North Korean officials confirmed the first deaths in the country from COVID-19 on May 13, and the latest North Korean news media reports state that well over a million North Koreans are suffering “fever symptoms.” (See reports in The Washington Post, The New York Times, the Guardian, BBC, CNN, Voice of America.) Kim Jong-un appeared on television on Thursday May 12 with a face mask, the first time that North Korea watchers have seen him publicly wearing a mask.
Kim held an emergency meeting with senior regime officials on Sunday (May 15). He blasted senior government and public health officials for “irresponsible work” and poor “organizing and executing” of their duties. He also publicly criticized the director of the central public prosecutor’s office of “idleness and negligence of his duty.” Clearly, the message had to be delivered that the leader himself bears no responsibility for the current health crisis, but other officials are responsible and must focus full attention on the issue.
Statements of officials and North Korean media reports have used terms other than COVID-19, referring instead to an “explosive fever.” KCNA, the official state news agency called the disease “A fever whose cause could not be identified” and said it has “spread explosively nationwide from late April.”
North Korean official news media on Thursday May 19 reported 263,370 new cases in the 24 hours ending at 6 PM (North Korean time) on May 19. Since the “fever” was publicly acknowledged on May 13 until May 19, the total number of cases is around 2 million individuals or roughly 8 percent of the country’s population. The officially reported number of deaths through May 20 is some 65 individuals, but that is a lagging number and may be reported lower than the actual number out of political concerns. In covid pandemics elsewhere, deaths have consistently lagged behind the onset of infections. It will not be clear for another couple of weeks what the death rate might be and how it will compare with the experience of other countries.
The Scope of COVID in North Korea is Difficult to Measure
Both political and medical reasons are behind the difficulty of identifying the disease as COVID. For the past two years of the covid pandemic, North Korea has consistently reported it has no COVID cases. In April 2021, health officials in Pyongyang officially reported to the World Health Organization (WHO) that it had tested a total of 23,121 people for the coronavirus and it had no cases. As of May 18, 2022, WHO stated that the People’s Democratic Republic of Korea still had reported no COVID cases.
A reason for publicly not identifying the “explosive fever” as COVID is that North Korea has very limited capability to test for the COVID virus. In 2021, a full year into the world-wide pandemic, health officials reported they had tested 23,121 people for the coronavirus. This means that less than 1 person in 1000 in the country had been tested. Even if the North Koreans were more transparent with regard to their COVID testing results, the tiny proportion of individuals tested would still give no clear picture of the scope of the COVID infections.
Getting information about the health situation is also difficult because Pyongyang has closed the country to foreign visitors, much of the diplomatic community has left, and North Koreans are under much tighter restrictions on travel outside the country for any reason. The result is that even anecdotal information about what is happening inside the country is far less available than in the past. This has made it difficult, if not impossible, to get even a rough picture of what’s happening inside the country and confirming whether the “explosive fever” is indeed COVID.
When Kim Jong-un announced the “fever” pandemic, he was harshly critical of government and party officials. He blamed them for the outbreak and accused them of failing to perform their duties. In fact, the policy at the very highest levels has been at fault.
Mass Mobilization Suggests Serious Leadership Concern
Once Kim Jong-un publicly announced to the North Korean people the pandemic, party mobilization effort sprang into action. Military medical personnel augmented regular health workers so round-the-clock medication could be provided. Senior party and government officials were inspecting pharmacies and health-care facilities. Party organizations at all levels were organizing and publicly pledging to “take timely steps for disease screening and medical checkup, drug supply and material supply for living.”
The party newspaper published an editorial calling upon government “officials, Party members and working people to thoroughly implement” the leadership’s directives. They were to “set the maximum emergency epidemic prevention system in position as regards the fact that the most serious emergency case of the state occurred.” At the same time, the North Korean news media have published stories singling out front-line workers and citing their “selfless devotion” as the example to be followed. In particular, “nurses should be more caring than anyone else and always keep affable, cheerful looks.”
North Korea Previously Refused COVID Vaccines
Even before the confirmation in the media of COVID cases and the “explosive” spread of “fever” in recent days, the national budget approved by the Supreme People’s Assembly three months ago called for a 33 percent increase for emergency pandemic expenditures, a figure that is now likely to be seriously inadequate for the scope of the current situation.
The North Korean government, however, refused to take advantage of vaccines made available through United Nations health programs. The UN has sought to assure that poor countries are able to secure vaccines for their people. North Korea meets the need criteria for help with vaccines. UN agencies, however, reduced vaccine doses for North Korea because the North failed to accept and arrange for shipments of the vaccine.
