January 2021

Capitalist health-care systems don’t do well in epidemics as compared to health-care systems not organized around capitalist principles, and COVID-19 is no exception. As the economist Paul Sweezy once pointed out, if health care is the purpose of the U.S. health-care system, it fails miserably. But actually the system is successful, because the goal is something else: profit making and the accumulation of capital.^[1] With its corporate dominance, horrendous problems of access, high costs, lack of overall coordination, and de-prioritization of public health services, the USA has confronted the current pandemic with chaos. In general, government agencies and corporations have struggled to protect the previous profitable though ineffective arrangements, with deadly consequences.

A few countries have done relatively well in responding to COVID-19, and they all approach health care and public health very differently from the United States, even if their economies are capitalist. I focus now on one of those countries that I know best: South Korea. Then I move the focus to that other mysterious, non-capitalist country on the same peninsula: North Korea. Although I explain these countries’ initiatives to control the downstream effects of COVID-19, I also report what if anything the two Koreas have done about the upstream causes of the pandemic; I have addressed this issue already in parts 1 and 2 and will return to it later. In part 4, I summarize a continuing effort to understand the policies about the pandemic adopted by countries with varying political-economic systems, including capitalist, post-capitalist, and “mixed” with elements of both capitalism and socialism.

South Korea

During the pandemic I have had the good luck to experience and contribute in small ways in both the USA and South Korea. My partner and comrade, Mira Lee, is from Korea, and I served during 2019 as a Fulbright senior fellow, teaching public health at Seoul National University.^[2] I also have continued to work part-time at community health centers in the United States, most recently in February 2020, as Korea already had seen improvements in the pandemic and the U.S. encounter with the virus was rapidly worsening. In South Korea, I gathered information from publicly available bibliographic and media sources, interviews with colleagues and community residents, emergency cell phone messages, and unobtrusive observations at hospitals and community health centers. About Korean language skills, I slowly have progressed to about intermediate level.

South Korea, officially known as the Republic of Korea (ROK), is a capitalist country whose policies link closely to those of the USA. Some activists and scholars consider South Korea as a U.S. “neocolony.” Korea’s adoption of western medicine started in the late nineteenth century, due to efforts of U.S. missionary doctors and nurses. Yet it is hard to imagine policies about COVID-19 that differ more than those of these two countries.

The capitalist state in the ROK contains a welfare-state component with a single-payer national health program. In its relatively well organized and funded public-health infrastructure, personnel work in the public sector without apparent organizational motives to enhance corporate profitability. The organized medical profession, especially through the Korean Medical Association, usually leans toward the right wing. But several groups of doctors and public health professionals oppose the KMA and support progressive policies.

Some political, economic, and cultural features of the South Korean landscape provide a context for the pandemic.^[3] In the military realm, South Korea continues its interlocking relationship with the US military industrial complex. The ROK’s military expenditures have increased in a linear pattern since 2010. Although less unequal than the USA, South Korea’s social inequality has worsened during recent years to the highest level among east Asian nations. The impact of inequality on daily life is substantial, as depicted in the prize winning film, Parasite. Competitive values within South Korean society affect mental health and well-being, especially among young people who enter the fierce competition for university entry and jobs. The suicide rate is the highest among OECD countries. Although South Korea’s cultural productivity has achieved global impact, for example the the wildly popular music of K-pop (and its frequent messages of love, respect, and mutual aid), multiple young stars have committed suicide.

Often described as a homogeneous society, South Korea’s diversity expresses itself partly through geographic marginalization. The population has become concentrated in a small number of urban centers as the countryside has become depopulated. This trend has created healthcare access problems even within the single-payer national health program, especially in the rural south and southwest, as well as problems of isolation and loneliness for the remaining elderly population.

