Key Features and Controversies of the COVID-19 Epidemic and Response in North Korea

Abstract

Background: North Korea took strong border closure measures for about three years before and during the coronavirus disease 2019 (COVID-19) epidemic, and responded without diagnostic equipment and vaccines. This study systematically organizes the characteristics of North Korea's COVID-19 epidemic and response, and explores unanswered questions and policy implications. Methods: The study used reports from North Korea's two official media outlets, the Chosen Central News Agency and Rodong Sinmun, data submitted to the World Health Organization South-East Asia Region, and academic papers. To estimate and evaluate the number of COVID-19 cases and deaths in North Korea, the epidemiological data from other countries were used. Results: Faced with a severe shortage of appropriate diagnostic and therapeutic drugs and equipment, North Korea responded with prolonged, strict border closures, self-quarantines, restrictions on movement, and surveillance by identifying people with fever, without mass vaccination. The cumulative number of people with fever announced by North Korean authorities on August 4, 2022, just before the end of the outbreak, was 4,772,813, and the number of deaths from COVID-19 was 74. After the pandemic, efforts are underway to restore the healthcare system, including 'catch-up immunizations.' However, major controversies have been identified in the pandemic response process, such as 1) the initial inflow and spread route, 2) the final number of deaths, 3) the reason for refusing to provide vaccines to the COVAX facility, and 4) the success of North Korea's COVID-19 response. Conclusion: Identifying North Korea's response, outcomes, and key controversies to the COVID-19 epidemic can provide important information not only for North Korea but also for countries with similar political and economic situations and the international community to better respond to the next pandemic.