More than 4 million vaccine doses have been flown toPyongyang, raising hopes that North Korea could open up again to UN agencies and NGOs amid reports of a worsening health situation in the authoritarian state. “The return of essential vaccines marks a significant milestone towards safeguarding children’s health and survival in this country,” Roland Kupka, Unicef’s acting representative for the Democratic People’s Republic of Korea, said in a statement. The vaccines include those against hepatitis B, polio, measles and tetanus, and were provided by Unicef, the World Health Organization and Gavi, the Vaccine Alliance. Organisers say they are intended for 600,000 children and pregnant women who have missed out on vaccines since the Covid-19 pandemic. They are to be administered as part of a catch-up campaign in September by the North Korean ministry of public health. It follows numerous calls from the US and human rights groups for North Korea, considered one of the poorest countries in the world, to reopen its borders so that vital aid can be delivered. Almost all international aid workers had to leave during the Covid pandemic as the country shut its borders and tightened import controls. This diminished medicine and vaccine supplies as well as food imports, increasing malnutrition and leaving many – including newborns – vulnerable to deadly diseases such as tuberculosis and measles. Prior to the pandemic, almost half of the population was undernourished and since then several floods and typhoons have hit the country, further jeopardising health. Earlier this month, the head of the UN Food and Agriculture Organization, Qu Dongyu, visited North Korea in a bid to reactivate the agency’s relationship with the country and address food insecurity. “The reopening of the border and the return of Unicef’s full team to DPR Korea will be critical to ensuring more essential support can be provided in 2024 and programmes can be scaled up as necessary to meet the needs of children and women,” said Kupka. In 2019, Unicef had about 13 international staff in the country. “I’ve got a feeling they’re going to open again to UN agencies and NGOs,” said Nagi Shafik, who previously consulted for the UN on public health in North Korea, a country he described as “fussy about their security”. Shafik said the North Korean government may have used the hiatus to consider how it would like to work with aid providers. It no longer wants to be looked at as a recipient of aid, Shafik said, but as more of a development partner. “They hate to be reliant on other people,” he said, but are open to ideas and want to be engaged on issues including health. North Korea was voted on to WHO’s executive board last year. “They are open more than people expect,” Shafik said. In the meantime, Kupka urged the North Korean government to facilitate “the earliest possible return” of visiting agency workers.