North Korea's vaccine problem

By John Burton

North Korea surprised the world last week when it said that it was rejecting an offer by COVAX, the U.N.-supported global vaccine distribution program, to provide around 3 million doses of China's Sinovac COVID-19 vaccine.

The decision by Pyongyang was puzzling since North Korea has been in severe lockdown for around 20 months, which has done immense damage to its economy. The supply of vaccines offered the hope that the country might be able to reopen its borders to humanitarian aid and ease the economic pressure when it is also suffering from international sanctions, natural disasters and worsening food shortages.

So what is going on?

One explanation is that the rejection bolsters North Korea's repeated claims in the face of global skepticism that it has suffered no COVID-19 cases, while justifying its "Juche" policy of self-reliance. It also provides an opportunity to score propaganda points against the U.S., which has been criticized for not doing enough in providing vaccines to poor countries. Pyongyang said it was declining the COVAX offer so that the vaccine would be available to "severely affected" nations when there is a global shortage amid a surge in virus cases.

But North Korea has also been very picky about what vaccines it would accept, reflecting an attitude that borders on the paranoia of anti-vaxxers or at least reveals signs of vaccine hesitancy. The state media has declared that vaccines are "never a universal panacea."

Pyongyang may have decided to reject the Sinovac vaccine in response to reports that question its efficacy. North Korea also turned down a COVAX offer in July to provide 1.7 million doses of the AstraZeneca vaccine due to concerns over its side effects, including blood clotting.

North Korea might prefer the high-quality Pfizer or Moderna vaccines, but it lacks the ultra-cold storage units to preserve them except in limited geographical areas such as Pyongyang. A compromise choice would be Russia's Sputnik V vaccine, but there are reports that Pyongyang is demanding that Moscow deliver free supplies.

If North Korea does acquire vaccines, there is reasonable confidence that it could stage a successful rollout of jabs. It has already developed a national vaccine deployment program with the help of UNICEF and it is working to ensure that proper storage and delivery systems are in place, according to the World Health Organization. But less certain is whether North Korea will allow the entry of foreign humanitarian workers to supervise vaccine distribution.

North Korea has a history of successfully carrying out vaccine campaigns. For example, it conducted a measles vaccine program in 2007 that eradicated the disease. It is estimated that it has the capability to inoculate 3.3 million people per day.

Since initial supplies would fall far short of covering North Korea's entire population of 25 million, priority is likely to be given to health care workers, people over 65, those suffering from serious underlying illnesses and some military units.

North Korea's muddled response bodes ill for expectations that the pandemic might provide an opportunity for it to cooperate more closely with international agencies and other countries on health issues.

U.N. Secretary-General Antonio Guterres, for example, recently urged Pyongyang to do whatever it could to secure vaccine supplies for the population.

North Korea has also rebuffed offers by Seoul to work together on a COVID response. In his Liberation Day speech last month, President Moon Jae-in highlighted health as an issue that could serve as a bridge between the two Koreas.

Seoul has also been pushing a proposal for North Korea to join the Northeast Asia Conference on Health Security, which was set up at Moon's suggestion to deal with COVID-19 and future pandemics in the region. But Pyongyang has not responded.

Seoul and Washington have also discussed providing COVID-related humanitarian aid to North Korea either directly or through international organizations, such as the U.N., or NGO groups.

Although it is clearly in North Korea's interest to accept vaccine shipments soon and help relieve the economic strain, Pyongyang may be operating on a different calculation, deciding on an "all or nothing" strategy.

Watching how the pandemic has played out in the West, with regular surges of the virus following the relaxation of social restrictions as vaccines become more available, North Korea may have concluded that the early introduction of vaccines might have the same effect in its own society.

Officials may have concluded that they cannot risk letting their guard down since a widespread outbreak of COVID-19 could quickly overwhelm the tottering health care system. Vaccinating some of the population now would raise false hopes among the public that the country could soon return to what passes for normality in North Korea. Better to keep controls in place until enough vaccine is available to quickly inoculate most of the population at once.

John Burton (johnburtonft@yahoo.com), a former Korea correspondent for the Financial Times, is a Washington, D.C.-based journalist and consultant.