Shortage of tuberculosis drugs looms in North Korea

SEOUL, May 30 (UPI) -- North Korea, which has one of the world's highest rates of tuberculosis, is facing a crisis as a shortfall of life-saving drugs looms, according to the head of a humanitarian aid organization.

Stephen Linton, chairman of the Eugene Bell Foundation, a not-for-profit organization that provides humanitarian aid to North Korea, said during a meeting with reporters in Seoul on Tuesday that stocks of TB drugs are scheduled to run out by June 2020 and if new drugs are not ordered soon there will be a "potential catastrophe."

The main supplier of the medicine to the country since 2010, international aid organization The Global Fund to Fight AIDS, Tuberculosis and Malaria, abruptly withdrew from North Korea last June, citing concerns about the "level of assurance and risk management" in the country.

Linton estimates that there are 130,000 patients treating tuberculosis with drugs that were supplied by the Global Fund.

"If these drugs are not ordered, soon, there will be a vacuum where North Korea runs out of regular TB medicine," he said. "That's a disaster."

The disease is caused by a bacteria that most often infects the lungs and is highly contagious, spreading from person to person through the air. Globally, around 10 million people fell ill with TB in 2017, and 1.6 million died from the disease, according the World Health Organization.

Linton said it takes about nine months from purchase to delivery date to fulfill an order to North Korea for TB drugs, so orders for next year should already be taking place.

A shortage of drugs may lead to rationing, which can in turn spur lethal drug-resistant forms of the disease. Multidrug-resistant tuberculosis can result from patients not taking the correct dosage or combination of medications.

Roughly 5,200 new patients fell ill with drug-resistant tuberculosis in 2017, according to a report from the World Health Organization.

In an open letter to the Global Fund published in British medical journal The Lancet last year, a group of doctors warned that a rise in disease-resistant TB caused by a drug shortage could spread beyond North Korea's borders.

"An explosion of MDR-TB in North Korea would take decades to clean up and could detrimentally affect the public health of bordering countries like China and South Korea," the letter said.

Potentially complicating the issue are stringent international sanctions that remain in place on North Korea, which some claim have hindered NGOs from working in the country.

Humanitarian aid groups are able to apply for sanctions exemptions, which the Eugene Bell Foundation has successfully done in order to continue sending medical delegations to North Korea and providing needed diagnostic equipment, supplies and patient wards.

However, Linton said that political factors swirl around North Korean humanitarian aid issues.

"The tendency in [South Korea], as well as in the United States, is to lump emergency aid with developmental aid and use it as a negotiation carrot," he said. "And that is the wrong message all around. What it basically ends up doing is killing people."

He added that tuberculosis doesn't generate the same sense of urgency as a disease like Ebola because it is slower acting.

"The problem with TB is, unlike Ebola, it doesn't kill you fast enough," he said. "If it killed people as fast as Ebola, everybody would see that politics should have nothing to do with getting control of the situation. But the fact is, it takes years to cure, and therefore it almost never registers as an emergency."

Linton estimated that it would cost roughly $1 million per quarter to purchase the necessary drugs for North Korea. He recommended that South Korea buy the supplies and store them in a climate-controlled drug facility to keep ample stocks ready for next year, but doubted that the political atmosphere would allow it.

"Unfortunately, the linkage between diplomatic give-and-take and humanitarian assistance is so tight," he said. "And in the current environment, North Koreans are seen as so uncooperative that there is a visceral reluctance to initiate a plan that might ensure that this [medication] vacuum does not appear next year."

Also exacerbating the situation is food insecurity in the North. Poor nutrition leads to a compromised immune system, which can make victims more susceptible to the highly infectious disease.

Earlier this month, the World Food Program estimated that 10.1 million people, or 40 percent of the population, are food insecure and in urgent need of food assistance. Droughts, high temperatures and flooding led to below-average crop production, the organization concluded, and shortages of fuel and electricity may have increased losses.

In response, South Korea pledged to donate $8 million in food aid to the U.N. Children's Fund and the WFP to support their projects in the North.

If no action is taken on tuberculosis, however, the toll will be staggering, Linton said.

"It will be hard to pinpoint how many people will die," he said. "But if you're being treated actively for TB and then you are not treated, you will die. It's a question of whether you die in six months. Most people die in about four years. But you will die and every year you will move this bacteria to 10 to 15 more people. To me, that sounds like an emergency."