“The presumptive vice president is a good fit.
By Claire Lee
North Korea confirmed its first COVID-19 death on Friday, saying fever was spreading “explosively” nationwide and tens of thousands of people were being isolated after falling sick.
But with one of the most poorly equipped health services in the world and an entirely unvaccinated population, experts say the country will struggle to manage a major outbreak.
Here’s what we know:
North Korea’s is officially one of the worst healthcare systems in the world, ranked 193 out of 195 countries in a 2021 Johns Hopkins University survey.
According to the authorities, healthcare is free for all but rights groups say North Koreans have long had to pay for essential medical services— usually in cigarettes or alcohol.
“Refugees consistently describe chronically under-resourced hospitals,” Sokeel Park of Liberty in North Korea said.
Patients’ families have to buy medicine and other supplies through the black market, he said, and doctors are forced to make a living with off-the-books treatments.
“Doctors’ income is certainly not low by the North Korean standards, but even with that, it is difficult to buy a kilogram of rice,” researcher Choi Jung-hun told AFP.
Intensive care units and sophisticated diagnostic kits are “extremely scarce” and only available in Pyongyang, said Choi, a defector who worked as a doctor in the North.
There are no ICU-equipped hospitals in rural areas or smaller towns, where the majority of the country’s 25 million people live.
Are people healthy?
North Korea has long struggled to feed itself and state media said last year the country was facing a “food crisis”, with a UN expert warning vulnerable populations risked starvation.
“Most North Koreans are chronically malnourished,” said Lina Yoon, a senior researcher at Human Rights Watch.
After two years under a Covid blockade that has sealed the borders, “there are barely any medicines left”, she added.
Very little is known about the health of the population but the World Health Organization said in 2018 that non-communicable diseases like diabetes account for 84 percent of deaths in North Korea.
Such pre-existing conditions are a major risk factor in COVID-19 survival.
Defector turned researcher Ahn Chan-il said poor health, especially widespread malnutrition, made North Korea uniquely vulnerable to COVID-19.
Did they prepare?
North Korea closed the borders two years ago, shutting down trade, suspending inbound flights and reportedly issuing shoot-to-kill orders for anyone illegally crossing from China.
Pyongyang claims its draconian policies kept the virus at bay—but it did not use the time to conduct a vaccination drive.
The impoverished country rejected an offer for three million doses of a Chinese Covid-19 vaccine last year, suggesting they should be given to “countries in greater need”.
It also turned down the AstraZeneca vaccine through the WHO’s Covax scheme, apparently due to concerns over side-effects, a South Korean think tank said.
The WHO says North Korea and Eritrea are the only countries in the world not to have begun COVID-19 vaccination campaigns.
Are they equipped?
State media said this week that North Korea had used “strict gene arrangement analysis” to diagnose Covid patients, but experts say the country has extremely limited testing capacity.
Researchers have said it also lacks quarantine facilities with negative air pressure systems, and cold-storage systems needed to distribute mRNA vaccines.
North Korea’s broken health system would likely struggle to help anyone suffering vaccine side-effects—which may be why they rejected vaccine donations, experts said.
Malnutrition is believed to affect the quality of an individual’s immune response to vaccination—meaning the country might need major food aid, not just medicine, for a successful inoculation campaign.
Can the world help?
China, South Korea and the WHO all immediately offered support, with Seoul’s new government ready to send vaccines.
But the regime of Kim Jong Un, which test-fired three banned ballistic missiles hours after announcing the first COVID cases, does not appear to want international aid.
They soon may have no choice, however, experts said.
State media said “fever” was first detected in late April and by May 12 North Korea was recording 18,000 new cases a day—indicating a massive outbreak.
By announcing the details publicly in English-language media, the regime is “telegraphing needs”, said Yang Moo-jin, a professor at the University of North Korean Studies.
It sends an “indirect message that the North may request vaccine aid from the United States or international organisations in the future”, Yang told AFP.