ukraine.”

He said he was friends with a number of Russians when he was on the tour and had heard from a few of them. Mikhail Youzhny, a former Top 10 player, texted him periodically. “Sometimes I reply, sometimes I don’t,” Stakhovsky said. He told me that at the French Open last year, where he was trying to raise money for Ukraine, he ran into Khachanov in a hallway, and the Russian simply brushed past him. He mentioned a comment that Medvedev made at Wimbledon this year, about being in favor of peace. “Everybody is in favor of peace,” Stakhovsky said. “I’ve been in Bucha; I’ve seen the bodies. For us, unfortunately, peace is something that we will have to earn with blood.” He recalled that Medvedev’s parents had once approached him about coaching their son early in his pro career. (Medvedev did not reply to a request for comment, and Khachanov declined to comment.)

Near the end of our conversation, we talked about the match against Federer, and I asked if he had been in touch with the Swiss star. Stakhovsky, who is 37, said that he had, and he began scrolling through his phone. He saw that Federer had reached out twice in March 2022, to check in on him and to express his sorrow over the situation. I brought up the comment that Stakhovsky had made about his grandchildren and kicking Federer’s butt. He laughed ruefully. “Now I just hope that I will get to see my grandkids,” he said.

Alexandr Dolgopolov, too, is in uniform for Ukraine. He played professionally for more than a decade and attained a career-high ranking of 13 before retiring in 2021. These days, he is a drone operator close to the front lines. He spoke to me from his apartment in Kyiv, where he was recuperating from a concussion he suffered when a shell landed near his trench. He was resigned to the danger he faces in combat. “They try to destroy us, we try to destroy them, that’s how it works,” he said with a shrug. He was wearing a Diadora T-shirt, a reminder of his past; Diadora is the Italian sportswear company that sponsored him.

‘The Mountain Will Make Cowards Out of All of Us’

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Nate Boyer looked up as he began his ascent of Hope Pass about 40 miles into the Leadville Trail 100-mile race. The four-mile section rose 3,200 feet in elevation, taking runners to 12,600 feet above sea level. He would have to conquer the steep grade, run seven miles down the other side to a turnaround and repeat the process. The sun beat down as he maneuvered the trail, devoid of any shade.

“It’s ironic it’s called Hope Pass, because that’s the most hopeless feeling,” Boyer, 42, said after the race. “Like you are pushing the hardest you can to take the next step — and you’re not gaining ground.”

At mile 47, Boyer accidentally jammed his left foot under a rock. His shin swelled, and his leg throbbed. Fifty-three miles to go, he told himself. Keep moving.

Life in football had involved an entirely different kind of pain.

David Vobora, 37, started throwing up when he began the Hope Pass climb. He alternated between walking and jogging as he vomited. A runner in her 50s stopped and rubbed his back as he hunched over again.

At one point, Boyer and Vobora met on the trail. They hugged and offered words of encouragement. The two have been friends for years — and their experience with difficult physical challenges set them apart from most of the other runners.

Vobora was the last pick in the 2008 N.F.L. draft, earning the annual title “Mr. Irrelevant.” He worked his way up to starting linebacker for the Rams and then the Seahawks during a four-year career.

Boyer, a former U.S. Army Green Beret who went on to play football at the University of Texas, was an undrafted free agent who played long snapper in preseason games for Seattle in 2015.

Now, both men were trying to become the first former N.F.L. team members to finish the punishing 100-mile race before the 30-hour cutoff.

“Just being up against that distance, that elevation, that length of time — the mountain will make cowards out of all of us,” Vobora said. “It feels more spiritual than you versus an opponent. It’s you versus who will show up internally.”

After Vobora’s N.F.L. career, he founded the Adaptive Training Foundation in Dallas, which provides free training and community to wounded, ill and injured military veterans and civilians. He became interested in running Leadville after pacing a friend for 18 miles in 2021.

Vobora had started running during the pandemic. He ran 10 miles one day and felt surprisingly fine afterward. In April 2021, he completed a marathon, running loops around a pond, and then tried 100 miles in 24 hours, finishing with nine minutes to spare.

“I was a total mess afterward,” Vobora said. “Laying on the ground. I couldn’t eat. I was peeing blood.”

But he said he had also thought, “How far could I take this?”

To prepare for Leadville, Vobora started an intense training schedule. He stopped drinking alcohol and ate only meat and fruit, dropping from 255 to 205 pounds to adopt a more runner-like build.

“Before Leadville, it was about taking on the task and having the buckle,” he said, referring to the belt buckle runners receive for finishing. “Now it was, ‘You’re going to do this because you said you would.’ The stakes were so high, and it took 100 percent of me to train, maybe for the first time since football. That was something I had missed.”

Boyer is a filmmaker and a co-founder of Merging Vets and Players, a nonprofit organization that helps combat veterans and former professional athletes make transitions to new lives. He also hosts the Discovery Channel show “Survive the Raft,” in which contestants work together on a raft to complete challenges.

In 2022, Boyer ran the Austin Marathon and, five weeks later, a 50K. After the latter race, he said, he didn’t feel the bone and joint soreness he had experienced after the marathon.

“I thought, ‘That’s interesting,’” Boyer said. “‘Maybe I’m more made for this distance?’”

So Leadville it was.

“I don’t know if it’s about running at all,” Boyer said. “It’s the challenge of seeing what your body is capable of. A lot comes from a very deep-seated insecurity, most likely — feeling like you need to do something incredible with your life..”