Some historical experiences influenced South Korea’s response to COVID-19. First, during the epidemic of Middle East respiratory syndrome (MERS) in 2015, the government of President Park Geun-hye received harsh criticism for its disorganized and secretive approach to case finding and treatment, which the government later claimed was intended to prevent anxiety and panic. A similar lack of transparency caused distress throughout the country earlier in 2014, when Park and her colleagues did not communicate honestly and supportively during a disaster when a ferry boat, the MV Sewol, sank and 304 people died, mostly high school students. These events, plus scandals centering on corruption, led to Park’s impeachment after months of protests, comprising the so-called “candlelight” revolution. After Moon Jae-in’s more progressive presidency began in 2017, the Ministry of Health and Welfare initiated multiple reforms and new programs, including a sophisticated plan for responses to future epidemics like MERS.

The South Korean government reacted quickly and decisively when the seriousness of the epidemic in China became clear during January 2020. South Korea implemented several distinctive policies and practices:

• No travel ban: South Korea has not prohibited travelers from any country. Even during the early phase of the pandemic, when it reported the second highest number of cases after China, it did not ban travelers from China. This policy has led to strange situations like Korean airline companies’ continuing operations as the only airlines operating international flights during certain time periods at some international airports such as Los Angeles.^[4]
• Aggressive, mandatory diagnostic testing for travelers and residents at high risk of infection, with mandatory contact tracing, quarantine, and treatment if needed: At certain times, all travelers to Korea from some countries, including the United States, have had to accept a mandatory two-week period of supervised quarantine. To reduce financial insecurity and inconvenience for people in quarantine, the government has provided subsidized housing and food at rented facilities including luxury hotels with otherwise low occupancy during the pandemic. High-technology approaches including required GPS cell phone apps have assisted with contact tracing and quarantine procedures. The government responded to privacy concerns by modifying procedures so that places rather than individual people were identified to help with contact tracing. A well organized and financed system of public health clinics at the county level has implemented these epidemiological procedures, coordinated from the national and provincial levels of government. These techniques have led to remarkable successes in containing transmission, for instance from churches, enclosed workplaces like call centers, and nursing homes.^[5] In short, South Korea has applied all the straightforward procedures taught in Epidemiology 101, as described above in Part 2.
• Medical, financial, nutritional, and social support from government and public health agencies and community health centers at the local level: Everybody can receive free or very low cost medical care through the single-payer national health program. Coordinated at the national, provincial, and county levels, public health agencies also provide other needed services for people in quarantine and for individuals, families, businesses, and other organizations experiencing adverse financial impacts. Through a simple application, all Korean citizens and permanent residents could apply for grants through debit cards that they could use only for purchases from local merchants. Rather than to means test for the grants according to income or wealth, the government encouraged people not to apply if they felt they did not need the assistance.
• No general lockdown and limited overall economic impact of the pandemic: Most businesses stayed open. These included businesses serving the public such as restaurants, bars, gyms, singing rooms, and so forth, although periodic restrictions have limited numbers of customers and hours of operation. Messages from government agencies encouraged people to practice social distancing and to avoid such businesses, as well as religious and cultural organizations, until notices went out that the locations had been decontaminated and safety had improved due to decline in new cases. The government required all organizations to comply with epidemiological procedures such as contact tracing and decontamination if a case was diagnosed.
• With rare exceptions, no coercive command techniques by government: The government has made recommendations but has issued very few orders. One such order involved school closures for several months, for which the government provided an explanation regarding increased risk of contagion that actually was not clearly supported by epidemiological research (a South Korean study showed the importance of contact tracing when schools do reopen).^[6] In general, the government encouraged voluntary adherence with recommendations rather than acquiescence to commands.
• Multiple procedures to strengthen transparent communication with the general population: The national government has operated twice daily news conferences, extensive media broadcasts; and cellphone based messaging. The cellphone messages, labeled as “emergency disaster alerts” and distributed by the Ministry of the Interior, have originated at the federal, provincial, and county levels. The messages convey sensitivity to people’s feelings, needs, cultural traditions, and security. On a single day, an individual may receive around 100 messages from different levels of government.

