A reunification Rx for Korea

Could «vaccine diplomacy» work on the Korean peninsula? The short answer is yes.

North Korean leader Kim Jong Un, in a New Year’s Day speech, called for reductions in international tension and an end to confrontation with South Korea, while raising the prospect of reunification between the North and South. Ultimately, science diplomacy could play an essential role in helping catalyze improved North-South relations in 2013, with joint programs for elimination of neglected diseases as a cornerstone.

To understand how this might work, it is helpful to examine how North Korea and South Korea diverged more than 50 years ago in their respective disease-control efforts.

Today, South Korea has one of the world’s largest economies and is a member of the Group of 20 major economic powers, but in the period after World War II, the South and the North were equals. Both countries were impoverished — among the poorest in Asia — and comparable to some sub-Saharan African nations today in terms of economic development. Most schoolchildren were infected with intestinal worms, and accumulated evidence indicates that these parasites actually impeded economic development by reducing future wage earning, possibly through their adverse effects on children’s growth and intellectual development.

Rapid economic growth in South Korea began in the 1960s, coinciding with an ambitious program of national disease control based on widespread and mass deworming of schoolchildren. A nongovernmental organization — the Korea Assn. for Parasite Eradication, today known as the Korea Assn. of Health Promotion — led a nationwide effort to administer deworming medicines twice a year from 1969 to 1995. This program, together with parallel improvements in living standards and agricultural technologies, largely eliminated intestinal worm infections in the country.

Additional mass treatment efforts led to the elimination of elephantiasis in South Korea, while great strides were made in malaria control, except when malaria-infected mosquitoes from the demilitarized zone on occasion entered South Korea and caused the infection to re-emerge.

In contrast to South Koreans’ public health and economic gains over the last five decades, North Koreans remain poor and sick. Malnutrition is widespread, as is tuberculosis, and based on studies of refugees fleeing into South Korea, intestinal worm infections are still prevalent, as are other parasitic infections. As a whole, the North’s health system is depleted and in disarray.

So we are faced with this dichotomy: a Western-style, largely parasite-free and highly developed nation juxtaposed with crushing poverty and widespread endemic neglected tropical diseases.

Here’s where vaccine diplomacy can play a key role. For example, the Korea Assn. for Health Promotion, in collaboration with the South Korean government, could implement a program to control neglected tropical diseases, or NTDs, throughout the North. And it wouldn’t be expensive. Providing pills once a year could treat and protect against these diseases for about 50 cents per person. Most such treatments in other nations are donated by pharmaceutical companies, and many programs use existing infrastructure, such as schools and community centers, to administer the treatments, making NTD control and elimination one of the most cost-effective public health initiatives available.

In a few instances, neither the South nor the North has been successful on its own in controlling particular NTDs. A good example is the food-borne trematode infection known as clonorchiasis, which leads to bile-duct cancer. The infection remains highly endemic in both countries, affording a unique opportunity for joint control efforts.

Finally, there is the opportunity of true scientific alliances between nations. There is an urgent need not only in Korea but also in much of Asia for new drugs, diagnostics and vaccines to combat NTDs. During the 1990s the South Korean government collaborated with the United Nations to establish the International Vaccine Institute to develop new vaccines for Asia and the rest of the world. Alliances to share research and development as well as advocacy are underway, such as a new strategic one between the International Vaccine Institute and the Sabin Vaccine Institute.

North Korean scientists also could become partners in biomedical research. For example, in 2009 an advanced tuberculosis laboratory was established in the North to tackle its epidemic, and this activity could be greatly expanded. Further, South Korea hosts five of the top 150 universities worldwide, so these institutions could be encouraged to work with the North.

With adequate political will and support, this could become a breakout year for science and vaccine diplomacy to reduce the disease burden on the Korean peninsula and promote an unprecedented level of scientific collaboration.

Peter Hotez is president and director of the Sabin Vaccine Institute and the Texas Children’s Hospital Center for Vaccine Development, dean of the National School of Tropical Medicine at Baylor College of Medicine and fellow in disease and poverty at the James A. Baker III Institute for Public Policy at Rice University.

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