By See-Won Byun, Paul Choi, Kevin Shepard, Adrian Yi, Yun Yi

H1N1 Outbreak in North Korea

IntroductionPrimary Concern:• Disease crossing DPRK borders and becoming a

global pandemic. Scenario Background:• South Korea detects a recent outbreak of the H1N1

virus with a high mortality rate and believes it is spreading throughout the DPRK. Within one week, NGOs report 500 casualties and over 5000 infections.

• DPRK kicks out WHO officer Ilsa Nelwan, the officer responsible for the WHO's collaborating center in Pyongyang (the Institute of Public Health Administration, Ministry of Public Health).

• Accepted protocol is that international coordination of such outbreaks should be done through the WHO's International Health Regulation system, but the DPRK has ceased communication.   

Actors•D

emocratic Republic of Korea (DPRK, North Korea)

•Republic of Korea (ROK, South Korea)

•United States (U.S.)

•Japan

•People’s Republic of China (PRC, China)

Task: Simulate Collaboration to Prevent a Global Pandemic

Phase I• Divide group into teams that represent each of the 5 actors• Each team will:

• Identify top 5 threats and top 5 priorities/interests of their respective countries

• Prioritize these 2 categories in descending order• Return to group. Teams present and share findings.

Phase II• Given these different sets of interests, develop an action plan of

10 steps to take within the 1st 24 hours that maximizes objectives of your team.

• Then, develop a coordination strategy that includes:• A mechanism for cooperation• Burden/cost sharing system

Phase III• Simulate a negotiation to reconcile the 5 plans

North Korea

North Korea: Responsible Offices

National De-fense Com-

mission(Kim Jong Il)

State SecurityDepartment

Ministry of Peo-ple’s Armed

Forces

Supreme People’s As-

sembly

Cabinet

Ministry of Foreign Af-

fairs

Ministry of People’s Se-

curity

Ministry of Public Health

North Korea

Background Reading• “National Strategy for Successful Control and Prevention of Avian Influenze in DPR

of Korea,” Ministry of Public Health,DPRK, July 22, 2006. http://ochaonline.un.org/roap/WhatWeDo/PandemicPreparedness/PreventionandControloftheNextPandemic/NationalPlansofCountriesinAsiaPacific/tabid/4308/language/en-US/Default.aspx

• General understanding of DPRK government view of NGO’s, by Gordon Flake: http://www.mansfieldfdn.org/pubs/pub_pdfs/hirctestimony.pdf

• Most recent population data for the DPRK: http://unstats.un.org/unsd/demographic/sources/census/2010_phc/North_Korea/2008_North_Korea_Census.pdf

• http://www.redorbit.com/news/health/731721/report_scarlet_fever_spreads_in_nkorea/index.html

• http://www.eugenebell.org/eng/business/business_01.html• http://www.caritas.or.kr/DPRK/

South Korea

South Korea: Responsible Offices

System & Actors I - Macro: Foreign and Security Policy Coordination CouncilDirect Control: Chief of StaffChair: MOFAT MinisterCouncil Members: Defense Minister NIS Chief, Chief of the PM Office, Unification Minister, Sr. Pres. Sec. For. Affairs & Nat’l Sec.

South Korea: Responsible Offices (2)System & Actors II - Micro:

South Korea

Background Reading• Reform locally, act globally?  Crisis management trends in Korea, James Schoff and Choi Hyun-jin, KEI Apr 2008

• http://www.magnetmail.net/images/clients/KOREA/attach/SchoffChoiFINAL.pdf • Trilateral tools for managing complex contingencies: US-Japan-Korea cooperation in disaster relief and stabilization/reconstruction missions, James Schoff IFPA Nov 2005, http://www.ifpa.org/pdf/Trilat_Tools_DC_Seminar_Rprt_1105.pdf

• “The Pandemic Influenza Challenge: Multilateral Perspectives on Preparedness, Response Planning, and Areas for Cooperation,” IFPA, January 2007. http://www.ifpa.org/pdf/pandemicDTRA_s.pdf

• “Pandemic Influenza Preparedness and Response Plan 2006,” Ministry of Health & Welfare, Korea Centers for Disease Control & Prevention, 2006. ROK Pandemic Flu Response Plan

United States

United States: Responsible Offices

Domestic Response

Overseas Response

State Dept.