The cellphone disaster alerts reveal a great deal about South Korea’s decentralized, participatory process during the pandemic. During the springtime of 2020, the alerts emphasized the sad necessity of not going in groups to view the beautiful cherry blossoms. As the seasons passed, the messages acknowledged disappointment about missing other cultural traditions that became problematic during the pandemic: folks enjoying the beach in summertime; families returning from cities to their ancestral villages on chuseok (roughly similar to Thanksgiving) to cut weeds around their ancestors’ graves and to celebrate their memory; group excursions to see the colors of autumn leaves; organized efforts to support high-school students’ tense experiences with the national university qualifying exams; and then the winter holidays leading to lunar new year.

Messages, which are individually composed by officials at different levels of public health and government organization, arrive at almost any time of day or night. Although the topics resemble one another, the specific content of each message varies and generally pertains to the local level. The impact of the messages on people’s attitudes and behaviors is unclear. At the least, the messages communicate that many people at all levels of public health and government are working hard to communicate information that will help themselves and others cope with the pandemic.

Here are some simple categories and examples from messages that I gathered, using a computerized random sampling method.

• Concrete information about local COVID-19 spread. This information comes mainly from local levels of government, based on communication between public health personnel and government officials responsible for the emergency notifications. The information includes statements assuring the safety of visiting locations after decontamination, including small businesses.
  • “[Yeongdong County Office] 7.9.(Thu), if you have visited ‘Jjamppongui Daega(Chinese Restaurant)’ between 11:30~12:30 in Yangsan-myeon, Yeongdong-gun, please contact Yeongdong-gun Public Health Center (043-740-5611~2). 2020-07-17 12:52”
  • “[Gwangju Metropolitan City] Since we have completed the disinfection and sterilization of the facilities visited by confirmed case: Hwangtaemyeonga Yongdaeri Deokjang, Yege Chamchi, Maewol Heukyeomso Garden, you can visit there without worries. https://c11.kr/ggfq 2020-07-17 17:13”
• Specific information about the travel history of new cases, and what to do if people have visited those places at those times.
  • “[Gwangju Metropolitan City] The confirmed case Jeonnam no.9 (M, 20s) The travel history in Gwangju 1 3.26 (Thu) 09:25 Arrive at Incheon International Airport (Entry from Thailand) 14:30 Youth Square 15:05 Shinsegae Department Store (Gucci Store) ※ Wore a mask. 2020-03-29 10:18”
  • “[Gangjin County Office] If you have visited places where Mokpo City’s Patient No. 3 went- Mokpo Laito PC Room North Port Branch (3/27 19:26 ~ Dawn 01:05), should report to Gangjin County Public Health Center (061-430-3592). 2020-03-29 10:17”
• General recommendations about prevention, tailored to local conditions and cultural traditions:
  • “[Cheongju City Hall] To overcome COVID-19, let’s actively practice in social distancing. In particular, please be patient with cherry blossom viewings this year. 2020-03-29 10:00”
  • “[Jeonnam Provincial Government] When using swimming pool, bathing beaches, valleys and rivers in summer season, be sure to wear a mask outside of the water, and ‘keep distance’ between people even in the water. 2020-07-18 09:00”
• Different text for each message, indicating that separate people are writing messages at each governmental level, with some similarity of content based on current national and provincial policies. The inclusion of local writers producing locality-specific messaging resonates with prior findings about the importance of community participation rather than top-down messaging in public health responses, such as Ebola and COVID-19 in Africa.^[7] The appendix gives further examples of the cellphone messages from those received on Christmas Day, 2020, when South Korea had entered a third wave of the pandemic.

