One of the few foreign aid groups operating in North Korea and the only privately funded NGO treating tuberculosis (TB) has identified a growing challenge in reducing TB in the North: the increasing prevalence of multidrug resistant tuberculosis (MDR-TB) that is more difficult and more expensive to treat than regular TB.
“Multidrug resistant TB requires more precision, the medicine costs alone are 150 times as high, there’s a lot less margin for error,” Stephen Linton tells The Diplomat in an interview.
Linton chairs The Eugene Bell Foundation, the Seoul-based organization that is dedicated to treating TB patients in North Korea.Enjoying this article? Click here to subscribe for full access. Just $5 a month.
The foundation began working in North Korea during the 1990s after being invited by the government to provide food aid to people impacted by the famine that ravaged the country. After two years of providing food aid, the North Korean government asked the organization to switch to TB treatment as the malnutrition the famine caused led to a spike in the number of North Koreans infected with TB. The foundation agreed.
According to the World Health Organization’s (WHO) 2012 Global Tuberculosis Report, there are 345 TB infections per 100,000 people in North Korea, one of the highest in the world outside of sub-Saharan Africa.
Precise statistics on multidrug resistant TB in the North are not available.
In a March press release, the WHO and the Global Fund to Fight AIDS, Tuberculosis, and Malaria called for increased funding for the treatment of multidrug resistant TB, calling it the area of TB treatment that needed funding most urgently.
The North Korean state’s capacity to treat TB is lacking, particularly when it comes to treating multidrug resistant TB. The Global Fund therefore provides funding and WHO-approved medication to North Korea’s National TB Control Program.
“The National TB Control Program has only started to implement the MDR-TB program on its own since 2012, therefore their capacity is not yet at the level where they could treat every single person with MDR-TB,” said Marcela Rojo of the Global Fund.
To be cured, TB patients require a course of four different antibiotics for a minimum of six months. If treatment is interrupted or not completed, the exposure to the drugs can cause the TB strand to mutate and become drug resistant. Eugene Bell estimates that 15,000 people in North Korea fail to complete their treatment for regular TB each year.
Eugene Bell’s medical director and physician, Kwonjune Seung, argues that the primary reason multidrug resistant TB has become more prevalent in North Korea is because the Global Fund doesn’t provide enough treatment for MDR-TB. Marcela Rojo of the Global Fund, however, denied such a connection in a written statement to The Diplomat.
Although Article 56 of North Korea’s Constitution stipulates free medical care for all citizens, the North Korean government has been unable to afford the system since the economic downturn in the 1990s. As a result, access to healthcare is no longer universal and many illnesses go untreated if the patient is unable to provide money or gifts to doctors, according to a 2010 report by Amnesty International, which was based on interviews with more than 40 North Korean defectors.