Author: Alfred Zylyftari, Denisa Lazi, Hejli Haxhija
With the outbreak of the COVID-19 pandemic, Albania, like all countries in the region, faced an increase in the number of infected people, which at the beginning of this year led to the almost collapse of the hospital system! Many people chose to be treated at home, and in private hospitals, and often used medications not found in state hospital protocols and in some cases administered drugs trafficked from neighboring countries.
The question remains, what made Albanians treat themselves privately and lose trust in state hospitals? Was it a spirit of distrust in service quality, fear of protocols used, or suspicion of medications in state-owned pharmacies?
Three protocols against Covid
At a time when many of the world’s top medical institutions have made treatment and management protocols for COVID-19 public, to gain the trust of the general public, on the website of the Ministry of Health or the Institute of Public Health it is almost impossible to find any information on this issue.
ACQJ addressed the Ministry of Health with questions on the protocols used in COVID hospitals for the treatment of patients with COVID-19, and the latter, in a general response specified that “the anti-covid protocols used in Albania are bult by the covid hospitals themselves with WHO suggestions and orientation. Covid Hospital 1 has implemented three protocols. The first Covid 19 Clinical Management Protocol (February 14, 2020) was built by adapting the WHO and some Infectious Diseases Associations and Hospitals guidelines of the advanced countries of the world. The second Covid Management Protocol was established on May 21, 2020, and the third protocol (January 21, 2021) is a revision of the previous protocols.
“Covid Hospital 2 has built its protocol based on 6 WHO guidelines: community pneumonia protocol, pulmonary thromboembolism, respiratory failure, respiratory dendrites, non-invasive and invasive ventilation and oxygen therapy. The treatment protocol for the infected at home was approved by order no. 579, on October 14, 2020. ”- was written in the response of the Ministry.
The Regional Cooperation Council (RCC), based in Bosnia and Herzegovina, with the outbreak of the pandemic and based on the experience gained in the first months of coping with the disease, in cooperation with the Italian government has distributed guidelines and protocols in the Western Balkans the Italian protocols for the treatment of patients with Covid-19.
Given the current situation in the fight against the COVID-19 outbreak in the economies of the Western Balkans and Italy’s extensive experience in treating infected patients, the Italian government has contributed to the region’s battle against the spread of the virus by sharing its operational guidelines for treatment of patients with COVID-19.
This Council, at the request of the Italian Embassy in Bosnia and Herzegovina, provided translation of the protocols into the languages of the Western Balkan economies and distributed them to governments throughout the region for further sharing with their respective physicians. The Albanian Center for Quality Journalism had a communication with the RCC where the latter was asked if they have received any feedback from the Albanian state regarding this protocol they have distributed, and if this protocol has been implemented or taken into account by the Albanian government.
In its response, the RCC said that monitoring the implementation or consideration of this protocol is not in their competence, and in the communication with the Ministry of Health and Social Protection we were told that to build anti-Covid protocols in Albania have been following WHO guidelines, protocols of various hospitals in the world, online video conferencing with managers and doctors of international hospitals and conversations with teams coming to Albania from WHO, but without giving a concrete answer whether these protocols have been used or taken into account. Some doctors say that in Albania health protocols have not been a problem, but the conditions to implement these protocols, leading to a situation in which distrust of the state system has forced the public to find alternative means of treatment, and where deaths due to covid, during 2020, have been exponentially higher than in the countries of the region or the EU.
Pandemic, but on open-doors and borders policies
Albanian citizens who wanted to travel to EU countries and beyond, in recent years have encountered many difficulties to cross the border. Until May 2021, only Albanian citizens who had residence permits of the countries to which they were traveling, or had special reasons of movement for health or business reasons were allowed to cross the border. This travel permission, initially, had as an essential condition the presence of a PCR test, and then, with the start of the vaccination campaign, the vaccination certificate. However, many countries did not recognie the vaccines used in Albania, as long as some them were not recognized by the European or American authorities, further hampering the movement of citizens abroad.
