North Korea admitted the inevitable this week — that covid-19 had finally reached its population. But for global health experts, there’s a particularly worrying detail: It is one of just two countries without any vaccines.
North Korea and Eritrea — both poor and led by brutal governments — have refused to join global vaccine-sharing initiatives, leaving their populations vulnerable to fast-spreading variants of the virus.
In Pyongyang, authorities Thursday attributed the outbreak to the highly contagious BA.2 omicron subvariant. On Friday, state media reported that one person had died and some 350,000 people had shown symptoms of fever.
Many health experts were already skeptical that North Korea had yet to report a single coronavirus case — more than two years into the pandemic. For its part, Eritrea has admitted about 10,000 confirmed coronavirus cases and 103 deaths, figures that are far lower than those of its neighbors.
“North Korea, with a huge immunity gap — no protection acquired with vaccines or prior infections — is an open field for uncontrolled transmission, which maximizes the odds of new variants,” said J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies.
John P. Moore, professor of microbiology and immunology at Cornell University’s Weill Cornell Medicine, said in an email that unless North Korea was able to limit transmission through a lockdown, “a very high percentage of the population” would soon be infected.
“The carnage could be awful,” he said. “To the extent that it might affect the regime’s hold over the population.”
In both countries, rumors have swirled that the political elites are already vaccinated — and that their dismissal of foreign-made vaccines is just for show.
Eritrea, under longtime president and strongman Isaias Afwerki, has ignored requests by other African nations to join Covax, the global vaccination effort backed by the World Health Organization. Some activists say the country is rife with propaganda that paints Covax as a Western tool to destroy Africa.
In December, the head of the African Centers for Disease Control, John Nkengasong, said Eritrea was the only member of the African Union that had not “joined the family of 55 member states that are moving forward with vaccination, but we are not giving up.”
In North Korea, the government rejected doses of the AstraZeneca vaccine out of apparent concerns about potential side effects. It also turned down the delivery of nearly 3 million doses of China’s Sinovac vaccine, saying the shipments should go to other countries suffering more severe outbreaks.
Last month, a panel of experts convened by the Center for Strategic and International Studies recommended that North Korea be offered a high-volume donation of mRNA vaccines. But the vaccines previously allocated for North Korea under the Covax plan are no longer available.
Morrison said Covax and other donors had “grown weary” of North Korea’s nonresponsive nature during the pandemic. “That does not rule out revisiting the issues of what to do on a crash basis,” he added.
A spokesperson for Gavi, a nonprofit that helps coordinate Covax, said the initiative had “currently not committed any volume for” North Korea. But, the spokesperson said, if Pyongyang moves forward with a national vaccination program, Gavi could work with Covax to help North Korea catch up with immunization targets.
Pyongyang might not have a choice. Even in partially vaccinated places such as China or Hong Kong, omicron subvariants have spread incredibly fast among pockets of unvaccinated people — with deadly consequences similar in scale to the first wave of cases in other parts of the world.
China, North Korea’s most important ally, is battling a BA.2 outbreak and has imposed a severe lockdown on its commercial hub, Shanghai.
“China is itself struggling with the spread of the omicron variant, so I am not sure whether it has strong incentives to help North Korea battle covid,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.
A model released as a preprint this week estimated that if China relaxed what it calls its “zero covid” policy, the virus could kill up to 1.5 million people.
In North Korea, it would be “far worse,” Moore said, “because of the minimal vaccine uptake there.”
Michelle Lee contributed to this report.