ABSTRACT

A Preceding Study for the Restoration of the Pediatric Immunization System of North Korea after Reunification

Seulki Song
Advisor: Joon Seok Bang, PharmD, PhD
Department of Clinical Pharmacy
The Graduate School of Clinical Pharmacy
Chosun University

Abstract
Background: 8,000 children died in North Korea in 2013 before they could reach 1 year of age.1) North Korea has developed its own public health system based on Socialism. The system, however, has failed since the economic crisis of the 1990s. Consequently, the health of children has been at risk. The infant and under-five mortality rates of North Korea in 2013 are 7 times higher than those of South Korea.1) The high mortality rate of children under five years of age is mainly caused by infectious diseases and malnutrition.2) Judging from the mortality rate, a huge gap exists in pediatric immunization coverage between the two Koreas. The need for national pediatric immunization and supply of vaccines will be vital when the abrupt reunification occurs. There are few studies on this issue. Therefore, it is necessary to study infectious disease morbidity, the immunization coverage, and the supply of medications in North Korea.
Objective: The purpose of this study is to scrutinize the outbreak of infectious diseases, morbidity, immunization coverage and cures for the diseases. Additionally this study aims to give an estimate of the amount and the costs needed to vaccinate the children of North Korea.
Methods: The target population is the children of North Korea. The integrity of the data from international organizations and from North Korea itself is lacking. Access to information is limited. However, the people who can most likely provide actual information are the North Korea defectors. Therefore the method is based on a pre-survey and an interview of defectors. The target interviewees searched for are as follows; doctors who would understand the pediatric immunization coverage, teachers who have had close contact with children, and others who would offer a different perspective. The interview includes questions on nativity and mortality rates; outbreak of diseases; immunization coverage; cures for the diseases; medical circumstances; medications. The analysis is largely based on the statements of the health care providers within the selected group. The level of credibility relies on the periods of stay in North Korea, age, residence, and living status.
Results: The interviewees are 8; 7 female and 1 male. The birth years range from 1956 to 1982, with an average age of 46.8. The years arrived in South Korea vary between 1997 and 2010. 3 out of 8 are former health care providers; a doctor, a pharmacist, and a nurse. The non-health care providers are 4 former teachers and 1 laborer. The actual number of births and the child mortality rates are beyond the numbers reported by UNICEF which are 358,000 of births, 22 of the infant mortality rate, and 27 of the under-five mortality rate. The morbidity rate of infectious diseases exceeds the data from WHO. 1 out of 10 has tuberculosis. 30~50% of people have hepatitis B. Children are affected by measles, pertussis, and other infectious diseases. The immunization coverage of interviewees collected is 87.5% of tuberculosis (BCG), 37.5% of hepatitis B (HepB), the 75% of diphtheria, tetanus, and acellular pertussis (DTaP), 62.5% of measles, mumps, and rubella (MMR), 75% of varicella (Var), 37.5% of typhoid fever (ViCPS). The immunization coverage, however, is nearly 0% after 1980s. The treatments for the diseases are only palliative. Moreover, the deficit of medications, health-care providers, and medical equipment combined affects the already poor heath of the children. In order to ensure the welfare of North Korean children, at least 8,234,000 vaccine doses are needed. The estimated cost of pediatric immunization required is over 105 million U.S. dollars.
Conclusion: The morbidity rate of infectious disease in North Korea is conspicuous. The preparation for supply and expenditure of vaccines is vital.


Key words: North Korea, pediatric, child, immunization, vaccine, reunification