At the beginning of June, Albania almost “said goodbye” to Covid. The number of daily infected nationwide reached only two, but the situation changed dramatically within a few weeks, when the number of daily infected reached 1000, as a result of the open door policy at the Albanian borders.
In June 2021, most European countries opened their borders to all Albanian citizens, who had to be equipped with a vaccination certificate or PCR test or rapid test. This process was in stark contrast to the procedures put in place for foreign or Albanian travelers entering the Albanian territory. Foreign travelers who wanted to visit Albania found it very easy to enter our country as neither a vaccination certificate nor a test was required until September 2021.
Asked about the protocols of quarantine and health verification at the entry points of the territory, the Ministry of Health pointed out that since June 2020, the latter has issued relevant orders to monitor and report suspected cases of COVID-19 at airports and country-wide border crossings, and a number of subsequent orders to amend the latter. However, how effective these orders have been can hardly be confirmed.
In the period of January 2021 – August 2021, more than 13 million passengers traveled through the different border points in the territory of the Republic of Albania, with about 6.7 million passengers entering the territory of the Republic of Albania and 6.7 leaving the territory. The vast majority of them have not complied with any quarantine protocol, seeing that the largest number of passengers was during the tourist season, May-August 2021.
Tritan Shehu, former Minister of Health, when asked by the ACQJ regarding the protocols applied by the Albanian state for all persons entering the territory, said that “Albania had to implement the protocols of European countries regarding tourists.”
From Kosovo alone, in the summer months there were about 1.1 million travelers. With the beginning of the tourist season, in Kosovo and Northern Macedonia, the number of infected people started to increase exponentially, with the peak of infections during the summer months. Although most tourists in Albania were from these countries, and the numbers of infections and deaths in the respective countries were constantly increasing, the Albanian government took no precautionary measures and entry to the border from these countries was free without a vaccination certificate and without a test until at the end of the tourist season.
The number of foreign nationals, according to the Ministry of Tourism, entering Albania during the eight months of 2021, is 4,384,072, of which 2,177,412 are Kosovar citizens and 448,370 are from Northern Macedonia, with only during August more than 790,000 and 110,000 travelers being from the respective countries.
Asked why there are strict travel restrictions for Albanian citizens, but these measures are not reciprocal and if such a thing endangers public health, Ilir Alimehmeti, clinical epidemiologist said that “the documentation to the border, the protocols that were for preventing cross-border distribution we have clearly noticed that it has failed everywhere so it never happened even at the beginning of the pandemic when it was easier to block cases could not be done, no longer that the infection is in the community. The request for documentation has remained as just an inertia, but we clearly can not block the virus by looking for pieces of paper. Even people who have been vaccinated can become infected and as a result, we cannot stop the virus through these measures. I use the expression that the sun is not covered with a sieve. In this regard no one is protected. So, it does not matter that to get out we have them stricter protocols than those to enter the country. This element does not make a big difference.”
According to the police data, during the period of January-August 2021, even citizens from India and Bangladesh, with respectively 6034 and 1347, have entered the country. In this specific period of time, these countries had the peak of infection numbers among the community, and yet they were able to enter our country freely without any restrictions.
From a number of observations conducted, on the coast cities and towns, during the tourist season, the ACQJ noticed that no Covid protocols were implemented or respected in bars, restaurants and other public spaces, despite the fact that such protocols have been in power throughout the time span. It has often been the local and central authorities themselves who have organized and allowed events with the participation of hundreds or thousands of citizens, in violation of orders and regulations issued by these institutions themselves.
