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SEOUL — As mask mandates and social distancing requirements lift around the world, North Korea remains one of two countries that have not administered any coronavirus vaccines, with no sign of how it can ever begin to reopen despite a brewing humanitarian crisis for its people.

The vaccines that were allocated for North Korea through a United Nations-backed global vaccination effort are no longer available, officials said this month, after Pyongyang repeatedly rejected the initiative's offers of millions of doses.

North Korea, already one of the most closed societies in the world, remains in a strict pandemic lockdown and has shuttered its borders except to a minimal level of trade with China, with grave implications for the health and food security of its population.

The pandemic closure has exacerbated the food crisis, said Tomás Ojea Quintana, the United Nations' special rapporteur on North Korean human rights. In a recent report, Quintana said the country's "covid restrictions, including border closures, appear to have prevented an outbreak inside the country, though likely at considerable cost to the wider health situation and further exacerbating economic deprivation."

No one is clear on the exact situation inside the country, however, because North Korea's retreat inward in the pandemic has restricted remaining channels of information — with diplomats, humanitarian aid groups and tourists no longer able to enter.

In light of the impending crisis, Quintana urged the international community to find some way to get the needed 60 million doses into the country to immunize its population of 25 million.

Last year, North Korea rejected nearly 3 million doses of China's Sinovac vaccine, saying shipments should go to other countries that need them more. North Korea also rejected 2 million doses of the AstraZeneca-Oxford University vaccine out of apparent concerns about potential side effects.

North Korean officials have privately indicated that they would prefer mRNA vaccines, such as Pfizer or Moderna, according to a report by a panel of experts convened by the Washington-based Center for Strategic and International Studies. The panel concluded that North Korea probably would be interested in a high-volume offer of an mRNA vaccine.

With no vaccines at all, North Korea risks becoming the epicenter of new variants as a result of the population's low immunity to the virus, the panel found.

"It is inevitable that they will have to reopen the border, and when they do, the best way to protect their population — which is what they're already interested in — is to vaccinate the population as much as possible, which they are capable of doing," said Kee Park, a global health expert at Harvard Medical School who has worked on health-care projects in North Korea.

"They have to take a different strategy at this point. Zero COVID strategy is starting to crumble," Park said.

Officials at the North Korean Mission to the United Nations did not respond to a request for comment on whether the country intends to accept vaccines or what it hopes to see before moving forward on an immunization program.

North Korea and Eritrea are now the only two countries in the world that have not administered vaccines.

The Gavi Alliance, part of the Covax initiative that aims to deliver vaccines to the world's most vulnerable people, said this month that it no longer has vaccine doses allocated for North Korea but that they could be made available again if the country changes its mind and starts an immunization program and meets technical requirements.

North Korea had completed some of the requirements for accepting Covax deliveries, but there were ongoing negotiations on whether North Korea is willing to indemnify the vaccine manufacturer against unexpected side effects.

Two years since North Korea's declaration of a "national emergency response" to the coronavirus, the lockdown shows no signs of letting up, with state media this week urging the public to "strengthen the anti-epidemic work in preparation for the prolonged emergency." A piece published in the state newspaper Rodong Sinmun warned against "sloppiness and idleness" in anti-epidemic work.

Still, at the year-end party plenum in December, North Korea announced it will shift from a "control-based anti-epidemic work" to an "advanced and people-oriented" measure that seeks to "strengthen the anti-epidemic stronghold while overcoming circumstances that ignore convenience for our people," according to state media.

"Such a change in the basis of their anti-virus approach is a confession that there are limitations to fundamentally solving the problem with control and restriction alone, and that the long-term restrictions caused fatigue and discontent among the people," said Kim Ho-hong, a researcher at Seoul-based Institute for National Security Strategy, in a report.

Ahn Kyung-su of the Seoul-based research center dprkhealth.org said Pyongyang's "people-oriented" slogan was probably an effort to alleviate pandemic fatigue, and he noted that the restrictions remain in place partly because of the virus resurgence in China, which is being closely tracked in state media.

"North Korea showed signs of reopening earlier this year in January, when trains briefly ran across the Chinese border, but the virus spike in mainland China led North Korea back into a strict isolation," he said.

Anti-viral drugs could be a potential route for North Korea to reopen without needing to accept outside monitoring of its technical capabilities, the CSIS panel suggested. While the mRNA vaccine requires a sophisticated cold-chain and other logistics, anti-viral pills can be distributed more easily.

In light of what could possibly be an unfolding humanitarian crisis, the international community needs to find some way to persuade Pyongyang to reopen, U.N. special rapporteur Quintana asserted.

"A new way of thinking needs to take hold. This will require vision and initiative, driven by the needs of the North Korean people rather than any other agenda," he said in his report.

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