From Zero-COVID policy to no COVID policy - can North Korea follow China´s lead?

By Bernhard J. Seliger

One of the most stunning reversals of health policy anywhere in the world happened in early December, when the three-year-old Chinese strict zero-COVID policy was effectively abandoned, to such an extent that the Chinese Center for Disease Control had to admit, after less than a week, that they had no more clue where and how frequent the COVID virus was infecting citizens.

The end of mandatory testing and the new rules for self-tests only when symptoms of the virus showed means that asymptotic infections, which take a vast share of total infections, are no longer recorded. Combined with rather low vaccination rates with a vaccine with sub-standard performance (Sinovac or Sinopharm mostly), this means that infection rates are supposed to grow exponentially for some time now.

Given the mostly harmless nature of the current prevailing omicron variant of the virus, this might still be acceptable, certainly more than a continued policy of harsh and sometimes deadly lockdowns disrupting economic and social life in a huge way. But nevertheless, it was a stunning reversal from earlier policies, and it did not come as a deliberate policy after consideration of expert opinions, but rather was hastily introduced to quell discontent everywhere in the country, the white-paper-protests.

In October, when the Communist Party of China held its 20th party congress, there was hope for an announcement of eased COVID policies. But no such distraction was allowed to mar the coronation mass for Chinese President Xi Jinping. Instead, after the tragic death of people in a fire in a locked down area, a protest wave not seen before for decades in China forced political change.

It is not yet a complete change of policies, in particular regarding international travel and visits. But this might be quite intentional and not so much related to fears of imported COVID cases, but rather a general disdain for a return to the much stronger interaction with foreigners in the pre-COVID period. And North Korea?

North Korea followed the Chinese zero-COVID policy very faithfully. For two years they boasted that they were the only country in the world without any COVID outbreak. The early and complete isolation of the country, which even prevented its own citizens and diplomats to enter since January 2020, was the price to pay for such a boast. It was a harsh price to pay, since it meant that necessary food supplies (like cooking oil) and medicine no longer could be imported for prolonged periods of time, bringing, among others, strong increases to food insecurity in the country, which until 2018 had seen moderate gains in food security.

And it went ultimately wrong, most probably when one of the signature night-time parades of the regime in late April 2022, on occasion of the military foundation day on April 25 became a mass spreader event. When North Korea had to admit massive COVID outbreaks in May 2022, the published figures of millions of infections in only a few days were amazing, but equally amazing was the alleged rate of recovery, and after a few weeks North Korea could again claim "complete victory" over the virus.

Given that North Korea could not even test for COVID due to a lack of reliable testing equipment and trained personal, this claim (and the figures published by North Korea) were outlandish. But they allowed North Korea to again follow the strict isolation policy and COVID protocols established by the country.

Like in China, parts of North Korea's elite was probably quite happy with the exodus of the few foreigners in the country in 2020 and the tight control of the own population. Fears of COVID outbreaks on the Chinese side of the border in Dandong and the Korean side in Sinuiju led to subsequent restrictions on trade on both sides, further prolonging the plight of the population.

By December, trade slowly normalizes and also trade with Russia via railway finally picked-up again. While this is good news for the population of North Korea, will North Korea also be able to follow the Chinese relaxation of COVID rules at home?

For North Korea, the situation is even more complicated than for China. Here, only a tiny part of the population has been vaccinated, though vaccinations seem to go on slowly by now. For two years, North Korea rejected Chinese offers to help with vaccines, due to their inefficacy, in sometimes quite blunt reproaches.

The more desired mRNA vaccines (like Biontec/Pfizer) were not available for North Korea, since the necessary cold chain for the vaccines could not be organized. Chinese vaccines, which can be stored at 2-8 degrees, are much easier to handle. So, relaxations might again lead to massive outbreaks of COVID.

Given the lack of even simple medicines to deal with coughing, fever etc. this might be a huge risk to the population. However, simply waiting longer is also no solution. Currently, given its aggressive military posture and (sad) record-breaking missile testing, there is no great willingness on the part of South Korea or the international community to aid North Korea to open up in a way secure for its population.

After all, several times North Korea rejected offers for international vaccine aid through the global Covax initiative. It is sad to say that North Korea rejected available Astra-Zeneca vaccines, due to alleged health issues, while now relying on no or on Chinese vaccines.

More important than forcing vaccines upon an unwilling North Korea state could be help to provide basic medicines to the population, through private initiative, and maybe the remains of the WHO and U.N. networks in the country. By strengthening the basic resilience of the population, also a basis to overcome a relatively mild form of the Corona virus could be built.

A coordinated and joint initiative to return to North Korea by international actors (international organizations like the U.N., NGO and diplomatic representations) might be more successful than individual negotiations by single actors, and might be a necessary prelude to strengthened medical aid for the population.

Clearly, this is not a popular option today. But we should not confound the people of North Korea, who suffer from the worst medical and nutritional situation in a decade, with the leadership and their antics. Also, any serious attempt to renew any form of diplomacy with North Korea would require a basic representation, however small, on the ground. For humanitarian reasons alone, this might be well worth. But will North Korea be up to the task and allow it?

Dr. Bernhard J. Seliger is resident representative of Hanns Seidel Foundation (HSF) in Korea, based in Seoul. Before the COVID-19 outbreak, he frequently travelled to North Korea, where he implemented projects on forestry, environment and renewable energy as well as medical cooperation. He is honorary citizen of Seoul and Gangwon Province.