North Korea’s TB crisis

It is approaching crunch time in dealing with North Korea’s tuberculosis crisis. Stocks of TB medicine could be severely depleted by the middle of next year.

This is due to a shortage of funding by international donors and difficulties in delivering medical assistance as a result of sanctions against Pyongyang for its nuclear program.

North Korea had more than 130,000 TB patients in 2017, according to the World Health Organization, while there were at least 5,200 new cases of multidrug-resistant TB (MDR-TB), the deadliest form of the illness, up from 3,500 cases five years earlier. The WHO estimated that 16,000 North Koreans died from TB in 2017. North Korea accounts for around 1.3 percent of TB cases worldwide and one percent of all TB deaths.

North Korea is estimated to need $5 billion to $6 billion to get normal TB drugs annually, but this amount excludes more expensive MDR-TB drugs. Medicine supplies in North Korea are already stretched. The number of TB cases is expected to grow due to food shortages, which exacerbate chronic malnutrition and leave the population more vulnerable to infections such as TB, which is known as “the disease of the poor.”

International humanitarian organizations in general are facing funding shortfalls worldwide, but the problem is worse when it comes to North Korea due to the difficult operating environment and sanctions.

UNICEF recently said it has received only a third of the $19.5 million in donations it needs this year to carry out its activities in North Korea, which includes treating childhood TB.

One reason for that was that the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria decided last year to end funding for North Korea programs. UNICEF’s operations in North Korea have been a principal recipient of the Global Fund grants.

The Global Fund said it had suspended funding due to North Korea’s “unique operating environment” that prevented the fund from “achieving the required level” of oversight “on the deployment of resources and the effectiveness of grants.”

But many suspected the Global Fund bowed to pressure from the U.S. and Japan, two of its largest donors, to cut off funding as part of their campaign to impose tougher economic sanctions on North Korea.

Other humanitarian groups, such as the Stop TB Partnership, are now urging the Global Fund to resume funding in time to prevent TB medicine stockpiles from running out next year.

International sanctions are affecting the fight against TB in other ways. Some humanitarian groups are prevented from bringing in ultraviolet germicidal irradiation devices, which can detect the spread of TB transmission in hospitals, and GeneXpert machines that can quickly diagnose TB cases. The prefab assembly of TB patient wards have been delayed since the sanctions prevent the delivery to North Korea of construction materials using metals.

In the meantime, North Korea’s first line of defense against TB consists of local doctors who are trained to identify TB cases and supervise treatment. They are supported by several foreign-based organizations willing to continue working in North Korea.

They include the Geneva-based Stop TB Partnership, which is supported by WHO funding to provide treatment to 1,200 patients with MDR-TB, and the Seoulbased Eugene Bell Foundation which is treating more than 1,800 MDR-TB patients.

MDR-TB is viewed as posing the greatest threat in spreading the infection. People with MDRTB are resistant to rifampicin, the most effective first-line drug to treat the disease. As a result, they require more expensive second-line medicines.

The disruptions in global funding support for North Korea’s TB efforts make dealing with the problem much harder. The example of the Eugene Bell Foundation, named after a pioneering Christian missionary to Korea in the 1890s, shows the best way in addressing the TB challenge.

It is the NGO with the longest experience in providing TB treatment in North Korea, having embarked on this activity in 1997 and overcoming numerous obstacles since then by working closely with the Ministry of Public Health in Pyongyang and local medical teams. One sign of its success is that its cure rate is nearly 75 percent compared to a world average of 55 percent. But the foundation alone cannot solve the TB problem.

While the Eugene Bell Foundation’s achievements are based on its ability to nurture good relations with North Korean officials and earn their trust, the Global Fund’s decision to cut TB funding could prove to be counterproductive since it undermines the constancy of its medical support.