Public health communication has become a highly contested component of the pandemic worldwide. South Korea has combined cell phone messaging with several other efforts to enhance transparency and collaboration. An emphasis on local public health communication, case finding, surveillance, quarantine with adequate social and economic support, public health infrastructure and staffing through local community health centers, and an accessible single payer national health program together have created a relatively favorable situation. This organized and disciplined approach to public health has linked with economic policies that have prevented the high levels of suffering experienced in the USA and many other countries.

In this capitalist country with a strong welfare state, efforts to control the epidemic and also to prevent economic collapse caused by lockdowns, travel restrictions, and other drastic measures became notable public health accomplishments. To consider just one point in time: As of Christmas 2020, South Korea experienced its third wave of the pandemic, with increases in numbers of new cases to the level of about 1000 daily in a population of about 52 million people.^[8] If South Korea had a similar population as the USA, about 330 million, this rate of new cases would amount to about 6000 per day, rather than roughly 200,000 that the USA was experiencing, or even higher considering the obvious problems of under-diagnosis and under-reporting. At the same time, South Korea’s deaths from COVID-19 totaled about 800; if adjusted to the size of the U.S. population, the deaths would total about 5000, compared to actual U.S. deaths of 322,000.

Although South Korea obtained supplies of vaccine, there was no immediate plan to deliver the vaccine through a population-based program but rather a longer term plan to begin later in the winter of 2021. As well as some concerns about efficacy, safety, and costs, the reasons for not emphasizing vaccine mostly have to do with the relative success of standard epidemiological methods to control infectious outbreaks.

Despite South Korea’s accomplishments, criticisms have arisen. The Korean Medical Association, with its right-wing ideology, resists any policy of the Moon government that interferes with private practitioners’ ability to work without interference. So strengthening of the country’s public health infrastructure in response to the pandemic has led to the KMA’s protests against further regulatory controls and opposition to policies like not closing the borders to travelers from China and starting new medical schools in rural areas to improve primary care services.

Progressive critics in South Korea, while expressing general support for the government’s policies, have called attention to some fundamental problems affecting the country’s responses to the pandemic.^[9] The private sector continues to provide most medical services in South Korea, with socialized funding under the single-payer national health program. Partly due to the predominance of private services, South Korea lacks an organized approach to primary care. People tend to seek specialty rather than primary care, especially from elite medical institutions in Seoul. The contradiction between private and public sectors has created inefficiencies and challenges for public-health coordination during the pandemic.

Social and economic inequalities rooted in class structure have impeded public-health initiatives. For instance, during the pandemic working-class employees at call centers and delivery services have faced higher risks of infection, adverse health effects of overwork, and some difficulties in obtaining needed care. Among couriers working for the extremely busy home delivery services, multiple people employed as outsourced couriers for logistics companies, unprotected by labor laws, reportedly have died from gwarosa, a Korean term referring referring to death from overwork.^[10] From the perspective of gender inequality, critics also have called attention to the predominance of men at most levels of government and public health decision making, as well as the disproportionate caretaking role for women during the school and work closures when they have occurred.^[11]

During the pandemic, South Korea has not addressed or even called attention to the upstream causes of COVID-19 and similar epidemics through capitalist industrial agriculture, mining, development projects, and other processes that lead to the destruction of natural habitat. As noted in Part 1, these processes aiming to accumulate capital through habitat destruction have grown more pervasive, even though historically such habitats have protected against pandemics. Although South Korea has reversed the earlier severe deforestation brought about mainly through exploitation of wood products by the Japanese empire during the first part of the 20th century, there are important exceptions, such as the destruction of ancient forests to build skiing facilities for the 2018 Olympics. South Korean corporations such as POSCO have devastated natural habitats in other countries, as in the construction palm oil plantations. Under international pressure, POSCO recently promised to stop these efforts and even to provide compensation that can be used for habitat restoration.^[12]

