Public health experts say promising COVID-19 treatment pills could play a key role for North Korea, one of the only countries yet to begin coronavirus vaccinations.
For nearly a year, North Korea has rejected vaccine offers from other governments and from COVAX, a United Nations-backed global vaccine distribution program.
As VOA reported in July, North Korea is worried about the efficacy and side effects of the AstraZeneca vaccine that COVAX has allocated for the country. It is also concerned about the presence of foreign aid workers that would help facilitate a vaccine campaign.
North Korea, which remains in a total lockdown, insists it has no COVID-19 cases. But that claim has failed to convince observers, who warn an outbreak could devastate the impoverished country.
With vaccine efforts stalled, an urgent shipment of coronavirus treatment pills may be the best way forward, according to physicians and public health experts who have worked in North Korea.
“It’s less trouble as far as logistics to send some tablets or medicine in general,” said Nagi Shafik, former World Health Organization project manager in Pyongyang. “It doesn’t take the same effort as sending vaccines.”
Crucial tool
The pills, most prominently those developed by Pfizer and Merck, could be a gamechanger in the pandemic battle, many experts say. The antiviral pills are expected to work against all variants of the virus, unlike many COVID-19 vaccines, which become less effective as the virus mutates.
Pfizer’s pill seems most promising. On Tuesday, the company announced its final test results showing the drug reduces the risk of hospitalization and death by 88% if taken within five days of the onset of symptoms. Merck’s pill has an effectiveness of around 30%.
This undated image provided by Pfizer in November 2021 shows the company's COVID-19 pills.
Both pills are expected to be widely available within weeks, first in wealthy countries that purchased the first batches. But crucially, Pfizer and Merck have signed licenses with the U.N.-backed Medicines Patent Pool (MPP) to allow cheaper generic versions to be distributed without royalties to dozens of poorer countries. Both licenses specifically mention North Korea.
Although only the Merck product is currently available in a generic form, industry experts expect both pills will eventually be available for as little as $10 per treatment, compared to more than $500 that many governments are currently paying for the name brand versions.
Challenges
Delivering the antiviral pills to North Korea would face some of the same difficulties as the vaccine efforts.
One of the main barriers has been North Korea’s reluctance to sign a COVAX liability waiver in case of vaccine side effects. Pyongyang may have similar concerns about the pills, especially the Merck product. Some studies suggest the pill can insert errors in DNA, potentially harming sperm cells or a developing fetus. However, the Pfizer pill doesn’t carry the same risk, since it uses a different technology.
North Korea, which has an antiquated and uneven healthcare system, would also likely need more COVID-19 testing capacity to take advantage of the pills. North Korea has reported only about 700 COVID-19 tests per week to the World Health Organization — a minuscule figure for a population of 25 million. It is unclear whether those figures represent only the tests conducted with equipment provided by the WHO. In August, North Korea said it has also developed its own COVID-19 tests.
Shafik, former WHO project manager, told VOA it would not be difficult for the WHO to provide more test kits to North Korea, if needed.
Advantages
Shafik, who has worked for decades with North Korea, also said it may be easier for Pyongyang to accept the pills, which could be shipped to North Korea without foreign staff present.
For nearly two years, North Korea has barred all foreigners and almost all international cargo out of fear of letting in the virus. However, the WHO as recently as October sent a shipment of medicine and other medical supplies to the North Korean port of Nampo, where it underwent a quarantine. According to Shafik, COVID-19 therapeutics could be sent in a similar manner.
“If you send medicine like antiviral tablets, like the Merck or Pfizer products, you don’t have to send any foreigner,” Shafik said. “I would think that it would be a very appealing idea for the North Koreans actually.”
It would also be easier to transport and administer the pills once they arrived in North Korea.
Unlike the most effective COVID-19 vaccines, which use advanced mRNA technology, the pills do not require a network of ultra-cold refrigerators and specialized delivery trucks.
“These [medications] can be stored on shelves. They don’t require a cold chain like the vaccines. And it can be administered orally — it’s just pills,” said Kee Park, director of the Korean American Medical Association’s North Korea program, a U.S.-based nonprofit organization.
Who would be involved?
It is not clear who would facilitate a shipment of the COVID-19 drugs. The WHO’s Access to COVID-19 Tools Accelerator (ACT-A) initiative is perhaps the most obvious option. In an October budget request, ACT-A requested $3.5 billion to help supply COVID-19 therapeutics to countries in need for the next 12 months. But so far, it has only raised $40 million, according to Unitaid, an international agency working with ACT-A.
“Fully funding these efforts will be essential for new treatment options to reach their full potential in 2022,” Janet Ginnard, Director of Strategy at Unitaid, told VOA.
A broad range of other organizations could also spearhead such an effort, including governments, international agencies, NGOs, or for-profit companies, according to James Love, director of Knowledge Ecology International, a U.S.-based group that focuses on global access to medical products.
But many groups may be deterred by U.S. sanctions, which prohibit a broad range of engagement with North Korea. While there is a process to obtain sanctions exemptions, it is lengthy and complicated, said Love. “A lot of organizations just don’t [apply for exemptions], because they simply don’t have the internal staff or private counsel capacity. And it just makes it that much more expensive,” he added.
Another option: North Korea could eventually produce its own generic pills under the MPP licenses. “They’re not particularly difficult to manufacture. It’s not very high-tech,” Love said.
Kee Park, the neurosurgeon who has made more than 20 trips to North Korea, agrees. “As long as you have the information, you just have to make it and press it,” he said.
Will North Korea accept?
There’s always the possibility that North Korea will reject the pills, since accepting them would undermine its own claim that COVID-19 has not entered its borders.
But if North Korea eventually decides it must live with the virus rather than try to eradicate it, the drugs could play a key role.
“This is truly a therapeutic drug — a drug cure,” said Park. “So, we need to figure out a way to equitably distribute these medicines.”