CDC

DHS

USFK

IPAPIDept. of Health

and Human Services

DOD

UN and other

International and

Regional Agencies

Regional Gov’s

United States

Background Reading• Trilateral tools for managing complex contingencies: US-Japan-Korea cooperation in disaster relief

and stabilization/reconstruction missions, James Schoff IFPA Nov 2005, http://www.ifpa.org/pdf/Trilat_Tools_DC_Seminar_Rprt_1105.pdf

• MED Pandemic Influenza Information: http://medical.state.gov/index.cfm?fuseaction=public.display&id=4d41223b-890b-4fc1-b1c9-11578578f25a

• Office of Foreign Missions Pandemic Influenza http://www.state.gov/ofm/c19455.htm• US Department of Defense Global Emerging Infections Surveillance and Response System (DoD-

GEIS): http://fhp.osd.mil/aiWatchboard/ • “The Pandemic Influenza Challenge: Multilateral Perspectives on Preparedness, Response

Planning, and Areas for Cooperation,” IFPA, January 2007. http://www.ifpa.org/pdf/pandemicDTRA_s.pdf

• Pacific Public Health Surveillance Network: http://www.spc.int/phs/PPHSN/index.htm• World Health Organization http://www.who.int/csr/disease/swineflu/en/ • http://www.cdc.gov• http://www.pandemicflu.gov

Japan

Japan: Responsible Offices

Ministry of Health,

Labor, and Welfare (MHLW)

Ministry of Foreign Affairs

Ministry of Defense Coast Guard

Prime Minister

National Institute of Infectious Disease

WHO collaborating

center

JapanActors & RolesMinistry of Health, Labor, and Welfare (MHLW) Adopts response policies Leads planning & coordination among relevant government bodies:

Cabinet Secretariat; Ministries of Foreign Affairs; Finance; Environment; Land, Infrastructure & Transport; Agriculture, Forestry & Fisheries; Education, Culture, Sports, Science & Technology; Ministry of Defense; Coast Guard; National Police Association; Small & Medium Enterprise Agency

Coordinates international & local efforts in public & private sector:Healthcare providers & suppliers; Medical institutions; Social welfare facilities; Public transportation; Media; Private & nonprofit corporations

Prime Minister Takes lead from MHLW at human-human transmission phase

National Institute of Infectious Diseases As WHO collaborating center conducts surveillance; provides

technical assistance for development of national & regional health programs

Japan

Background Reading• WHO, “Coordinated approach for responding to early pandemic

events”, Japan-WHO Joint Meeting on Early Response to Potential Influenza Pandemic in Asia, Tokyo, Japan, 12-13 January 2006.

• Trilateral tools for managing complex contingencies: US-Japan-Korea cooperation in disaster relief and stabilization/reconstruction missions, James Schoff IFPA Nov 2005, http://www.ifpa.org/pdf/Trilat_Tools_DC_Seminar_Rprt_1105.pdf

• “The Pandemic Influenza Challenge: Multilateral Perspectives on Preparedness, Response Planning, and Areas for Cooperation,” IFPA, January 2007. http://www.ifpa.org/pdf/pandemicDTRA_s.pdf

China

China: Responsible Offices

Central Military Commission

PLA

State Council

MOFA

Dept of Asian Affairs

Dept of North American and

Oceanian Affairs

Ministry of Health

Center for Public Health Emergency

WHO in China

Communicable Disease

Surveillance and Response

team

China CDC

Office of Disease Control and Emergency

Response

China

Background Reading

• Huang Yanzhong, “China’s Reaction to H1N1 Pandemic Flu,” EAI Background Brief No. 498, January 8, 2010. http://www.eai.nus.edu.sg/BB498.pdf

• “China’s H1N1 Response and Public Opinion: Promise and Potential Challenges,” CSIS, Novmber 5, 2009. http://www.smartglobalhealth.org/blog/entry/chinas-h1n1-response-and-public-opinion-promise-and-potential-challenges/

