Why the international community should move to mass vaccinate North Korea — now

With COVID-19 infections raging in South Korea to levels unthinkable just several months ago, and COVID control and quarantine policies buckling there as well as in COVID-zero regimes such as Hong Kong, the importance of vaccination to mitigate morbidity and mortality risks remains as important as ever. Moreover, the necessity to eliminate potential reservoirs and check the chances of an even more lethal variant of the virus from emerging in under-vaccinated populations is also critical. The U.S., global vaccine institutions, especially South Korea and its new president Yoon Suk-yeol, elected last week, should think big and offer on a humanitarian basis to vaccinate the roughly 25 million population of North Korea — which is totally unvaccinated. 

After COVID-19 emerged in January 2020, North Korea sealed itself off from the outside world. The already secretive country closed its borders, cut off most trade links with foreign states, restricted domestic travel, and locked down its population. North Korean leader Kim Jong Un recognized that his COVID-zero pandemic policy would be painful, admitting that North Koreans should brace for the “worst ever” outcome — invoking the country’s devastating 1990s famine. Sadly, he was not far off. Although it recently reopened rail links with China, trade continues to move slowly, hunger in North Korea remains widespread, and only a trickle of shipments of humanitarian, COVID-related supplies will soon resume.

But with highly effective vaccines in ample supply globally — Africa’s Centres for Disease Control and Prevention is turning away vaccine donations — Pyongyang continues to shun offers from international organizations and governments to provide vaccines. The country’s vaccine-zero policy only reinforces the need for its COVID-zero policy, which likely will eventually falter, as it has in Hong Kong and as a spike in cases in China have forced the authorities to relax somewhat their draconian lockdowns. 

Despite this hardship, Pyongyang repeatedly has refused nearly all forms of external assistance — including vaccine aid. In September 2021, for example, Pyongyang took the unusual step of refusing 3 million doses of China’s Sinovac vaccine, distributed via the COVAX initiative. The North’s rejection of external help has gone so far that COVAX actually cut the number of doses allocated to Pyongyang from 8 million to 1.54 million. Previously rationed shots are “no longer relevant” given existing policies, explained a spokesperson for Gavi, the charity that runs COVAX.

If it so chooses, North Korea certainly has the demonstrated organizational capacity to pull this off. DPT3 childhood vaccine coverage bounced back to greater than 90 percent following the disruption caused by the collapse of the Soviet Union in 1991. The country’s nationwide campaign against measles in 2007 demonstrates how “quickly and efficiently” the country could vaccinate its population against COVID, in the words of three medical experts with first-hand experience in North Korea. And a panel of experts recently postulated that cold-chain technical obstacles are not an insurmountable hurdle for distribution — even for the highly effective  mRNA vaccines produced by Moderna and Pfizer-BioNTech, which North Korea most likely would demand. 

Would a mass vaccination program be affordable for donors? The Organisation for Economic Co-operation and Development (OECD) estimated late in 2021 that a global campaign to vaccinate the world would cost $50 billion. Scaling to North Korea’s small population, the cost of such a program would be in the ballpark of $600 million for mRNA vaccines, according to an international health expert (between 1995 and 2018, the South Korean government provided about $2.2 billion in humanitarian assistance to North Korea).  

North Korea’s recent expansion of its missile tests, and its failure to join the international community to condemn Russia’s invasion of Ukraine, should not stand in the way of vaccinating the North Korean population. Trust-building steps, either taken or proposed, have not and most likely will not deter the North Korean leadership under the prevailing geopolitical conditions from modifying the country’s behavior. Such concerns should be set aside as the urgency to effectively control this global pandemic offers the best rationale for offering sweeping vaccine aid to North Korea. 

South Korea’s new president could take the lead in this cause, not as a wedge to restart the North-South dialogue, but out of self-interest for the citizens of South Korea — and a sense of humanity for the Korean people in the North.   

Thomas J. Byrne is president and CEO of The Korea Society in New York City. He is an adjunct professor at Columbia University’s School of International and Public Affairs in New York and Georgetown University’s Graduate School of Foreign Service in Washington.