Democratic People's Republic of Korea

Shrinking the Malaria Map

UCSF Global Health Group’s Malaria Elimination Initiative (MEI)

DPRK, which was malaria-free from the early 1970s to 1997, reported 6,805 cases of local malaria transmission in 2015 and is working to achieve elimination by 2025.

The Democratic People’s Republic of Korea (DPRK) achieved a 92% reduction in malaria cases between 2000 and 2015, from 90,582 reported cases in 2000 to 6,805 local malaria cases in 2015. DPRK first eliminated malaria in the early 1970s and remained malaria-free until cases reemerged in 1998 and quickly spread along the border with the Republic of Korea. Malaria cases are reported throughout the country, except in the three northern provinces of Jagang, Ryangagn, and North Hamgyong. The majority of cases occur in the three provinces bordering the demilitarized zone between DPRK and the Republic of Korea. Plasmodium vivax is the only malaria parasite found in DPRK.

Malaria in DPRK is unstable and seasonal, with more than 95% of annual cases in the past few years reported from May to October, peaking in the summer months. About 70% of all malaria cases occur among overnight workers in the agricultural and industrial sectors, and, as observed in other Asia Pacific countries, most of the at-risk population resides in rural areas. No malaria deaths have been reported in DPRK in more than 30 years, and mass chemoprophylactic efforts--called Mass Primaquine Preventive Treatment (MPPT)--have been credited for the successful reduction of malaria burden to low levels relative to the 2001 peak. In light of this progress in reducing transmission, DPRK launched a national malaria pre-elimination strategy in 2009 and updated it in 2012, emphasizing microstratification of risk areas, geographical reconnaissance to improve targeting of interventions, intensified surveillance, and community education, with an ultimate goal of national elimination by 2025. DPRK is also a country partner of the Asia Pacific Malaria Elimination Network (APMEN).

6,805 # of cases (2015)

2025

Elimination goal

Low

Income level

Reported cases

P vivax transmission limit (2010)

Challenges to elimination

Characteristics of the P. vivax malaria parasite

Research conducted by the Ministry of Public Health in 2000 indicated that there are two strains of P. vivax in DPRK, one with a short incubation period of 2-3 weeks, and the other with a significantly longer incubation period of 6-18 months. The majority (70-80%) of infections in DPRK are caused by the latter strain, which means that most annual infections do not manifest until the following transmission season. MPPT administered prior to the annual transmission season has proven very effective in reducing malaria incidence, but this program requires extensive time and human resources to ensure safety and high coverage.

Sustained financing for elimination

Economic and trade sanctions prevent DPRK from obtaining finances or supplies for malaria elimination activities to which other low-income countries have access. Although the country received Round 8 funding from the Global Fund and US$13.9 million has been allocated under the new funding model for the period 2014-2016, DPRK does not qualify for many other international aid programs, only receives sporadic donor support, and domestic resources are insufficient to cover the funding gaps. Until recently, Republic of Korea provided annual funds and materials to DPRK’s malaria program via the WHO, but this support ceased once the Global Fund grant was awarded. Persistent food shortages and recent flooding have necessitated the diverting of aid toward malnutrition and other infectious diseases, compounding the malaria program’s financing challenges.

Cross-Border Collaboration

No formal cross-border collaboration exists between DPRK and Republic of Korea (South Korea). This is problematic since most of DPRK’s cases are concentrated in the southern provinces bordering the DMZ. Political tension between the North and South is prohibitive to any formal agreement concerning a peninsula-wide approach to controlling malaria. Small-scale collaborative efforts between DPRK and provincial governments of Republic of Korea facilitated by non-governmental organizations have had success in the past, but these are limited in scope and hindered by ongoing political tensions.