The Leadville 100, which begins and ends in Leadville, Colo., started at 4 a.m. on Aug. 19. Runners traverse the Rockies in what organizers describe as a “true elevation roller coaster.” High-altitude sections, trails and paved roads, and technical sections of the Colorado Trail combine for over 15,000 feet of net elevation gain.

Seven hundred runners ranging in age from 18 to 72 started the race. Only 365 finished within the time limit.

Six and a half hours after the start, Boyer entered Twin Lakes, the aid station at Mile 37.9. His three-person crew laid out gummy worms, bars and gels for energy, pretzels and other snacks. Boyer sat in a folding chair and changed his socks and shoes. He drank coconut water and ate blueberries and a banana.

“My legs are killing me,” Boyer said. “My back hurts. And I’m dehydrated.” He paused and smiled. “Otherwise, life is great.”

A couple of hours later, Vobora jogged into Twin Lakes. His eight-person crew had set up a tent near the aid station entrance.

His tone was all business. “The things that hurt the worst are my knees,” Vobora said, who also said he was cramping.

His wife, Sarah, unpacked and repacked his bag. “Pack the big gloves,” Vobora said. “My hands went fully numb this morning.” Temperatures seesawed from the low 40s at the start to the high 70s midday and back into the 40s that night.

“I feel like I should be further than 38 miles,” Vobora said, chuckling, as he started jogging away. “My energy is good. My stomach has been all over the place. I’m trying to force-feed myself so I can have all the energy for the climb back up Hope Pass the second time. My main thing is the clock. The time stamp getting back over to Twin Lakes before 10 p.m. That’s the cutoff, right?”

Vobora had arrived in Leadville two weeks before the race to acclimate to the elevation. He had a detailed 28-hour race plan: go fast on the downhills, aggressively hike the ascents. Remain steady on the flats. While football is a team sport in which everyone must work together, for Leadville, Vobora would be running alongside people with their own individual goals and motivations. He liked that distinctive challenge.

“Of the hundreds of miles leading up to this race, I’ve probably felt good in about 10 percent,” Vobora said before the race. “Maybe 20 if I’m being liberal. The rest have just been work.”

After almost 17 hours on the course, Vobora trudged back into Twin Lakes. On Hope Pass, he hadn’t stopped vomiting for three hours. He had experienced intense cramping. A medical official had recommended that he drop out, and he relented.

As he rode the shuttle down the mountain, he leaned his head against the window and bawled.

“Damn it, man,” he said, his voice catching. He started talking about his strategy for next time: He would put someone at every aid station. “They’ll have a bag and say, ‘Here,’ and I’ll keep running. I know I can run this thing.”

Vobora walked to the tent where his crew waited. He and his best friend, Mo Brossette, also a member of his support team, tried to determine what had happened: too many salt tablets? Too much food?

“I’m so mad right now, dude — and I’m so sorry, you guys,” Vobora said to his crew.

The next day, Vobora reflected in a text message: “More and more grateful each moment that I did not complete it. Because the questions I am asking and the places I am exploring … I couldn’t be here without it.”

Boyer had arrived in Colorado the day before the race, staying in a hotel 40 minutes away from the starting point. As darkness fell and the temperatures dropped, he tried not to overthink the miles he had left. “Focus on what you can do in these next few steps,” Boyer had said before the race. “The mountain won’t look like it’s getting any closer if you keep looking at it.”

Vobora said the physical challenge of an ultramarathon was entirely different from the pain of playing football, which he said involved “short bursts that are very aggressive, warring, violent actions.”

He continued: “Ultramarathoning is the complete opposite side of the coin. It involves patience. It involves the state of sort of equanimity to approach difficulty and pain.”

Chris Long, an 11-year N.F.L. veteran who now has a foundation dedicated to providing education and clean water around the world, is a friend of both Vobora and Boyer; both have worked with him on foundation projects.

He said their experience in football had prepared them well for the challenge of Leadville.

“Playing in the N.F.L. teaches you how to turn your brain off, put your head down and work,” Long wrote in an email. “You get good at going to your ‘happy place’ and distracting your mind from the challenge itself.”

After more than 24 hours on the course, Boyer crested the second-to-last hill. Stars were scattered across the sky as he ran, headlamp on, toward the finish line a block south of Leadville’s main street. Small pockets of spectators cheered as he jogged the final ascent.

“Let’s go, Nate — what a finish!” Mitch Moyer, his crew chief, yelled as he ran alongside Boyer.

Boyer finished in 24 hours 31 minutes 7 seconds. The announcer called his name out to the nearly empty stands. Boyer was the 57th male finisher and the 63rd finisher overall. He embraced Merilee Maupin and Ken Chlouber, the race’s co-founders.

“Do you want anything?” Moyer asked.

“Is there any beer?” Boyer asked, smiling. Moyer handed him a nonalcoholic beer. “That’s actually better,” Boyer said. His walk turned to a hobble, and he began to shiver.

Racers who finish in under 25 hours receive a bigger buckle than other finishers get. As Boyer walked to retrieve his, the pain started to set in.

“Is running fun for me?” he said, laughing. “No. It’s not. It’s therapeutic — but therapy is not always fun. There’s nothing better than finishing a run, no matter what the distance. The worst part is starting it, and the best part is finishing it. Everything in between is up and down.”

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