North Korea’s H1N1 Watch: Isolation Vs. Contagion

For a country that appears to be so isolated from the outside world, North Korea seems to have been on edge for months regarding the possible impact of swine flu (H1N1) on its population. These rumors of North Korean anxiety have been underscored by an unusual admission last week of nine confirmed cases of swine flu in Pyongyang and Sinuiju (The WHO has reported that all nine have recovered), but these cases may be the tip of the iceberg. North Korea’s admission has prompted a South Korean offer to supply 500,000 doses of Tamiflu to the North and an unusual North Korean acceptance of the South’s offer on Thursday, December 10.

If negotiators can agree on how the assistance will be delivered, South Korea’s delivery of the medicine will mark the first case in which the North has actually accepted assistance from the Lee Myung-bak administration. North Korea rejected a South Korean offer of 50,000 tons of corn in the spring of 2008 and has not responded to the South’s offer of 10,000 tons of corn this fall, which followed Red Cross dialogue held in conjunction with the family reunions held at Mount Kumgang in September.

The North Korean concern about the impact of swine flu is striking evidence of its human security vulnerabilities and the increased information flow into the country. North Korea’s antiquated health system and a population already suffering from decades of malnutrition could easily make the flu a potent killer among the average population in the North. The South Korean NGO Good Friends reports that rampant rumors about the disease from abroad have forced North Korea to have open meetings to coordinate a response instead of dealing with the issue in a closed manner as in the past.

The international and South Korean response to the flu is consistent with over a decade of efforts by American NGOs such as Eugene Bell Foundation and Christian Friends of Korea as well as the World Health Organization to provide the drug combinations necessary to fight against tuberculosis. Stanford University has joined in these efforts to build a national tuberculosis center inside North Korea that will provide national-level data regarding efforts to fight the disease. The establishment of such a center is a prerequisite for North Korea to receive additional TB-related funding as part of a global effort to fight the disease.

A Korean saying refers to behavior in which you “give the disease, and then you give the medicine.” In the health sector, North Korea’s response to the swine flu is one means by which to secure North Korea’s limited opening to the outside world. On nuclear issues, North Korea gives the disease of proliferation to the international community, but holds out on providing the cure. The South Korean offer to provide Tamiflu provides a tactical opening for improved inter-Korean relations, but it also reveals both North Korea’s weak underbelly and the long-term development challenge posed by the gap between North Korea’s backwards isolation and a modern, industrialized South Korea.