A number of policy reforms were initiated in Albania in recent years to ensure adequate resources for health, including efforts to reduce private out of pocket spending for health care and to increase public spending on health; further consolidated efforts are under way to further improve sustainable health financing. Before the COVID-19 pandemic, Albania embarked on a process of transforming its health system through increasing integration of social governance and services, improving policy-making systems and structures, regionalizing specialized health services, expanding the use of digital health tools, and improving screening and early detection (especially for non-communicable diseases, which are a substantial burden in the population). These planned reforms, among many others, aim to improve universal health coverage; however, some have been delayed over prioritizing COVID-19 response efforts during 2020.

Albania was impacted by the COVID-19 pandemic while gradually recovering from another crisis. On November 26, 2019, some three months before its first COVID-19 case, Albania was hit by a severe earthquake, triggering substantial human suffering, and resulting in an estimated cost burden of 1.9 million euros to the health sector (including costs to infrastructure and services).[1] Fifty-one individuals died, 943 were injured, and approximately 13 000 were displaced. Thirty-six health facilities were damaged, and four health facilities were destroyed, prompting the need to evacuate many patients. Some health services and facilities (e.g., blood banks) were left temporarily dysfunctional, compromising the health system's response capacity. The Albanian Ministry of Health and Social Protection (MoHSP) coordinated and worked with international partners to quickly establish temporary health centres and redeploy healthcare professionals to treat those injured and displaced. Recovery and reconstruction began soon in December 2019, with some facilities regaining function in mid-December.

The earthquake was graded as a health emergency under the WHO’s Emergency Response Framework, and an emergency team was established both at the country and regional level to support Albania’s immediate response, and post-disaster needs assessment. The WHO Country Office (WCO) in Albania worked closely with the MoHSP to mobilize a strategic and immediate response to the earthquake. This included:

• identifying and coordinating key actors (knowing which entity does what, where and when)
• conducting a needs assessment for field hospitals to ensure continuity of health services
• supporting risk communication to the public
• mobilizing essential resources and procuring supplies
• gearing up early warning and surveillance systems (for displaced populations)
• monitoring water quality and hygiene conditions

The earthquake also led to the revision and redevelopment of Albania's emergency preparedness and readiness plans. Many of these initiatives, spearheaded both by the MoHSP and WCO, facilitated the establishment of robust coordination mechanisms, which had a positive impact on the COVID-19 response and mitigation later. These efforts included conducting the Albanian Post Earthquake Need Assessment and the Albanian Strategic Risk Assessment, developing the Emergency Operation Plan for the National Centre of Medical Emergency, piloting the First Pandemic Influenza A Cases and Contact Investigation protocol, and supporting the Institute of Public Health and their laboratory quality management system.

Aside from improving emergency preparedness, the earthquake experience was also reflected in broader health system reform efforts and integrated into existing plans for the provision of health services. Lessons learned were factored into developing the Primary Healthcare Development Plan and the new National Health Strategy 2021-2030, with notable additions to ensure continuity of essential health services while responding to emergencies.

When the first cases of COVID-19 were registered in March 2020, Albania responded quickly with public health safety measures and strategies, including lockdowns, curfews, closures of certain services and workplaces, suspensions of public transport, and police and army checkpoints at points of entry. Designated COVID-19 treatment units were established, and non-essential health services were reduced to reprioritize resources. The WCO supported overall response coordination by providing updated technical guidance and international evidence as well as facilitating a coordinated MoHSP and broader government response through strategic alignment of UN agencies and stakeholders (especially in procurement, surveillance, and strategies to prevent the spread of COVID-19). WHO directly supported capacity building in laboratories and health services, healthcare and public health workers' training, risk communication training for journalists, and supplied personal protective equipment, testing equipment, and other medical supplies. Overall, these efforts enhanced the national pandemic response, leading to lower initial infection rates and the ability to start a gradual easing of restrictive measures by the end of April 2020.

Albania also enrolled 65 patients into WHO's International Solidarity Trial, which pools 12 000 patients from more than 500 hospitals worldwide to investigate the effects of various drug combinations on mortality, initiation of ventilation and length of hospital stay among COVID-19 patients. This is the first time that Albania has been involved in a large international trial. Albania is also an active member of the International Steering Group, where it interprets intermediate outcomes of the trial and offers recommendations on new research directions.

With effective responses to two health emergencies occurring only a few months apart, Albania demonstrated that a timely integration of lessons learnt from one crisis could improve response measures to a consecutive crisis. Specifically, it achieved this through proactively adapting broader health system structures and plans based on reflections gained from an ongoing emergency. With new COVID-19 cases declining continuously since the end of February 2021 and with the COVID-19 vaccination campaign expanding, Albania seems on a positive trajectory to address the health challenges of the COVID-19 pandemic and strengthen its response capacity to manage future health emergencies.