• Chinese Center for Disease Control and Prevention: http://www.chinacdc.net.cn/n272562/

Coordinating a ResponseIn Resolving the issue, “How do regional actors collaborate in order to get

the DPRK to cooperate in order to prevent a global pandemic?”, the following should be considered:

Prioritization of objectives Coordination of resources Division of cost/burden Areas for Joint Response: (1) Detection & reporting (2) Assessment & decision-making (3)

Resource mobilization (4) Implementation (5) Monitoring & evaluation Common Priorities/Challenges Interagency; public-private; civil-military; domestic-international coordination mechanisms Availability of supplies: Possible nationalization of production facilities Pandemic-related global economic crisis; social instability at home Spread of biological terrorism

DPRK-Specific Challenges Uncertain DPRK leadership response: reluctance toward info-sharing, foreign intervention DPRK non-membership in international organizations DPRK domestic situation; possible insurgency against police & military enforcement of

quarantine Diplomatic/political tensions: DPRK-Japan, DPRK-U.S., inter-Korean Inefficient distribution of external supplies to DPRK (and who distributes/how); Training of

international & DPRK staff for common understanding; human & material resource constraints Lack of legal & other national capacities to implement measures, standard operating procedures Delay in DPRK-WHO reporting; Lack of rapid & transparent info-sharing

Reading Lists

Required Reading “Pandemic H1N1 Influenza: The Evolving Saga,” Smart Global Helath.org.

http://www.smartglobalhealth.org/issues/entry/h1n1-influenza

The pandemic influenza challenge: Multilateral perspectives on preparedness, response planning, and areas for cooperation, James Schoff and Marina Travayiakis, IFPA Jan 2007, http://www.ifpa.org/pdf/pandemicDTRA_s.pdf

Reform locally, act globally?  Crisis management trends in Korea, James Schoff and Choi Hyun-jin, KEI Apr 2008, http://www.magnetmail.net/images/clients/KOREA/attach/SchoffChoiFINAL.pdf

General understanding of DPRK government view of NGO’s, by Gordon Flake: http://www.mansfieldfdn.org/pubs/pub_pdfs/hirctestimony.pdf

Preparing for the next influenza pandemic: roles and responsibilities of Roche and other stakeholders, Roche May 2008, http://www.roche.com/sus_csoc-acc_influenza.pdf

Recommended Reading WHO, “Coordinated approach for responding to early pandemic events”, Japan-WHO Joint Meeting on Early Response to

Potential Influenza Pandemic in Asia, Tokyo, Japan, 12-13 January 2006.

“The Pandemic Influenza Challenge: Multilateral Perspectives on Preparedness, Response Planning, and Areas for Cooperation,” IFPA, January 2007. http://www.ifpa.org/pdf/pandemicDTRA_s.pdf

Trilateral tools for managing complex contingencies: US-Japan-Korea cooperation in disaster relief and stabilization/reconstruction missions, James Schoff IFPA Nov 2005, http://www.ifpa.org/pdf/Trilat_Tools_DC_Seminar_Rprt_1105.pdf

Most recent population data for the DPRK: http://unstats.un.org/unsd/demographic/sources/census/2010_phc/North_Korea/2008_North_Korea_Census.pdf

Huang Yanzhong, “China’s Reaction to H1N1 Pandemic Flu,” EAI Background Brief No. 498, January 8, 2010. http://www.eai.nus.edu.sg/BB498.pdf

“China’s H1N1 Response and Public Opinion: Promise and Potential Challenges,” CSIS, Novmber 5, 2009. http://www.smartglobalhealth.org/blog/entry/chinas-h1n1-response-and-public-opinion-promise-and-potential-challenges/

Related Sites

MED Pandemic Influenza Information: http://medical.state.gov/index.cfm?fuseaction=public.display&id=4d41223b-890b-4fc1-b1c9-11578578f25a

Office of Foreign Missions Pandemic Influenza http://www.state.gov/ofm/c19455.htm

US Department of Defense Global Emerging Infections Surveillance and Response System (DoD-GEIS): http://fhp.osd.mil/aiWatchboard/

