North Korea and Eritrea are the only two countries without vaccines

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North Korea admitted the inevitable this week – that Covid-19 has finally hit its population. But for global health experts, there is one particularly worrying detail: it is one of two countries without vaccines.

North Korea and Eritrea – both poor and led by brutal governments – have refused to participate in global vaccine-sharing initiatives, leaving their populations vulnerable to fast-spreading variants of the virus.

In Pyongyang, authorities on Thursday attributed the outbreak to the highly contagious BA.2 omicron subvariant, although the exact number of cases and their severity are unclear. Many health experts were already skeptical that North Korea had yet to report a single case of the coronavirus — more than two years after the pandemic. For its part, Eritrea has admitted around 10,000 confirmed cases of the coronavirus and 103 deaths, numbers far below those of its neighbors.

North Korea admits coronavirus outbreak for the first time

“North Korea, with a huge immunity gap – without protection gained from vaccines or previous infections – is an open field for uncontrolled transmission that maximizes the chances of new variants,” said J. Stephen Morrison, director of the Center for Policy on Global Health from the Center for Strategic and International Studies.

John P. Moore, professor of microbiology and immunology at Weill Cornell Medicine at Cornell University, said in an email that unless North Korea manages to limit transmission through a lockdown, “a very high percentage of population” will soon be infected.

“The carnage can be terrible,” he said. “To the point of affecting the regime’s rule over the population.”

In both countries, rumors have surfaced that political elites are already vaccinated – and that the rejection of vaccines manufactured abroad is for show only.

Eritrea, under former president and strongman Isaias Afwerki, has ignored requests from other African nations to join Covax, the global vaccination effort backed by the World Health Organization. Some activists say the country is rife with propaganda that paints Covax as a Western tool to destroy Africa.

In December, the head of the African Centers for Disease Control, John Nkengasong, said that Eritrea was the only member of the African Union that “has not joined the family of 55 member states that are moving forward with vaccination, but we are not giving up .”

As the world reopens, North Korea is one of two countries without vaccines

In North Korea, the government has rejected doses of the AstraZeneca vaccine due to apparent concerns about possible side effects. It also refused to deliver nearly 3 million doses of China’s Sinovac vaccine, saying shipments should go to other countries experiencing more severe outbreaks.

Last month, an expert panel convened by the Center for Strategic and International Studies recommended that North Korea receive a high-volume donation of mRNA vaccines. But vaccines previously allocated to North Korea under the Covax scheme are no longer available.

Morrison said Covax and other donors had “got tired” of North Korea’s unresponsive nature during the pandemic. “That doesn’t preclude revisiting the questions of what to do on an accident basis,” he added.

A spokesperson for Gavi, a nonprofit that helps coordinate Covax, said the initiative did not “currently commit any volumes to” North Korea. But, the spokesman said, if Pyongyang moves forward with a national vaccination program, Gavi could work with Covax to help North Korea reach immunization targets.

Pyongyang may have no choice. Even in partially vaccinated places like China or Hong Kong, the omicron subvariants have spread incredibly fast among pockets of unvaccinated people – with deadly consequences similar in scale to the first wave of cases in other parts of the world.

China, North Korea’s most important ally, is currently battling an outbreak of BA.2 and has imposed a severe lockdown on its commercial hub, Shanghai.

“China itself is struggling with the spread of the omicron variant, so I’m not sure it has strong incentives to help North Korea fight Covid,” said Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations.

A model released as a preprint this week estimated that if China relaxed what it calls a “zero Covid” policy, the virus could kill up to 1.5 million people.

In North Korea, it would be “much worse,” Moore said, “because of the minimal acceptance of the vaccine there.”

Michelle Lee contributed reporting

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