The COVID-19 pandemic set off an unprecedented scale of border closures, a rise in health nationalism, and inequitable global distribution of vaccines, which have all exacerbated the humanitarian situation in low-income countries. This has led to calls for greater cooperation to support vulnerable populations beyond sovereign borders.
The recent COVID-19 outbreak and the ongoing humanitarian situation in North Korea exemplifies the impact of the pandemic on humanitarian response. As one of the poorest countries in the world, North Korea relies heavily on international aid agencies to address issues of public health, especially childhood malnutrition, and infectious diseases such as tuberculosis and malaria. As the pandemic hit, however, all international aid workers left the country by March of 2021 due to the far-reaching COVID-19 quarantine measures and strict border closures introduced by Pyongyang, as well as the increasingly comprehensive international sanctions imposed in response to North Korea’s pursuit of nuclear and missile technologies. Unless the country secures sufficient COVID-19 vaccines for its population, it seems unlikely that aid organizations will resume their essential work to address these concerns.
The historical and continuing Korean conflict has affected the perception of health aid in both recipient and donor countries. North Korea seems to have ongoing anxieties about power relationships underlying unidirectional humanitarian aid. Those in donor countries who oppose aid to North Korea appear to have concerns that such aid could harm their national security by assisting the dangerous regime. The major challenge remains–how do we bridge this gap between the dire humanitarian situation in North Korea and the ever more hostile geopolitical climate?
Global health diplomacy: a conceptual framework and bridge
Our recent article in International Affairs presents global health diplomacy as a conceptual framework to bridge the dichotomy between humanitarianism and international politics, using health aid to North Korea during COVID-19 as a case-study.
In traditional notions of international relations, nation-states formulate their foreign policies on the basis, almost exclusively, of national interest, and distinguish humanitarian aid as a separate endeavor categorized as philanthropy. This dichotomy often quarantines aid from foreign policy. COVID-19 has forced us to question this traditional assumption.
On one hand, health is a critical component of human dignity and can be a normative motivation for cooperation beyond sovereign borders. On the other, health is also an important element of national interest and can be a strategic motivation for transnational cooperation. The conceptual frame of global health diplomacy highlights the nexus between global health aid and foreign policy in an increasingly interdependent world. Because disease knows no borders, state actors can view international health aid as necessary and justifiable action from both humanitarian and national interest perspectives.
COVID-19 vaccine diplomacy in North Korea
Initial efforts of COVID-19 vaccine provision to North Korea highlight limitations of the traditional donor-recipient aid model in a tense geopolitical climate. COVAX had initially allocated approximately 2 million doses of the AstraZeneca vaccine to North Korea in February 2021, but delivery was not implemented. There was speculation that North Korea had reservations about receiving the AstraZeneca vaccine because of the potential side-effects. COVAX later offered nearly 3 million SinoVac doses through UNICEF; however, North Korea rejected the offer in September 2021, stating that the doses should go to harder-hit countries. In 2022, North Korea again declined offers of AstraZeneca and Novavax doses.
International aid workers speculate that this is because the COVID-19 plays into an ongoing trust issue of North Korea about the international aid in the context of the protracted Korean conflict. From the North Korean perspective, the global community operates from a disingenuous model of quarantining aid from foreign relations. Thus, North Korea puts up their guard and looks for ulterior geopolitical motives.
Rather, genuine health cooperation with North Korea would not only meet donor countries’ enlightened self-interest to prevent resurgences of new COVID-19 variants but also imbue all parties, including aid recipients such as North Korea, with the global cooperative responsibility to address health. This convergence between normative and strategic action in global health diplomacy could reassure North Korea that it would not be singled out, and that COVID-19 assistance would not be tied to unrelated political and security agendas. Additionally, North Korea could see this as an opportunity to elevate its legitimacy as a member of the international community. In this sense, global health diplomacy reframes the tensions between humanitarianism and politics, morality and rationality, and cosmopolitanism and nationalism, from antithetical to complementary.
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