Photos of various events organized or allowed by the local and central government in the municipalities of Tirana, Vlora and Saranda, posted on the social networks of these institutions or organizers
Asked about the possible connection between the increase of infections at the end of the tourist season and the correlation of infections in Kosovo and Northern Macedonia, and those in Albania, epidemiologist Alimehmeti noted that the reason for the increase in the number of infections was the delta variant. “If we look at this epidemiologically and compare it with the region, i.e. with Kosovo and Macedonia, which have also the largest number of tourists in Albania, we will see that they were in the highest epidemiological curve 2-3 weeks before us and we followed 2-3 weeks later. So, the peak in Kosovo and Macedonia was on August 25, and in our country on September 8-10. So about 2 weeks later, which means that potentially in Albania the infections have come from the massive entry of tourists from Kosovo and Macedonia. Would we have been able to stop it through control? I’m afraid not. We could have postponed it a bit, but no, we would not have stopped it.” says Alimehmeti.
At the beginning of September 2021, at the end of the tourist season, the Government imposed new and tougher restraining measures on all travelers entering the Albanian territory, with requirements for PCR tests and vaccination certificates, including citizens of Kosovo and Northern Macedonia. However, the damage was done. From 5 infections per day during the first months of summer, in September, Albania caught records of infections with more than 1000 infections per day, and with deaths that were gradually increasing in the following weeks. Subsequent months showed a gradual and slight decline in the numbers of infections, but the low summer 2021 figures are not expected to be reached at least until the end of winter, or the increase in the numbers of vaccinated citizens.
Albanians travel to Europe, but at extreme costs
At a time when travelers almost all over the world have the obligation to generate only one vaccination certificate, Albanian travelers, or even foreigners who have to travel outside the Republic of Albania, beyond the travel costs that are normally applied, have increased costs due to to the verification of their status as not infected with COVID-19. In the case of travel to many European countries, or beyond, they are required to deposit to the border authorities a PCR or rapid test, at a price many times higher than in Europe, regardless of their vaccination status.
From a simple online verification, it is clear that rapid tests in Europe are sold in supermarkets at a price of 1-3 Euros while in Albania they cost in specific pharmacies or at test points at airports or border points at a cost of more than 20 Euros. Often, in Europe, if a person is insured, PCR swabs are included in the free medical service, while in Albania, except when a person is suspected of being infected with COVID-19, this service is provided only by private clinics. This fact was confirmed by the Ministry of Health for ACQJ, stating that for trips abroad, the medical administration does not provide PCR test service, but only in cases of suspected infection. Even in these cases, this tampon performed at the family doctor cannot serve as proof for travel.
Various citizens interviewed by ACQJ, near the border crossings of Hani i Hotit, the port of Durres and near the airport of Rinas, say that these prices are high for the budget of Albanian citizens. In many European countries, their governments subsidize or offer them for free to certain groups such as pensioners or students.
S.V. student in Austria, who is forced from time to time to travel to Albania to meet family, when asked if the private practice of tampons or their price is justified says that “It is not justified because it is a relatively expensive price, especially when we refer to Albania which is a country in transitional development. In other European countries, the test is free, and even doctors at home can assist.”
ACQJ, during 2021 conducted a survey of the PCR swab test service market for overseas travel in the cities of Tirana, Durres and Shkodra, in June and October 2021. What we noticed is that in most cases, the price of this service not only has not followed the trends of its cost reduction like any many other countries, but is static in most operators at a price which raises suspicions of anti-competitive practices and tacit collusion for price fixing. The Ministry of Health itself has set a ceiling price on PCR tampons at the end of 2020, and there has been a statement from laboratories on setting a common price in the same period that raises suspicions of a tacit illegal agreement between these operators. .
Asked by the ACQJ if there have been complaints from citizens about the price of tampons or rapid tests in private clinics and if the institution itself has undertaken an administrative investigation into possible anti-competitive practices, the Competition Authority stated that no complaint had been filed with them, and the institution had not undertaken any investigation propriu motu on the statements of the operators and the fact that the prices in the respective market are almost identical.
At the same time, Ersida Teliti, Executive Director of the Albanian Consumer Center tells the opposite regarding this issue. In an interview with ACQJ, she states that in fact her center has sent a complaint to the Competition Authority due to the increase and fixation of the price of swabs. “In fact, we have sent the complaint of some customers who have written to us at the address of the center via Instagram, where they complained about the price setting by the Ministry of Health, where theoretically it seems, although it is an issue related to traders and since we are focused on consumer protection and human rights, we initiated exactly this complaint with the Competition Authority. ”- she says.