Meat consumption has increased markedly in South Korea during recent years, along with the industrial production of pork and chicken products through large industrial farming enterprises that have caused environmental problems. South Korean animals raised for meat suffer from periodic viral epidemics, including African swine fever and swine acute diarrhea syndrome, the latter caused by a coronavirus that reportedly has not yet been documented to cause significant human infections. South Korea’s lack of expressed concern about industrial meat production as an upstream cause of pandemics remains a contradiction of public health policy.^[13]

On the other hand, as in multiple other countries, a network of farmers has been studying and trying to implement a return to peasant agriculture. For instance, in the rural Southwest, farmers have held a study group reading a Korean translation of an important book that shows the advantages of peasant agriculture in terms of costs and efficiency, in comparison to capitalist agriculture.^[14] These farmers have grown increasingly concerned about industrial approaches to monoculture crop production as well as meat production processes that foster viral epidemics due to unsanitary processes. Resistance to the expansion of factory farms for pork and chicken production has been increasing in several areas of South Korea. In general these efforts remain separated from public policies to address industrial processes that increase the likelihood of pandemics.

North Korea

In addition to a capitalist country that operates a universally accessible national health program as part of its welfare state, the Korean peninsula also contains a country with a non-capitalist political economic system. How has North Korea dealt with the pandemic? The usual assumption in the dominant media including the dominant public health media, or even the left-wing media, is that any data from the Democratic People’s Republic of Korea (DPRK) are unavailable, inaccurate, or untrue. Horror stories about North Korea based on limited information abound throughout the world, so in asking the question about the pandemic’s impact there, I expected to find either completely inadequate information and/or a very adverse situation.

However, last year I had decided to study the DPRK’s health care system in the public health courses I coordinated in Seoul. Reportedly, this was the first time such an attempt at teaching about North Korea had ever happened at the ROK’s leading School of Public Health. Trying to keep an open mind about North Korea can become a surprising experience. As with my observations about South Korea, what I am reporting here came from publicly available sources, plus interviews with a few South Korean colleagues who have visited the DPRK during the past decade for various public health collaborations. I don’t intend the account that follows as the “truth,” but rather an effort to make sense of some expected and surprising information.

We were able to find much more information than expected. WHO maintains a country office in Pyongyang and issues regular reports about the DPRK. As one example, a collaborative report by WHO and the DPRK’s Ministry of Health, published by WHO during 2016, presented an apparently honest account of the country’s major public health challenges, including a high rate of smoking (the report emphasized a smoking rate of 54.5 percent of the adult male population), nutritional difficulties, outbreaks of infectious diseases, inadequate services with disappointing outcomes in maternal and child health, respiratory disease from indoor air pollution, and thyroid disease from insufficient iodized salt.^[15]

In this collaborative report, a “Message from Honourable [DPRK] Vice Minister of Health and WHO Representative to DPR Korea” emphasized, “In DPR Korea, health policies are being made and implemented based on the great people-centered Juche Idea and on the principle of serving the best interests and health promotion of the people.” Juche refers to a re-interpretation of Marxism-Leninism by Kim Il-Sung, North Korea’s revolutionary commander during the struggle against Japan and the DPRK’s supreme leader beginning with independence from Japan after World War II. Kim presented this reinterpretation respectfully, praising Marxism-Leninism while arguing that the Korean context required modifications through a less “dogmatic” approach.^[16] Through Juche, Kim tried to resolve the continuing challenges of building “socialism in one country,” as opposed to a worldwide revolutionary struggle in which international solidarity could facilitate revolutions in multiple countries. These contrasting strategies preoccupied V. I. Lenin, Joseph Stalin, Leon Trotsky, and many others, generating fierce and sometimes deadly conflict.

