North Korea’s Covid-19 Lockdown: Current Status and Road Ahead
March 9, 2022
- North Korea has instituted a “zero Covid-19 policy,” involving border lockdowns and quarantine measures, that it claims has enabled the country to remain Covid-free. The country is one of two in the world that has not begun a Covid-19 vaccination initiative.
- North Korea’s zero Covid-19 policy has precipitated secondary health and food crises.
- The combined effects of the lockdown, continued UN sanctions, and severe weather caused North Korea’s economy to contract by 4.5 percent in 2020, the worst decline since the great famine of the 1990s.
- The lockdown creates an added impediment to denuclearization talks, which have been stalled since 2019.
- North Korea can, and will most likely choose to, endure a continued lockdown.
- The regime may manage ongoing health and food crises through small and sporadic openings of the sort that occurred last fall and early this year, with the release of some shipments of humanitarian aid and a limited resumption of trade with China.
- Several factors could shift North Korea to ease its lockdown, including:
- A closing window of opportunity to receive aid as high levels of vaccination globally lead to a managed endemic situation;
- The easing of pandemic restrictions by China and South Korea after the Omicron wave;
- A worsening food crisis;
- The global proliferation of anti-virals; and
- The onset of a dangerous new variant.
- A high-volume humanitarian package proposal (e.g., 80 to 100 percent coverage with mRNA vaccines) to entice North Korea’s opening is untested and operationally feasible but would face political obstacles, monitoring concerns, North Korean “forum-shopping,” and North Korean resistance to linkage to denuclearization negotiations.
North Korea’s Covid Lockdown: Current Status and Road Ahead
CSIS hosted a panel of experts for a discussion of the impact of the Covid-19 pandemic on North Korea. The group discussed what is known about the current situation, the primary and secondary effects of the border lockdown, and the broader impact on North Korean society and markets. The group also examined North Korea’s path going forward, the possibility of an easing of restrictions, and the feasibility of humanitarian aid policies to North Korea. The meeting took place under Chatham House Rule on a not-for-attribution basis.
The Current Situation
North Korea has instituted a “zero Covid-19 policy” involving border lockdowns and quarantine measures since January 2020. It claims this has enabled the country to remain Covid-free. The country is one of two in the world (in addition to Eritrea) that has not begun a Covid-19 vaccination initiative, despite multiple offers from the global vaccination program COVAX. Presumably, the main impetus for the lockdown is the country’s vulnerability, as its fragile healthcare system is not equipped to deal with a Covid-19 outbreak. North Korea’s population, with no immunity from infection or vaccination, is exceedingly vulnerable to the virus. If a mass outbreak occurs, there will be no short-term solutions. The lockdown has precipitated the exit of almost all UN technical experts and senior managers, who would be needed at some level to oversee the delivery of vaccines in the event that North Korea accepts any in the future.
North Korea’s zero Covid-19 policy has precipitated secondary health and food crises, with supplies of imported medications drying up, routine immunization programs facing stock-outs, and sick people prohibited from traveling domestically to access hospitals. The country is also experiencing a food shortage, with the importation and internal distribution of food, fertilizer, farming equipment, and humanitarian aid severely restricted. Typhoons in 2020 caused flooding that further diminished crop yields. In July 2021, the United States assessed that 63.1 percent of the total population is food insecure, and one expert on the panel estimated that North Korea will suffer from 66,000 excess deaths per year as a result of its Covid-19 policies.
In addition to these human costs, North Korea’s economy contracted by 4.5 percent in 2020 due to the combined effects of the lockdown, continued UN sanctions, and severe weather, the worst decline since the great famine of the 1990s. North Korea’s Covid-19 measures have also stifled bottom-up marketization processes, which North Koreans have been dependent on to support their livelihoods since the late 1990s.
The lockdown has also created an additional impediment to conducting diplomacy with North Korea on its nuclear and missile programs, which has been stalled since the collapse of U.S.-North Korea talks in 2019.
Despite these severe, multidimensional challenges, multiple experts assessed that North Korea can, and will most likely choose to, endure a continued lockdown. There are several reasons for this:
- First, the North Korean regime has survived periods of extreme hardship in the past, including the great famine of the 1990s that caused an estimated 1 to 2 million deaths. By comparison, one expert estimated that the worst-case scenario for North Korea in the event of an unmitigated Covid-19 outbreak would involve around 160,000 deaths.
- Second, North Korea’s leadership has accrued benefits from the zero Covid-19 policy insofar as it has provided the government with tools to strengthen ideological control, dominate markets, and stifle outside information.
- Lastly, according to conversations between experts and North Korean officials, the regime touts the country’s Covid-19 policy as a success that has protected the population. One North Korean official reportedly expressed astonishment and indignation about the death toll in countries that “don’t follow the rules” and noted that the world could have ended the pandemic if everyone followed North Korea’s example.
