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US sanctions fan tuberculosis epidemic in North Korea
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Doctor O Yong Il explains how patients are diagnosed at the National Tuberculosis Reference Laboratory in Pyongyang, North Korea.AP
PYONGYANG, North Korea — Doctor O Yong Il swings open a glass door with a bright orange biohazard sign and gestures to the machine he hoped would revolutionize his life’s work. It’s called the GeneXpert and it’s about the size of a household microwave oven. As chief of North Korea’s National Tuberculosis Reference Laboratory, Dr. O saw it as a godsend.
Tuberculosis is North Korea’s biggest public health problem. With this American-made machine, his lab would be able to complete a TB test in just two hours, instead of two months.
It took years, but Dr. O got the machines, only to discover that GeneXpert needs cartridges he can’t replace. It’s not entirely clear what about the cartridges would violate international sanctions. For a long time, the producer refused to disclose what agents were inside because that was patented information. But it doesn’t really matter. No one, it seems, is willing to help him procure them from abroad and run the risk of angering Washington.
Despite a budding mood of detente on the Korean Peninsula since the summit between President Donald Trump and North Korean leader Kim Jong Un last month in Singapore, ongoing sanctions championed by the U.S. and Trump’s “maximum pressure” policy continue to generate an atmosphere of hesitation and the fear of even unintentional violations. And that is keeping lifesaving medicines and supplies from thousands of North Korean tuberculosis patients.
Dr. O’s laboratory, built with help from Stanford University and Christian Friends of Korea aid group, has essentially been running on empty since April.
But the idle GeneXperts may soon be the least of his troubles.
‘Unique operating conditions’
Tuberculosis kills more than 1.6 million people a year. When left untreated it will be fatal in half of those it infects. It’s the world’s most deadly infectious disease and is so contagious that each case can be expected to lead to 10 to 20 more.
In developed countries, it has largely been brought under control. There’s a vaccine that prevents it and a cocktail of drugs that can be used to treat, and often cure, it in a matter of months. But it’s a major scourge in less affluent places, including North Korea and sub-Saharan Africa.
To help North Korea control its tuberculosis problem, a Geneva-based international aid organization called the Global Fund to Fight AIDS, Tuberculosis and Malaria has dispersed more than $100 million in grants since 2010. Last year it supported the treatment of about 190,000 North Korean TB patients.
But, two weeks ago, Global Fund ended all of its North Korea-related grants, saying it could no longer accept the North’s “unique operating conditions.” Spokesman Seth Faison said the fund informed Pyongyang in February so it would have time to look for alternative funding sources. He said Global Fund is providing buffer stocks of medicines and health products to help support the treatment of tuberculosis patients through June next year.
Faison said Global Fund welcomes the “positive diplomatic efforts underway” between Pyongyang and its neighbors. But the fund’s position stands.
The decision shocked the doctors at the Pyongyang tuberculosis lab, who praised Global Fund for the work it had done but accused it of bowing to political pressure from the United States and Trump’s vow to keep the pressure on and not ease sanctions until the North makes major steps toward denuclearization. The United States government, which has pledged $1.4 billion this year, is one of Global Fund’s biggest donors.
The fund’s retreat sparked outrage outside of North Korea as well. In an open letter published in the medical journal Lancet, Harvard physician Kee Park, director of North Korea programs for the Korean American Association, warned the fund’s withdrawal could create a “humanitarian and public health crisis” and called the move “a cataclysmic betrayal of the people of the DPRK.”
Whatever the reason, its departure is valid cause for concern.
When tuberculosis patients reduce or go off their medications prematurely, or begin taking lower quality ones, the bacteria that causes their disease can develop a resistance to the two most powerful anti-TB drugs, making the condition harder and much more expensive to treat. This kind of multi-drug resistant TB is most often found in China, India and Russia.
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