Editor’s Note: Dr. Kee B. Park is the director of Korea Health Policy Project at Harvard Medical School and is also the director of the North Korea Program at the Korean American Medical Association. He leads the collaboration between US and DPRK physicians and has made multiple visits to North Korea. Katharine H.S. Moon is a professor of Political Science at Wellesley College and is on the Advisory Committee of the US National Committee on North Korea. She is writing a book based on interviews with North Korean defectors, “North Korean Lives Matter.” The views expressed here are their own. Read more opinion at CNN.
Five hours. That’s how long the man standing behind the anesthesia screen at North Korea’s top university hospital had been squeezing the football-sized balloon, every three seconds, to push oxygen into the lungs of the patient. Even at Pyongyang Medical College, ventilators are rare.
The man with the balloon had worked with us as I (Kee B. Park) and North Korean neurosurgeon Dr. Choe removed a tumor from the spinal cord of a woman in a dimly lit operating room of the college. Now, one can only wonder how, with such limited resources, North Korea can cope with the threat of Covid-19.
This is more than an academic question. While President-elect Joe Biden prepares to deal with the raging pandemic at home, he should consider that the health crisis presents a rare opportunity for the incoming administration to engage with the DPRK (North Korea) in a practical and politically low-risk way.
“Covid diplomacy” could help stanch the mistrust between the two governments and resuscitate efforts to rein in Pyongyang’s nuclear program. It would also reflect Biden’s preferred approach to politics and foreign policy: reliance on experts and knowledge-based institutions, multilateral coordination, and basic human decency.
2020 has been a year of reckoning. The unconventional “summit diplomacy” between President Donald Trump and Kim Jong Un yielded no movement toward denuclearization since their last meeting in the Vietnamese capital of Hanoi in February 2019. Since then, North Korea has conducted 30 missile tests and might soon boast operable submarine-launched ballistic missiles and potent ICBMs that can reach the US mainland.
Not engaging North Korea sooner rather than later is a poor option.
Internally, North Korean people face severe health risks, including the threat of a Covid-19 outbreak and a public health infrastructure that is already at the breaking point. Since the virus knows no borders, US failure to facilitate medical assistance could harm people inside and outside the country, including South Korea and Japan, two longtime US allies.
Before the Biden team can put nuclear weapons on the negotiating table, they need to induce Pyongyang to come out of its self-imposed total lockdown and near silence.
North Korea sealed off its borders in January 2020, one of the first countries to take such a step against Covid-19. Preventing the virus from spreading internally is a sound public health decision for a country with an under-resourced health system. But as the pandemic persists, the prolonged closure is crushing its economy. China-DPRK trade, an economic lifeline for North Korean people, declined precipitously during the pandemic – by 99% in recent months. In a country that faces chronic and severe food shortages, with malnutrition afflicting at least 40% of the population, preventing the pandemic has been described by the government as a “matter of national survival.” (North Korea has not officially confirmed any infections, though it has said there were thousands of “suspected cases.”)
Although the country does not report confirmed infections of Covid-19, experts believe that the worsening poverty, degradation of essential medical services, disruption of medical supply chains, and the suspension of international humanitarian aid programs will increase the number of non-Covid-19 premature deaths. Eventually, the human costs of prolonged closure will exceed the devastation from a Covid-19 outbreak in the country.
It is in the interest of the US – and the international community – to ensure North Korea is able to suppress the virus. In a pandemic, no one is safe until everyone is safe, and the US holds the key to integrating North Korea into the regional and global health security network.
“Covid diplomacy” with North Korea will need to start with support for a large-scale testing program, significant upgrades in treatment capacity, and access to Covid-19 vaccines while ensuring vulnerable populations outside the major cities are not left out.
The current international and US sanctions regime on North Korea, with its layers of approvals for humanitarian exemptions, was designed for “normal” times and fails at handling the science-based approach required during a global public health emergency. In June 2020, the UN special rapporteur on human rights in the DPRK, who reports to the UN Human Rights Council, urged sanctions relief to ensure food supplies. He emphasized the detrimental impact of sanctions on the fulfillment of basic economic and social rights. Medical supplies would certainly be a logical addition.
Any major changes to the sanctions regime will need the US to agree.
International health security cooperation with North Korea requires the following changes: A functional banking channel to transfer funds for humanitarian work, which is lacking at the moment. A general waiver for humanitarian organizations to deliver supplies – currently, the exemptions are sought for each shipment and approved on a case-by-case basis. Ending the US travel ban – presently, US humanitarian workers are required to apply for special validation passports for each trip to the DPRK. And a rollback of the parts of the sanctions with the greatest impact on humanitarian conditions and civilian economy, such as the cap on refined fuel imports and ban on exports. All of these items require US agreement or action.
Why might North Korea respond favorably? First, it has a long-standing cooperative relationship with Gavi, the Global Vaccine alliance, and has cofinanced and implemented nationwide vaccine programs successfully in the past. Pyongyang is familiar with the procedures and expectations of Gavi, including cofinancing. North Korea is eligible for Gavi’s Covid-19 vaccine program (COVAX) and will not want to be left out. The Biden administration might earn some sorely needed good will from the international community by participating in Gavi-COVAX and donating vaccines, when available, along with the 87 countries who already committed as of November 2020.
With the promise of medical supplies, vaccines, and humanitarian sanctions relief, Pyongyang might begin to work with external aid organizations and reopen the country to essential travel and cargo. These highly professional and experienced organizations operate under an accountability framework that makes transparency and access paramount.
A multilateral cooperation strategy with North Korea would reflect a renewal of US international vision and principled engagement by tending to the most needy in an enemy country and by supporting a valued ally’s proposal for the Northeast Asia Cooperation Initiative for Infectious Disease Control and Public Health. South Korean president Moon Jae-in introduced it at the UN General Assembly (virtual) in September 2020, whereby North Korea would be invited to participate as a member along with South Korea, Japan, China, Japan, and Mongolia.
Many in the world are awaiting a threat reduction from Covid-19 and nuclear conflict. Diplomacy based on the promotion of health security could help advance both.