The doctrine of juche, or autonomy, served as a guiding principle for the ruling Kim Dynasty in North Korea for more than seven decades, as it kept its people isolated from the outside world.
But Kim Jong Un must decide whether or not to accept offers of international assistance to overcome the unprecedented health threat posed by the coronavirus. The choice of the 37-year-old dictator will have consequences for the international community’s struggle to end the global pandemic, with fears that Mr. Kim security concerns could hamper efforts to immunize the 25 million people under his rule.
“The nuclear and missile developments over the past two years have demonstrated how willing they are to sacrifice the well-being and prosperity of their own people for their own safety,” said Peter Ward, an expert on North Korea based in Seoul at the University of Vienna.
North Korea has expressed interest in participating in the Covax program, which seeks to ensure equitable access to vaccines around the world, according to people familiar with the matter.
International medical experts who have worked in North Korea see this as a positive sign that Pyongyang might be willing to accept help from Gavi, the UN-backed vaccine alliance that has nearly 20 years of experience in the country. The organization is leading the Covax initiative alongside the World Health Organization and the Coalition for Epidemic Preparedness Innovations.
A crucial question rests on level of foreign aid necessary to facilitate an inoculation program.
International staff are expected to enter North Korea to conduct initial assessments and support the logistical challenges of distributing the vaccine in one of the poorest and least developed countries in the world. They would also be required to train local staff and then, according to Gavi rules, monitor the vaccination program.
North Korea instituted a scan lock cross-border and internal movements in January. While she has not publicly confirmed any cases of the coronavirus, the measures also led most foreigners previously based in the country – including diplomats and aid workers – to leave.
Ramon Pacheco Pardo, an expert on North Korea at King’s College London, said “surveillance could be a problem” given the few foreigners in the country, despite Pyongyang’s long-standing working relationship with WHO, Gavi and other NGOs.
“If North Korea is unwilling to allow WHO or Gavi to monitor vaccine distribution, it would probably be at the end of the queue since every country in the world also wants to receive the vaccine. vaccine, ”he said.
Kee Park, a Harvard Medical School professor who worked in North Korea, was convinced Pyongyang could institute a conservative quarantine period with additional testing. This would mean that international aid workers would be able to enter the country “in a way that does not present significant risk to the population”.
“I think they can find a way to partially reopen, to at least allow the vaccination project to continue,” he said.
North Korea’s health system is relatively well prepared to support vaccine storage and distribution despite underfunding and insufficient resources in many other areas, analysts said.
This is a legacy of smaller-scale international efforts to combat diseases such as tuberculosis and hepatitis, as well as infant immunization programs.
Nagi Shafik, a former director of the WHO office in Pyongyang, said North Korea could handle the Oxford / AstraZeneca vaccine, which can be stored between 2 ° C and 8 ° C.
“The cold chain storage system has been in operation for a long time. . . I can tell you with confidence that they have a high coverage rate and keep it, ”said Mr. Shafik, who last worked in Pyongyang in mid-2019 and noted that data from Gavi backed up his claims.
But the extra cold temperatures needed to store Moderna and BioNTech / Pfizer vaccines would not be suitable.
Harvard’s Dr Park added that risk-averse North Korean health officials are unlikely to trust vaccines produced in Russia or China until there is more transparency about the jab success rates.
Border closures have challenged trade between North Korea and China, straining the cash-strapped economy and slowing deliveries of medical equipment and resources. the economic crisis pressured Mr. Kim to take action.
But one recurrence cases in neighboring Chinese provinces of Liaoning and Jilin renewed the risk of relaxing North Korea’s entry restrictions. Tens of millions of people have been locked up in China in recent weeks and mass tests have been imposed to eradicate the infections. Highlighting the speed at which the virus can spread, Jilin officials said more than 100 cases have been linked to a traveling salesperson.
The North Korean leader’s plight came as rich countries grapple with scathing criticism for not helping the poorest countries to access Covid-19 vaccines.
Health experts also called for the easing of sanctions against Pyongyang, imposed in response to its nuclear weapons program. They say the measurements threaten to slow vaccine deployment, and that the fears concerning the hoarding of drugs for the benefit of the military or elites close to the Kim regime are exaggerated.
“We have to separate the political question from the scientific question; science says no one will be immunized until everyone is immunized. . . it is a human thing, we cannot punish people, ”said Mr. Shafik.