This is an important blog – provoked by the unbelievable actions of an organisation which was set up to support the provision of healthcare for the world’s most needy.
On 21st February The Global Fund (the organisation set up to provide relief from the ravages of TB, HIV and malaria for the world’s poor) quietly published on their website that they were closing down all support for the peoples of North Korea.
Please note – there was no press release, no public briefing, just a discrete announcement on their website that almost went under the radar. Thankfully one of our team (Ulick Burke) picked it up in the course of conversations with UNESCO personnel while he was in Pyongyang, and he’s started a petition as a result.
YOU REALLY MUST SIGN THIS PETITION TODAY! (and we’ll explain why).
So first of all, what does this mean? Here’s what Ulick writes in his petition:
“The suspension of Global Fund grants, and the absence of any coherent exit strategy, is likely to lead to massive stock outs of quality-assured tuberculosis (TB) drugs nationwide. This will directly affect over 100,000 people living with TB and will lead to increased incidence and drug resistance.”
It’s worth considering what the Global Fund is all about – here’s what its own website tells us about its aims which are to:
Maximise impact against TB, HIV and Malaria
Build resilient sustainable systems for health
Promote and protect human rights and gender equality
Mobilise increased resources
So why has the Global Fund seen fit to close down its support for TB and malaria in the DPRK? Well here’s what they’ve told the world on their website:
They say that the Fund is "concerned that the unique operating environment in the DPRK prevents us from being able to provide the Board with the required level of assurance and risk management around the deployment of resources and the effectiveness of the grants".
But if you read the release carefully you can immediately see that this doesn't quite add up because immediately beneath this statement they tellingly add that they have already established existing "robust arrangements to monitor and supervise the grants we make to combat tuberculosis and malaria in DPRK, including a strict zero-cash-advance policy and detailed records on delivery of medicine and health supplies".
‘Robust’ arrangements along with a ‘strict zero-cash-advance policy and detailed records’. Seriuously, aren’t these good enough?
Please note that their support does not include money that can be syphoned off and used for other purposes. This is what it includes for tuberculosis control, for instance: drugs (bought and sent from Switzerland) and diagnostics. In other words the things that save TB patients’ lives – moreover, things which can’t be ‘weaponised’ in any way imaginable.
But a lot of vulnerable North Koreans certainly have just been effectively weaponised by this action – around 120,000 for a start who are currently living with TB and whose treatment is being supported by the Global Fund.
Let’s put this in perspective for a moment.
The DPRK has a really serious problem with TB. It’s not just being estimated to have the sixth worse national incidence rate of TB (with an incidence rate that is more than twice what the WHO defines as being a national emergency) but 49% of its existing TB budget is currently unfunded. Despite this, among the thirty-odd high burden countries it’s been doing better in finding its missing TB cases since 2000 than any other. But importantly around 40% of its population is estimated to be undernourished, and less than 10% have access to clean fuels and technologies for cooking (both major factors for promoting active tuberculosis). Does this all mean it needs help to manage its TB epidemic?
Of course it does!
But worse still, it has an MDR-TB epidemic that has been seen and assessed by only a few, but which has been reported by one of the few experts who’s been there as being the worst he’s yet seen. And without a consistent pipeline of first line TB drugs this most dangerous part of the pandemic can be guaranteed to get an awful lot worse.
Given these facts (which are anything but controversial) it's asked a lot for us not to conclude that it’s geopolitics that’s called the shots with this inhumane decision by the Global Fund rather than any new problems with assurances or real need. The DPRK now has no pipeline of drugs with which to fight its tuberculosis and the Global Fund is effectively levering the people of this benighted country back into the pit of despair that was tuberculosis control before there was any effective medication.
The goal of Ulick’s petition is simple: to ensure a continuous supply of quality-assured TB and malaria medications for patients in North Korea. If you can see anything wrong with that, please take a look at yourself in a mirror! But if you can understand our outrage that some of the most vulnerable TB patients on the planet have been so devastatingly victimised by an organisation whose stated aims are to ‘maximise impact on TB, HIV and malaria’, ‘build resilient sustainable systems for health’, ‘promote and protect human rights’ and ‘mobilise increased resources’ then PLEASE SIGN ULICK’s PETITION TODAY!
Here’s something more that Ulick wrote: “The next Global Fund board meeting is coming up on 9th May. They're relying on international apathy, the tacit understanding that North Korea is a special case where international standards do not apply. We must not allow this to happen.”
So please sign that petition quickly!
If you think we’re remotely off-the-wall on our outrage, please read three TB expert’s open letter to the Global Fund in the Lancet.
"The Global Fund's decision will cripple the efforts to control both diseases, and the effects on TB control will be particularly profound ... 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 decision to suspend The Global Fund projects in North Korea, with almost no transparency or publicity, runs counter to the ethical aspiration of the global health community, which is to prevent death and suffering due to disease, irrespective of the government under which people live."
And then you might also read Richard Horton's Lancet article on the case for Health Diplomacy in North Korea.
"The goal of western nations, united with China and Russia on the UN Security Council, is to squeeze Pyongyang to such an extent that the regime capitulates, even collapses....Punishing Kim Jong-un is one thing. Collectively punishing DPRK's 25 million people is quite another. The DPRK is not only a political entity. It is also a society of human beings....It is easy for western leaders to demonise a nation-state. But it is ethically unacceptable to demonise a population that is already suffering."
Thank you so much for reading – and if you haven’t already done so, please, please sign the petition.
 According to the WHO’s 2017 Global TB Report the only countries with higher incidence rates were South Africa, Lesotho, Kiribati, the Philippines and Mozambique.
 All of these data come from the WHO’s 2017 Global TB Report.