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Helminthiasis among North Koreans: a chronic public health challenge.

In this article, Eunsuk Chang attempts to describe the burden of helminthiasis in the Democratic People’s Republic of Korea (DPRK, North Korea) using a systematic review of both English and Korean literature [1]. In the end, it is not surprising that he is left with four articles to extract data and analyze – the most recent paper covering only up to 2014. A key reference by Li, et. al. is from 2003 [2]. Medical and health literature about DPRK is sparse. But, despite these glaring limitations, studies such as this are important for a better understanding of the health issues in North Korea and for spurring further research interest both by international and North Korean scientists. A common misconception is that the health of the North Korean people is being ignored by the government, a socialist state. The author uses the word ‘neglected’ to describe the state of helminthiasis in North Korea. It would be more accurate to describe the challenge as ‘chronic’. The DPRK Ministry of Public Health (MoPH), along with the World Health Organization, developed a Plan of Action for 2006 to 2010 for the Prevention and Control of Soil Transmitted Helminthiasis in DPR Korea (unpublished). In the most recent Medium Term Strategic Plan for the Health Sector 2016 to 2020, a strategy for control of Soil Transmitted Helminths & Trematodes as well as a survey to assess the prevalence of Schistosomiasis are included [3]. One of the authors(NS) can confirm that there were many efforts made by the DPRK MoPH to limit the impact of the problem with the support of the WHO and UNICEF. De-worming medicine, either imported or locally produced, were provided twice yearly where children received Vitamin A and Albendazole/ Mebendazole. Another misconception is to designate all responsibility to the DPRK government to address the health problem while failing to consider the geopolitical factors that impact the health of the North Korean people. While the UN agencies have determined there are urgent humanitarian needs in the DPRK impacting as many as 40% of its population and intends to deliver assistance [4], funding shortfalls and the most complex and harshest global sanctions regime have severely impaired the aid from getting through. As Eunsuk Chang correctly points out, improvements in water, sanitation, and hygiene (WASH), are essential in alleviating helminthiasis. Yet, the UN sanctions committee on North Korea has repeatedly delayed or blocked exemption requests by humanitarian organizations for water purification supplies to send to North Korea. Further, although medications are exempted, vehicles to distribute the drugs are scrutinized or blocked and fuel imports have been limited to 10% of previous import levels [5]. We researchers can and should do more to not only pursue the scientific facts but, when appropriate, also the nonscientific factors which so often impact the results.