North Korea Can’t Afford China’s Zero COVID Policy

For more than two years, North Korea officially declared itself COVID-free. That changed in mid-May when Pyongyang announced its first confirmed case of COVID-19 and a rapidly spreading fever, presumed to be a nationwide outbreak of COVID-19.

Faced with a growing health crisis, North Korea has not turned to the international community for assistance but instead suggested that it hopes to learn from China’s “success.” That would be problematic.

Coming into the current crisis, North Korea’s use of strict border controls to limit the passage of goods and individuals across the border by all indications largely succeeded in preventing a significant outbreak of COVID-19 domestically.

However, border controls, in combination with domestic lockdowns, are most effective in cases when the expectation is that the controls are only needed for a limited period. North Korea previously put in place border restrictions during outbreaks of SARS and Ebola. In both of those cases, the border controls were never in place for more than six months. In contrast, the restrictions for COVID-19 have now been in place for nearly two and a half years.

Keeping the border controls in place for more than two years has come with a cost – one North Korea did not pay during the prior border closures for SARS and Ebola. At a time when North Korea needed access to food and medicine, imports from China were down 81 percent in 2020 and an additional 47 percent in 2021. North Korea did continue to import these goods, and often prioritized imports of food, fertilizer, and medicine, but in most cases, even these essential items were imported at levels lower than prior to the pandemic.

This contrasts with the rest of the world, where global trade recovered from the pandemic induced decline in 2021 and reached a record high of $28.5 trillion.

If COVID-19 becomes endemic, as many experts believe will be the case, North Korea would need to transition to living with COVID rather than patterning its model off China’s “success.”

To stick to its “zero-tolerance” approach to COVID-19, China has resorted to a combination of lockdowns and mass testing. Shanghai was locked down for over two months this spring as officials continuously tested the population to ensure that the virus had disappeared from the city.

All major Chinese cities are building the infrastructure to test the entire population within 24 hours, with the largest cities required to have testing facilities within a 15-minute walk of every resident’s home. Some cities, such as Beijing, require regular COVID testing regardless of whether an individual has symptoms. Provinces and regions have been directed to build new hospitals and quarantine facilities to handle surges in COVID-19 similar to the one seen in Shanghai.

China has been able to keep its caseloads and deaths relatively low thanks to its zero COVID policy. Its total number of cases since the pandemic began is slightly less than 900,000 and it had reported only 5,226 deaths attributed to COVID-19 as of late June 2022. While there are reasons to question China’s data, it has likely seen fewer cases and deaths than the United States and other high caseload countries.

However, China’s success comes with its own costs. The lockdowns in China may have stopped the spread of COVID-19, including the recent Omicron variant that has kept many Chinese cities closed, but they have also put China on the verge of only its second recession in three decades. The zero COVID policy has also placed pressure on local and national budgets, which face declining tax receipts at a time those same localities are spending to build a new COVID-19 infrastructure.

For North Korea, the economic damage of a China-style zero COVID policy is less of a concern given the regime’s lack of commitment to economic growth, but other factors would hinder North Korea. Beijing is able to pursue a more aggressive zero COVID policy due to the size of its economy and the domestic resources it can draw on as one of the world leading producers of COVID supplies, capacities Pyongyang lacks.

For North Korea to pursue a similar policy to China, it would need to have access to a continuous supply of test kits to regularly test the population. While the World Health Organization helped North Korea develop its own test kit for COVID-19, the fact that Pyongyang has been reporting fevers rather than confirmed cases of COVID-19 is a testament to its lack of testing capacity.

Instead, North Korea has turned to the proxy of fever to track COVID-19 cases. to that end, North Korea imported $1.7 million in thermometers and pyrometers in 2020 – more than every year in the prior decade combined – and another $480,000 worth so far this year. The problem with using fever as a proxy for COVID-19 is that not all fevers are COVID and not all COVID-infectious individuals have a fever.

In addition, North Korea would need regular access to face masks, oxygen, surgical gloves, and gowns, as well as other supplies that would allow it to treat and quarantine individuals with COVID-19. Pyongyang also lacks a domestic vaccine to inoculate its population. While there have been reports that North Korea may have accepted some vaccines from China, it has declined vaccines from COVAX and not taken any known steps to administer a nationwide vaccination campaign.

Without the domestic capacity to fund and produce the goods needed to implement a Chinese-style zero COVID policy, North Korea would need to turn to outside sources to meet its needs. It is unlikely that China would be willing to expend its own resources to assist North Korea at the level Pyongyang would need while building up its own capacities, while the international community would also be reluctant to commit that level of resources. Without domestic production or international support, Pyongyang can only hope to continue the crude version of lockdowns it has already been utilizing.

Rather than studying China’s success, North Korea would be better served studying countries that have moved to a living with COVID policy to see what tools it needs to put in place to allow society to function now that the virus is widespread.

There is, however, one advantage for North Korea to following a Chinese-style zero COVID policy should COVID-19 become endemic. A Chinese-style COVID policy requires a significant degree of monitoring of the population and control over the flow of goods. If Pyongyang is looking to reassert authority over the economy and deepen its monitoring of the population, an endemic virus that requires constant vigilance could be an ideal tool to achieve those ends.