What should the response be to North Korea’s COVID-19 outbreak?

Dong Jin Kim discusses the challenges facing health officials looking to contain the country’s recent rise in cases

An official wearing a gas mask and a full body protective suit checks a woman’s temperature as she leaves a bus.
A ‘hygienic and anti-epidemic official’ checks the body heat of a traveller aboard a bus as part of preventative measures against COVID–19, at a roadblock at the entrance to Wonsan, Kangwon Province, North Korea on 20 October 2020. Photo taken by Kim Won Jin Via Getty Images.

While the true extent of North Korea’s ongoing COVID–19 outbreak remains unclear, the need for an effective international response that can overcome existing political impasses remains urgent. Drawing on his research on global health diplomacy and North Korea, Dong Jin Kim outlines the key features of the current crisis, the obstacles policy-makers face and potential ways forward designed to overcome the divide between global health and geopolitical approaches.

How severe is North Korea’s recent COVID–19 outbreak?

It is difficult to know the exact severity of North Korea’s recent COVID–19 outbreak. State media has reported limited information that we have as an international community:

● The first case was reported last Thursday 12th of May 2022

● There have been 2,646,730 cases of ‘fever’

● 579,390 people are under medical treatment and there have been 67 deaths

Although there is a consensus among North Korea watchers and medical experts that it is a very serious situation which could lead to a significant health crisis, many question the validity of this data for a few reasons. First, it is not clear that this is truly the first COVID–19 outbreak in North Korea, and some speculate a hidden motive in reporting this so close to the Biden administration’s visit to South Korea’s new Yoon administration. Second, the use of ‘fever’ rather than validated definitions of probable and confirmed cases likely both misses asymptomatic cases and counts non–COVID cases. Third, the very low case fatality rate based on 67 deaths (less than a fraction of a per cent) seems inconsistent with the omicron variant of COVID-19’s fatality rate in other countries with near-zero vaccination rates.

Though we could extrapolate from WHO data of similarly isolated and unvaccinated countries’ initial omicron outbreaks (e.g. Tonga), too many factors such as differences in urban/rural population and economic policies would confound such extrapolations. Ultimately, we have to operate with the limited available information.

What are the major obstacles preventing an effective response?

The major obstacles preventing an effective response span from geopolitics to public health infrastructure. The withdrawal of nearly all international humanitarian aid organizations and associated banking channels from North Korea by March 2021 has undercut the possibility of efficient and timely aid. Moreover, North Korea’s pre-existing mistrust of traditional donor–recipient relationships is now compounded by a new South Korean administration that campaigned on a harsher stance towards its northern neighbour.

Although major cities in North Korea such as Pyongyang have sufficient healthcare infrastructure, most of the country lacks the basic services needed to implement an effective pandemic public health response. North Korea also lacks access to essential components of pandemic surveillance and response, including COVID–19 testing, vaccinations and treatments.

Finally, an already vulnerable population may be more susceptible to severe morbidity and mortality. North Korea is suffering from its worst food crisis in decades due to flooding in 2021 and the World Food Programme estimates that 11 million of North Korea’s 25 million population is undernourished.

An effective response must consider and overcome each of these obstacles.

What concrete steps should international policy-makers take to address the current crisis?

International policy-makers must navigate delicately towards a path that balances effective aid with the complexities of the geopolitical situation in North Korea.

First, we must the consider optics of who provides COVID–19 assistance matters to North Korea. For instance, South Korea’s offer to provide unlimited testing and vaccination aid and US commitments to COVAX must be carefully redirected through more ‘neutral’ parties, such as the United Nations. We have seen North Korea decline assistance multiple times throughout the pandemic. Second, the international community should strategically reconsider sanctions on North Korea, which have skyrocketed in recent years, especially those that would impair the opening of humanitarian and banking corridors. Third, we need a model of global health diplomacy that empowers and includes North Korea at the table rather than one that belittles and alienates its leadership. North Korea could be invited to take on their own global responsibility, to accept international COVID–19 support to not only protect themselves but also protect others, which would help North Korea gain legitimacy as a member of the international community.

What long-term lessons can practitioners of global health diplomacy take from the present situation?

Practitioners of global health diplomacy, working in the context of a protracted conflict, need to understand that they are operating on a basis of decades of mistrust. If the preventable scale of this outbreak teaches us anything, it should serve as a lesson on the severe limitations of traditional donor–recipient relationships, the spillover and collateral damage of sanctions, and the deep interconnections between aid and international relations. This outbreak, albeit tragic in its likely death toll, also provides an opportunity to redefine how the international community engages North Korea as a diplomatic partner in global health.

As a sovereign state, the North Korea’s foremost responsibility is the protection of its citizens. However, the international community also needs to engage with North Korea to assist its vulnerable population from the perspective of global justice and ensuring equal access to vaccines. Indeed, this transnational cooperation is in the enlightened self-interest of the donor countries to address the global pandemic more effectively and efficiently while also preventing a recurrence of new variants of COVID–19.

Dong Jin Kim is Irish School of Ecumenics Senior Research Fellow in Peace and Reconciliation Studies at Trinity College Dublin.

His article, ‘Global health diplomacy and North Korea in the COVID-19 era’ written with Andrew Ikhyun Kim was published in the May 2022 issue of International Affairs.

This blogpost was commissioned by Joseph Hills, Digital Content Editor at International Affairs.

All views expressed are individual not institutional.

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