The number of doses available for the North “now stands at 1.54 million, down from as many as 8.11 million last year.” (This does not mean that 8 million doses are sitting in a warehouse waiting for North Korea to use them, but it did provide that the North could request that number of vaccine doses from UN health program supplies, and vaccines would be provided from the ongoing stream of UN vaccines as they are available.) North Korea has not imported any vaccines against COVID-19 through UN programs. In September 2021, the United Nations made 3 million vaccine doses available to the North, but Pyongyang notified the UN that it would not accept the vaccines.
It is not clear why North Korea refused. The vaccines offered were Sinovac, the Chinese developed vaccine, and AstraZeneca. It may be that the WHO program requires transparent distribution and monitoring, and this has always been a problem for the North Korean leadership. There have also been suggestions that North Korea was concerned about the reported side effects of AstraZenca. In addition to the UN program, Russia offered North Korea vaccines on two occasions which were also rejected.
There are reports that border guards and other security officials who have a greater risk of contact with individuals outside North Korea have been vaccinated, but this has not been acknowledged officially by Pyongyang, and no vaccine was provided through UN channels. There are also reports that Kim Jong-un and Kim family members were vaccinated with a Chinese vaccine under development early during the Pandemic, and other reports are more specific in suggesting that Kim was vaccinated in May-June 2021. However, at that time South Korean intelligence sources said there is no evidence Kim and his family were vaccinated.
How Will North Korea Cope with COVID?
Up until a week ago, North Korea insisted that it had no COVID cases. The enforcement measures imposed in an effort to discourage the spread of the virus, were certainly draconian by any standard. In the summer of 2020, the government in Pyongyang quarantined the entire North Korean city of Kaesong for several weeks because a defector from North Korea illegally crossed the border back into the North after spending three years in South Korea. The tightened control measures along the border with China included a virtual halt in trade between the two trading partners. All of this indicates the high level of concern over COVID reaching the North Korean territory.
Why, then, did Kim Jong-un don his mask and sound the COVID alarm a week ago? The public confirmation that COVID has reached North Korea probably came because COVID has become a problem of such dimension that continuing to cover up any indication of the pandemic simply will no longer work. The biggest problem for North Korea is that it has a fragile and a seriously underfunded medical system. Doctors are trained, but medicines and medical equipment are in very short supply.
The regime recognizes the need for outside help in dealing with the pandemic, but aid from the United Nations will not be quick nor will be come in large quantity. The fact that North Korea previously spurned UN aid and that anti-COVID resources are currently in short supply internationally will not put Korea at the head of the line. The demand for medical help in poor countries around the world continues to exceed international supplies. Help through the World Health Program, will be modest at best.
The attention of North Korea’s traditional allies is focused elsewhere. China is attempting to deal with serious COVID problems of its own. Medicines and medical equipment to deal with the pandemic is limited—even for an ally as close and important to Beijing as North Korea. South Korean authorities report that three Air Koryo aircraft were sent to Shenyang in the last few days for COVID treatment supplies, but what those three aircraft could carry back to Pyongyang is modest compared to the urgent and growing need.
Russia also has its own COVID problems, but the focus of attention in Moscow is on the conflict Russia provoked in its brazen attack on Ukraine. What was expected to be a quick military action has instead shown serious Russian miscalculation and military incompetence. Putin’s attention and resources are heavily focused on salvaging his own regime, not the needs of Russia’s East Asian ally North Korea.
This raises the interesting question of why Kim Jong-un appears to be preparing an ICBM launch, possibly in connection with President Joe Biden’s visit to Seoul for his first meeting with South Korea’s newly inaugurated President, Yoon Suk-yeol. Pyongyang may be seeking to deliver the message that despite COVID, the DPRK still has the capability to protect itself.
There may also be a domestic reason for this show of force. It will be touted domestically to emphasize that the American threat is serious. Despite the problems of the pandemic, the North Korean people need to rally around their leader.
But the worst is yet to come in North Korea. Deaths will significantly increase as the pandemic continues. Thus far, we have seen no signs that there will be enough vaccines to slow the growing infection rate and protect those who have not yet been infected by COVID, though the Pyongyang elite will certainly have access to the limited number of vaccine doses. The COVID pandemic represents the most serious threat to Kim Jong-un’s leadership since he assumed office just over a decade ago following his father’s death.
Robert R. King is a Non-Resident Fellow at the Korea Economic Institute of America (KEI). He is former U.S. Special Envoy for North Korea Human Rights (2009-2017). The views expressed here are his own.
Picture from Rodong Sinmun.