The Washington PostDemocracy Dies in Darkness

Opinion Dangerous covid variants could emerge from North Korea if the world doesn’t act

People wearing protective face masks walk in Pyongyang, North Korea, on May 15, 2020. (Kyodo Kyodo/Reuters)

Victor Cha is a professor at Georgetown University and senior vice president at the Center for Strategic and International Studies. Katrin Fraser Katz is a fellow with the Korea Chair at CSIS. J. Stephen Morrison is senior vice president and director of the Global Health Policy Center at CSIS.

North Korea’s nuclear-tipped missiles are not the only threat from the rogue nation that demands the world’s attention. It is also at high risk of a runaway coronavirus outbreak, which could create a breeding ground for new, dangerous variants.

For two years, North Korea has imposed a “zero covid” policy. Pyongyang claims that this has been successful in keeping the country covid-free, but it has also cut off critical food and medical supplies, resulting in severe shortages. It has also left its population of approximately 25 million people both unvaccinated (despite multiple offers from Covax, the United Nations-backed global vaccine initiative) and probably with minuscule immunity from prior infections.

An expert panel convened by the Center for Strategic and International Studies found this month that this has made North Korea uniquely susceptible to a sudden outbreak of the covid-19 omicron variant that could kill more than 100,000 people. That would obviously be terrible from a humanitarian perspective, but it could also worsen the pandemic by giving the coronavirus more chances to evolve and potentially even escape immunity provided by vaccines or previous infection.

What to do about this risk? The Biden administration has hit a rut in addressing North Korea’s nuclear threat, with Pyongyang expressing no interest in talking. But a stalemate in the denuclearization sphere should not stop the United States from considering multilateral pathways to prevent a covid-19 crisis in North Korea.

One possible initiative that might persuade North Korea to reconsider its previous rejection of coronavirus vaccines would be a high-volume offer from Covax of enough mRNA doses to inoculate more than 80 percent of North Korea’s population, combined with enhanced testing and eventual access to antivirals. This would probably get North Korea’s attention, especially as it witnesses the surge in hospitalizations and deaths in Hong Kong. In private settings, North Korean officials have indicated their preference for mRNA vaccines over the less effective Chinese Sinovac and AstraZeneca vaccines that Covax has previously offered. Such a program would also allow North Korean leaders to partially reopen their economy.

Such an initiative is feasible. Global supplies of mRNA vaccines and tests are ample, and North Korea has the infrastructure and experience necessary to implement mass vaccination campaigns at a relatively rapid pace (before the pandemic, more than 95 percent of North Korea’s population received shots for diseases such as measles and polio). Additional cold-chain investments for a national mRNA vaccine campaign would not be prohibitively costly.

Such a campaign would have to overcome some systematic hurdles. Although there is no “anti-vax” culture in North Korea, its leaders would have to actively engage with residents to explain why the nation is now turning to vaccines after saying that there was no need for them. North Korea would also probably push back against monitoring requirements or raise concerns that vaccine donations would be tied to requests, such as denuclearization.

North Korea’s approach to negotiation also creates challenges. Its leaders often do not reveal what they want, and they also “forum shop” among various aid organizations to seek the best possible deal. China, which adheres fiercely to its “zero covid” approach, may object to efforts to move North Korea beyond such an approach.

These problems have workarounds. Monitoring could be recast as “technical support,” with UNICEF or the World Health Organization serving as the main interlocutors with Pyongyang (not unlike their current role in sustaining health programs in Afghanistan). Washington could endorse a multilateral humanitarian approach, as it has previously, that emphasizes its de-linking of aid from strategic interests such as denuclearization.

This may seem a strange proposal coming on the heels of yet another series of North Korean missile tests. But the humanitarian crises already unfolding in North Korea, which would be exacerbated in the event of a covid-19 outbreak, can and should be addressed with urgency and separately from the nuclear issue. The inauguration of South Korean President-elect Yoon Suk-yeol in May could provide an opening for this type of initiative. While Yoon has advocated a tough line on denuclearization, he has not opposed humanitarian engagement with North Korea.

It is certainly possible that a mass-vaccination initiative could create better atmospherics between Washington and Pyongyang and dissuade North Korea from starting a new cycle of provocations. But even if it did not, it would still be a worthy endeavor. Protecting innocent North Koreans from a deadly disease is not only the right thing to do — it’s also in the interest of countries everywhere that seek to end the pandemic.