In the complaint dated 28.12.2020, addressed to the Competition Authority, based on the numerous denunciations, the QKSH has requested the latter to launch an in-depth investigation and put under market monitoring all entities that provide PCR test services, and launching the investigation and placing under monitoring the subjects that provide tests for COVID-19, such as: PCR, D Dimer, Blood test, etc. where an increase in prices is observed.
Teliti states that “The focus of the complaint, although in fact it seemed to affect and offend the operators, in reality at the end of the day is a matter of the consumer, focused precisely on the restriction of the service in the hands of two, three or four official entities through an order of the Ministry of Health. This would in fact lead to direct distortion of competition, impossibility to have reductions or other price changes in favor of the consumer, but in conditions when in fact no one is affected and does not consider either the quality or the ways of doing these, effectiveness in the results whether they are fictitious or not, this would directly affect the consumer.”
Although the complaint has been filed with the Competition Authority for a year now, and it has been continuously pursued by QKSH, no response has been received from the latter, and no administrative investigation has been initiated into the matter. For Mrs. Teliti, the liberalization of the service is the only way to protect the interest of the consumer, an attitude that has been expressed by Tritan Shehu as well, who states that “Liberalization of all tests, liberalization of laboratories and implementation of WHO protocols”, are the only effective steps for managing the situation.
According to Mr. Shehu, “In Albania there has been a great lack of tampons, not having tests means non-diagnosis, because Covid is diagnosed by tampons and if tampons are not used, […] reducing the number of tampons leads in concealing cases and tracking cases. This is a big problem that Albania still has and in general the policies that have followed the testing. Instead of liberalizing rapid tests, they are kept centralized and blocked for pharmaceutical companies and are not allowed to be brought to Albania. This is a big problem, it is a deeply wrong, centralist policy that seeks to hide the reality in Albania.”
Such a problem was also noticed by the Supreme State Audit, in its performance audit report on pandemic management by state institutions, in which it found a number of violations by state authorities, among which was precisely and the inability of the Institute of Public Health, as the only institution responsible for national surveillance and investigation of infectious diseases, in issuing the results of relevant tests for the effect of documentation and / or travel abroad of citizens.
The Public Health Institute, in June 2020, addressed the Ministry of Health with a request that testing for COVID-19 for documentation effect be performed in laboratories outside the PHI, which are certified by the latter. Following this request, the Technical Committee of Experts decided to allow the conduct of molecular PCR testing for SARS-COV-2 in non-public laboratories for administrative needs, recognized by the Ministry of Health, violating the legal provisions according to the SSA, because the certification of these laboratories cannot be performed by the Ministry of Health, but the General Directorate of Accreditation.
At the same time, the SSA has found violations with regards to law and performance in terms of subsidizing and compensating for medications or tests for COVID-19, as long as these procedures have been an unfathomable financial burden for citizens who have an administrative need equested by the Albanian state, in case of teaching and employment in the state administration, or for trips abroad, for citizens who pay state health contributions. It has been more than a month since the release of this report of the Supreme State Audit, and to date there has been no change in travel procedures outside the territory of Albania. Most European countries and beyond still require verification through a PCR test, regardless of vaccination status, and the state has not yet found a mechanism that no longer burdens travelers’ pockets.
While the WHO warns that Europe will face a severe pandemic situation throughout the coming winter, in Albania those who need to travel face the highest prices in the region for the PCR test. At the same time, the country is faced with many infected people trying to recover at home, and arrive at the hospital’s door when doctors do not have much to offer.
Albania is already facing the fourth wave of Covid and the number of infected and victims remains high, compared to Kosovo which a few weeks ago seemed to be losing the fight with the virus. At the time of writing, only 33% of adults have received both vaccines. Skepticism about vaccination has many reasons, one of which is doubt in what the authorities say.