Focusing on revolutionary struggle in Korea, Kim argued for the importance of analyzing Korea’s unique history, strengths, and needs, rather than applying a more general model based on the Soviet Union or China. He emphasized that a Korea-centered strategy also fostered and benefited from international solidarity. From this viewpoint, Korea’s future depended on sustainability through agricultural self-sufficiency and a lack of dependency on other nations, including socialist nations. Because historical and material conditions differed across nations, Kim argued, Korea must advance its own revolutionary policies. Although historical and material conditions were important, according to Kim, they were not determinate in shaping human history. Instead, Kim focused on the human “subject” and especially the importance of leadership by individuals like himself. As the 2016 WHO-DPRK report points out, Juche clearly serves as a conceptual basis for the DPRK’s public health policies. In particular, an emphasis on North Korea’s unique historical and material conditions, self-sufficiency and independence, and the key roles of the human subject and the leader figures prominently in the DPRK’s responses to the COVID-19 pandemic.

In the rare instances that Western media report on public health initiatives in North Korea, the reports usually question the veracity of the DRPK government’s claims or otherwise diminish the importance of the accomplishments. For example, on November 5, 2020, during the pandemic, the New York Times reported on the DPRK’s public acknowledgment that smoking, which affected 46 percent of the country’s adult men as of 2017 according to WHO (somewhat lower than in the above report of 2016), had become a major public health problem.^[17] As in China and some other countries, public health approaches to reducing smoking are weakened by the contradiction that a state-owned and -operated tobacco industry has relied on smokers’ cigarette purchases to generate a substantial part of the government’s revenues. The Times article also belittled the initiative by emphasizing that Kim Jong Un was continuing to smoke, just as U.S. media belittled Cuba’s mostly successful anti-smoking campaign by emphasizing Fidel Castro’s continued smoking of cigars, until he eventually quit.

North Korea suffers from serious shortages of medications and equipment, partly due to the extensive economic sanctions imposed and enforced by the USA and the United Nations (UN). At the UN and other diplomatic venues, the USA leads efforts to punish the DPRK for developing nuclear weapons and related policies as methods to protect its survival and sovereignty in the context of more than 70 years of hostility since the beginning of the Korean War. The Carnegie Endowment for International Peace has documented the extensive scope of these sanctions, whose goal is to cripple the DPRK’s economy by restricting its ability to export and import key products, to participate in trade with other countries, and to conduct international financial transactions. In January 2021, at a congress of the DPRK’s Workers’ Party, Kim Jong Un officially acknowledged that his five-year economic plan had mostly failed to achieve its goals.^[18]

Despite these problems and others, including periods of droughts, floods, and other natural disasters leading to famine and economic crises, the DPRK’s health indicators are more favorable than usually recognized. Health personnel like doctors and nurses per population and health outcomes like infant mortality and life expectancy are generally better than other countries in east and southeast Asia at similar levels of economic development. For instance, a study using data from WHO and other sources, published in the generally conservative Journal of the Korean Medical Association, showed that the DPRK’s life expectancy, age-standardized mortality, underweight among children less than 5 years old, infant mortality rate, under 5 years mortality rate, and maternal mortality rate were worse than more economically developed South Korea, but comparable or substantially better than those of Myanmar, Nepal, Bhutan, the Southeast Asian region as a whole, and global averages. As in China, traditional Korean medicine is integrated into the medical education as well as primary care in health centers.^[19]

The DPRK has cooperated with WHO and other international health organizations, including the Gates Foundation, in strengthening its childhood immunization programs. As a UN agency, WHO does a balancing act in the context of the severe UN sanctions against the DPRK. WHO’s work with the DPRK officially falls under the categories of collaboration that the UN promotes despite the sanctions: “Food and Nutrition Security, Social Development Services, Resilience and Sustainability, and Data and Development Management.” In 2016 WHO presented its annual award for the southeast Asian region to Sri Lanka and the DPRK “for their remarkable and sustained role in the public health gains of their countries.”^[20]