Hawaii’s Department of Health: http://hawaii.gov/health/about/H1N1.html Pacific Public Health Surveillance Network:

http://www.spc.int/phs/PPHSN/index.htm World Health Organization http://www.who.int/csr/disease/swineflu/en/ Center for Disease Control: http://www.cdc.gov

http://wwwn.cdc.gov/travel/contentSwineFluMexico.aspx http://wwwn.cdc.gov/travel/contentSwineFluUS.aspx http://www.pandemicflu.gov

Chinese Center for Disease Control and Prevention: http://www.chinacdc.net.cn/n272562/

References DPRK leadership chart: http://www.fas.org/irp/dni/osc/dprk-leaders.pdf WHO general outlook on North Korea: http://www.who.int/countries/prk/en/

WHO coverage of 2005 Avian Flu outbreak: http://www.who.int/csr/don/2005_03_30/en/index.html

WHO assistance on measles outbreak: http://www.who.int/immunization/newsroom/north_korea_measles/en/ Example of NK refusing help:

http://www.wfp.org/stories/north-korea-political-agreement-reached-still-no-response-humanitarian-crisis

NK treatment of US NGOs: http://blogs.abcnews.com/politicalradar/2009/03/north-korea-can.html

“North Korea Rejects US Food Aid, Kicks Out US NGOs,” http://blogs.abcnews.com/politicalradar/2009/03/north-korea-can.html

“NGOs Remain Committed to N. Korea Despite Expulsion” http://www.christianpost.com/article/20090321/ngos-remain-committed-to-n-korea-despite-expulsion/index.html

“First NGO Heading for North Korea this Week,” http://www.dailynk.com/english/read.php?cataId=nk00600&num=5243

S. Korean NGOs say aid for N.Korea is going to waste in Incheon Harbor,” http://english.hani.co.kr/arti/english_edition/e_northkorea/362526.html

“Pandemic Influenza Preparedness and Response Plan 2006,” Ministry of Health & Welfare, Korea Centers for Disease Control & Prevention, 2006. ROK Pandemic Flu Response Plan

References (cont.) http://www.redorbit.com/news/health/731721/report_scarlet_fever_spreads_in_nkorea/index.html

http://www.eugenebell.org/eng/business/business_01.html

http://www.caritas.or.kr/DPRK/

http://www.phac-aspc.gc.ca/tmp-pmv/pub-eng.php Canada - Public Health Agency - Travel Advisories

http://www.fco.gov.uk/en/travelling-and-living-overseas/travel-advice-by-country/north-central-america/mexico UK - Foreign and Commonwealth Office - Travel Advice – Mexico

WHO's International Health Regualtion system (http://www.who.int/features/qa/39/en/index.html

The pandemic influenza challenge: Multilateral perspectives on preparedness, response planning, and areas for cooperation, James Schoff and Marina Travayiakis, IFPA Jan 2007, http://www.ifpa.org/pdf/pandemicDTRA_s.pdf

(Abstract only) When the flu comes: political and economic risks of pandemic disease in Asia, Ann Marie Kimball, NBR Sep 2006, http://www.nbr.org/publications/element.aspx?id=339

“Japan’s contribution to the early response to pandemic influenza,” Presentation at Japan-WHO Joint Meeting on Early Response to Potential Influenza Pandemic, Tokyo, Japan, 12-13 January 2006, http://www.wpro.who.int/NR/rdonlyres/239FAEA5-255F-4611-A434-30F59FEAB335/0/DP6_Japan.pdf.

Pandemic Influenza Preparedness Action Plan of the Japanese Government, 2005 (rev. 2007), http://www.mhlw.go.jp/english/topics/influenza/dl/pandemic02.pdf.

DPRK Pandemic Control Plan : http://ochaonline.un.org/roap/WhatWeDo/PandemicPreparedness/PreventionandControloftheNextPandemic/NationalPlansofCountriesinAsiaPacific/tabid/4308/language/en-US/Default.aspx

USFK Public Health Emergency Officers (PHEO) program

http://8tharmy.korea.army.mil/g1_AG/Programs_Policy/UploadedFile/USFK/USFK%20Reg%2040-4%20Public%20Health%20Emergency%20Officer%20(PHEO).pdf