Rather than ending the lockdown, the regime may manage ongoing health and food crises through small and sporadic openings of the sort that occurred last fall and early this year, with the release of some shipments of humanitarian aid and a limited resumption of trade with China. The latter has included the refurbishment of military facilities near the border with China into quarantine and disinfection facilities for incoming cargo.
Nevertheless, certain developments could prompt North Korea to ease its lockdown.
- Globally, one expert noted that many countries with high levels of vaccination and immunity are starting to enter a managed endemic situation, which could decrease overall levels of international interest in providing pandemic support. North Korea may perceive a closing window of opportunity to accept pandemic-related aid in this context.
- Regionally, a shift in China away from its own zero-Covid policy would leave North Korea more isolated and could prompt Pyongyang to consider making the same move. This type of move is not expected in China until after the 20th Party Congress in late 2022, at the earliest. A potential South Korean decision to resume its more liberal “living with Covid” policies post-Omicron could have a similar effect.
- Internally, a worsening of the food crisis might prompt North Korea to reopen its borders to trade and aid. Multiple experts noted that food, rather than health, is likely to be the main issue driving any lessening of North Korea’s Covid-19 restrictions.
- The introduction of antivirals (once supply is more abundant, not expected until 2023) could make it easier for North Korea to reopen safely without needing to accept the level of outside monitoring that a vaccine program would entail.
- The emergence of a dangerous new variant could prompt a tightening of the lockdown, but it could also spur North Korea to rethink its openness to a widespread Covid-19 vaccine program. One expert noted that places such as North Korea are at high risk of becoming the epicenter of new variants due to their low vaccine access and uncertain immunity levels.
Factors Surrounding a Potential Humanitarian Package Offer
Experts discussed the prospects for a new, high-volume proposal from COVAX to entice North Korea to begin a mass Covid-19 vaccination program. Such an offer could entail enough Pfizer or Moderna mRNA vaccines to cover 80 to 100 percent of North Korea’s population.
North Korea would likely be interested. Its officials have indicated—privately but not publicly—that they would prefer mRNA vaccines to the less effective Chinese Sinovac and AstraZeneca vaccines offered in prior COVAX allocation rounds. A mass vaccination campaign would enable North Korean leaders to protect their population for an easing of the lockdown, even though they continue to claim zero cases (it would also require a regime-led campaign to change public attitudes toward the virus to accept some level of infection). Previously, the largest COVAX offer included enough (non-mRNA) vaccines to cover 20 percent of the population. Furthermore, because there is no “anti-vax” culture in North Korea, the leadership would not face the public resistance to such a program as seen in other countries.
This approach would also be operationally feasible. Sufficient levels of global supply exist (one expert noted that North Korea’s program would use a relatively small portion of planned expansions of Pfizer and Moderna vaccine production). North Korea also has the experience and infrastructure needed to roll out mass vaccine campaigns quickly (95 to 97 percent of North Korea’s population were routinely immunized against diseases such as measles and polio prior to the pandemic). Experts further noted that the additional cold chain investments that mRNA vaccines require would not be prohibitive for North Korea.
The program would likely face some obstacles. North Korea would balk at monitoring requirements or become worried that the vaccine offer would be linked to requests in other areas, such as currently stalled denuclearization talks. North Korea’s negotiation style also presents challenges. Specifically, it often does not disclose what it wants—leaving others guessing and negotiating among themselves about what to put on the table—and “forum shops” among aid groups to get the best possible monitoring deal. Experts suggested some workarounds for these problems, including reframing monitoring as “technical support” (appropriate because vaccines are not fungible like other forms of aid) and allowing a single humanitarian actor to serve as the key interlocutor with North Korea to hold the line on monitoring terms (similar to the approach the United States took prior to aid shipments provided in 2008). The United States could also publicly endorse a policy, as it has in the past, that de-links aid from strategic interests such as progress on denuclearization. The start of a new South Korean administration in May might offer an opportunity for a humanitarian initiative.
Victor Cha is senior vice president and Korea Chair at the Center for Strategic and International Studies (CSIS) in Washington, D.C. Katrin Fraser Katz is an adjunct fellow (non-resident) with the CSIS Korea Chair. J. Stephen Morrison is senior vice president and director of the CSIS Global Health Policy Center.
This is the first of three reports of the CSIS Korea Chair 2022 Tipping Points project, which looks at potential variables for critical change in North Korea and the peninsula. This project is supported by CSIS and the Korea Foundation.
This report is produced by the Center for Strategic and International Studies (CSIS), a private, tax-exempt institution focusing on international public policy issues. Its research is nonpartisan and nonproprietary. CSIS does not take specific policy positions. Accordingly, all views, positions, and conclusions expressed in this publication should be understood to be solely those of the author(s).
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