WHO recognized the DPRK again during 2018 for eliminating measles, as evidenced by “interrupted transmission of indigenous measles for more than three years” through its vaccination programs – an accomplishment that the USA and multiple other rich capitalist countries have not yet achieved. WHO’s Regional Office for Southeast Asia released a detailed report, “Eliminating Measles: A look at how Democratic People’s Republic of Korea did it,” which documents the collaborative procedures used and the verification processes coordinated between WHO and the DPRK. In the report, WHO’s regional director wrote, “DPR Korea’s example is a shining example to other nations struggling to control infectious diseases, and WHO very much looks forward to its continued partnership with DPR Korea as it continues to provide assistance and support in the control and elimination of other vaccine-preventable diseases.” Through their websites WHO and the UN explain their goals and activities in the DPRK, refer to recent planning documents, and provide further information about the WHO’s country office in Pyongyang.^[21]

The DPRK’s dramatic actions to address COVID-19 seemed to aim toward a single goal: to protect the North Korean population from the pandemic, despite predictably detrimental economic effects. This apparent goal appeared unexpected and counterintuitive, based on mainstream, hegemonic views about the government’s despotic purposes. But these policies also resembled those of several other countries or states with non-capitalist political economies, as we discuss later.

To combat COVID-19, the DPRK government quickly initiated drastic policies. On January 21, 2020, it closed its borders for all international travelers, apparently the first country in the world to do so. Foreigners and North Korean nationals with possible exposures experienced mandatory quarantine of up to one month in government-provided residential facilities. Sharing a border and maintaining extensive economic interactions with China, its main trading partner, North Korea through these measures greatly reduced the entry of people from China who might harbor the virus. Testing of people at risk for infection used kits that came mainly through donations from other countries, especially Russia. During the pandemic, the DPRK quickly constructed a large new general hospital in Pyongyang.^[22]

During the early months of the pandemic, the DPRK curtailed nearly all trade with China, including the imports of essential Chinese products and exports of North Korean raw materials and consumer products that had generated rare sources of needed currencies. Over time, the government allowed the resumption of some imports, especially by train, but publicized an elaborate process of sterilization and multiple weeks of quarantine for these products. North Korea had developed several tourist resorts in the mountains near the Chinese border, and these facilities generated increasing earnings mainly from Chinese tourists; by the end of 2020, the border remained closed to tourism.

The DPRK did not lockdown any cities until late July 2020, when the government declared an emergency because a defector from North Korea secretly came back from South Korea, where he had been reported as possibly infected with coronavirus. Kaisong, a city near the border to which the defector returned, was locked down until mid-August, as he and numerous contacts were quarantined and reportedly tested negative.^[23] Throughout the pandemic, the government generally tried to assure that people’s jobs would continue and that the economic impact on individuals and families would be limited. During the same time period as the Kaisong lockdown, the government also was working to reduce the effects of flooding on food supplies and housing. The absence of private corporations needing to pay both workers and shareholders enhanced the government’s ability to continue employment in public-sector jobs. Greater tolerance and even encouragement of informal markets, especially for selling food products produced on small farms, have been reported during the pandemic, despite the enormous financial stress imposed by U.S. and UN economic sanctions.

By closing its borders and continuing a nearly complete ban on travel to the country, the DPRK has taken a very different direction from South Korea, and the rationale is not fully clear. Speculation focuses on the deficiencies in health-care infrastructure for treating COVID-19, largely due to the impact of economic sanctions on the availability of hospital facilities, needed medications and equipment, lab capabilities to perform extensive testing, and public health personnel to trace contacts and manage quarantines. However, the government has not explained specifically why it decided to implement the drastic measures that it did, much earlier than most other countries.

WHO’s staff members have participated actively in the DPRK’s efforts to address COVID-19. These staff members hold responsibility for obtaining and reporting accurate health statistics from North Korea, as similar staff people do in other countries. The accuracy of this information depends on local public health officials who gather the primary data in the many countries where WHO maintains “country offices,” which WHO established in Pyongyang during 2001. In countries where WHO does not maintain a formal office, WHO staff members still communicate with officials in the countries when compiling public health statistics. Questions about the accuracy of public health statistics arise throughout the world regarding not only COVID-19 but also other indicators such as infant and maternal mortality. In its reports, WHO and other organizations like the World Bank provide estimates of statistical error and range of data accuracy.

