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.