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 had finally reached its population. But for global health experts, there’s one particularly worrying detail: It’s one of only two countries without any vaccines.

North Korea and Eritrea – both poor and ruled by brutal governments – have refused to join 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. On Friday, state media reported that one person had died and some 350,000 people had shown symptoms of fever.

Many health experts were already skeptical that North Korea had yet to report a single case of the coronavirus – more than two years into the pandemic. For its part, Eritrea has admitted around 10,000 confirmed coronavirus cases and 103 deaths, figures far below those of its neighbours.

North Korea admits coronavirus outbreak for the first time

“North Korea, with a huge immune deficiency – no protection acquired with vaccines or previous infections – is an open field for uncontrolled transmission, which maximizes the chances of new variants,” said J. Stephen Morrison, director from the Global Health Policy Center to the Center for Strategic and International Studies.

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

“The carnage could be terrible,” he said. “To the extent that it might affect the regime’s grip on the population.”

In both countries, rumors have swirled that political elites are already vaccinated – and that their rejection of foreign-made vaccines is just for show.

Eritrea, led by president and longtime strongman Isaias Afwerki, has ignored requests from other African countries to join Covax, the World Health Organization-backed global immunization effort. Some activists say the country is plagued by propaganda that paints Covax as a Western tool to destroy Africa.

In December, the head of the Africa Centers for Disease Control, John Nkengasong, said Eritrea was the only member of the African Union that had not “joined the family of 55 member states 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 rejected doses of the AstraZeneca vaccine over apparent concerns about potential side effects. He also refused delivery of nearly 3 million doses of China’s Sinovac vaccine, saying shipments should be destined for other countries with more severe outbreaks.

Last month, a panel of experts convened by the Center for Strategic and International Studies recommended that North Korea be offered a large donation of mRNA vaccines. But vaccines previously allocated to North Korea under the Covax plan are no longer available.

Morrison said Covax and other donors had grown “tired” of North Korea’s callous nature during the pandemic. “This does not exclude reviewing the questions of what to do in the event of a crash,” he added.

A spokesperson for Gavi, a nonprofit that helps coordinate Covax, said the initiative has “currently committed no volume for” North Korea. But, the spokesperson said, if Pyongyang moves forward with a national vaccination program, Gavi could work with Covax to help North Korea catch up to its vaccination targets.

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

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

“China itself is grappling with the spread of the omicron variant, so I don’t know if it has strong incentives to help North Korea fight covid,” senior health researcher Yanzhong Huang said. world at the Council on Foreign Relations.

A model released in preprint this week estimated that if China relaxes what it calls its “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 low vaccination coverage there.”

Michelle Lee contributed to this report.

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