The WHO country office in Pyongyang assumed responsibility for verifying reports about COVID-19 in the DPRK. According to WHO’s website, personnel in this office include the WHO Representative (“WR”), an administrative officer, and four “technical staff” members. Consultants and other outside experts travel to the country office each year for “training, capacity building and technical assessments, and program review.”^[24]

From November 2019 and during the entire COVID-19 pandemic in 2020, Dr. Edwin Salvador has served as WR for the DPRK. In that role, he assumed responsibility for confirming WHO’s data about the pandemic. He personally communicated with the media on multiple occasions about coordination between WHO and the DPRK government, as well as details of the DRPK’s initiatives and policies during the pandemic.^[25] Dr. Salvador is a native of the Philippines, where he received his medical degree. For postgraduate training, he studied at the University of Liverpool in the United Kingdom. Early in his career, he worked for 10 years in Doctors Without Borders and the International Medical Corps, addressing public health challenges in multiple countries of Africa and Asia. He joined WHO in 2006 as a public health officer in Sudan. Later he served at WHO country offices in Myanmar, Sri Lanka, and Nepal; for his contributions after the catastrophic earthquake in Nepal during 2015, he received WHO’s 2016 Award for Excellence. Before coming to the DPRK, Dr. Salvador held a position as WHO’s Deputy Representative in Bangladesh, where he coordinated WHO’s response to the crisis of Rohingya refugees from Myanmar.

Throughout the pandemic until the time of this writing (January 2021), WHO’s COVID-19 scoreboard for the DPRK has shown zero confirmed cases and zero deaths.^[26] The New York Times tracking project also reports zero cases.^[27] Other prominent tracking venues – for instance, Johns Hopkins University, the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, University College London, Oxford University, the Washington Post, and The Guardian – do not report any data for the DPRK. Despite skepticism expressed in the dominant media by public health commentators, the specific reasons for the skepticism remain vague. An unexpected conclusion for me and my colleagues, after studying documents from WHO and other sources, is that the report of zero cases and zero deaths is plausible. This conclusion has resulted from the observations in multiple publications from WHO and the DPRK that provide frank and detailed information about the country’s public health problems and accomplishments, including major achievements in addressing infectious diseases as noted above. The track record of Dr. Salvador and other staff members at WHO’s country office and elsewhere also gives no reason to doubt WHO’s reports about COVID-19 in the DPRK. In short, the DPRK may lead the world in the fight against COVID-19.

But as in most other countries, addressing the upstream causes of pandemics like COVID-19 has not made it to the DPRK’s publicly announced priorities.

During the Japanese imperial period terminating at the end of World War II and then during the Korean War, the Korean peninsula experienced massive deforestation. As noted already, the ROK recently has made some progress in reforestation. Under Kim Jong Un the DPRK officially has embarked on reforestation efforts, but progress has been slow, partly due to the continuing use of wood as fuel for heating and cooking, especially in rural areas.^[28] Industrial production of meat has not advanced to nearly the level in the ROK, let alone China, although the government has set goals to increase meat supplies to address the chronic problem of nutritional deficiencies. Unlike China and South Korea, the DPRK’s unique approach to socialist policy making has not provided an opening for multinational capitalist agricultural corporations, so the march toward factory farms that breed pathogens causing pandemics has not occurred, at least not yet. On the other hand, like the ROK and most other countries, capitalist or not, the DPRK’s approach to controlling the COVID-19 pandemic has not explicitly addressed its upstream causes in habitat destruction and industrial agriculture.

With this overview of the details of COVID-19 efforts in one small part of planet earth, let’s now turn to a general comparison of efforts in countries with different political economic systems, including capitalist, post-capitalist, and “mixed.”