(The) cooperation dilemma : North Korea's approach to health security and health cooperation during COVID-19

다국어 초록 (Multilingual Abstract)

Despite the emergence of a COVID-19 as a global contagion, The Democratic People’s Republic of Korea’s (DPRK, DPR Korea, or North Korea) decision to close its borders and impose strict quarantines from January 2020 has virtually eliminated the access of international humanitarian and health partnerships, and also presented new health risks due to food supply shortages and economic stagnation. This decision representing North Korea’s active non-cooperation during the pandemic poses a dilemma to North Korea’s approach to health security and health cooperation, which is caught between revitalizing the economy and health cooperation and anti-virus control measures.
In order to explain North Korea’s approach to health security and cooperation during COVID-19 and challenges to health cooperation, this study explores reasons why the degree of supranational health cooperation in North Korea has declined in the pandemic. In its approach to past infectious disease outbreaks and COVID-19, a combination of perceived threat and burden of disease were identified as determining factors. This high sense of threat connected with the severity of health crises is motivated by widespread deficiencies identified in its health system and overall public health, which suggest North Korea would suffer severe impacts from a large and protracted outbreak of COVID-19. North Korea’s intense lockdown of its borders and alienation of on-the-ground humanitarian assistance indicate that any foothold of COVID-19 within its borders would have resulted in an overwhelmed health system and mass casualties. While unintended impacts of sanctions were also found to represent a key challenge to carrying out health cooperation in North Korea in the long term, threat perception and the estimated scope and severity of disease is what ultimately determines its approach to ensuring its health security during infectious disease outbreaks.
By understanding this dilemma and North Korea’s approach to health cooperation in COVID-19, future policy can be better equipped to align with North Korean leadership’s COVID-19 control strategies and address North Korea’s major public health challenges more effectively.