With the outbreak of the pandemic COVID-19 on a global level, 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 in home settings and private hospitals and often used medications that were not found in the protocols of state hospitals and in some cases received drugs trafficked from neighboring countries.
But what made the Albanians to treat themselves privately and lose faith in state hospitals? Was it a spirit of mistrust towards the quality of the service, fear of the protocols used or suspicion of the medicines in state pharmacies?
Three protocols against Covid-Item
At a time when many of the highest medical institutions in the world rank the protocols of medication and treatment COVID-19 they have done public to win public trust wide, in websiteof 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 about the protocols used in hospitals Covid for the treatment of patients with COVID-19 and the latter in a general reply specified that "The anti-Covid protocols, which have been used in Albania, have been made by the Covid hospitals themselves with the suggestion and guidance of the WHO. The COVID 1 Hospital has implemented three protocols. The first protocol of the Clinical Management of COVID-19 (February 14, 2020) was built by adapting the guidelines of WHO and several infectious disease associations and hospitals of advanced countries of the world. The second Covid Management Protocol was established on May 21, 2020, while the third protocol (January 21, 2021) is a revision of the previous protocols.”
"The COVID 2 hospital has built its protocol on the basis of 6 WHO guidelines: the protocol of pneumonia, pulmonary thromboembolism, respiratory failure, respiratory distress, non-invasive and invasive ventilation and that of oxygen therapy. The treatment protocol for the infected at home was approved by order no. 579, on October 14, 2020.", - was written in the ministry's response.
Regional Cooperation Council (RCC), based in Bosnia-Herzegovina, with the outbreak of the pandemic and based on the experience gained in the first months of dealing with this disease, in cooperation with the Italian government, has distributed in the Western Balkans the Italian operating instructions and protocols for the treatment of patients with COVID-19.
Given the current situation in the fight against the outbreak of COVID-19 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 treating patients with COVID-19.
This Council, at the request of the Italian Embassy in Bosnia and Herzegovina, has provided translation of protocols in the languages of the Western Balkan economies and distributed them to governments across the region for further sharing with their respective practitioners. Albanian Center for Quality Journalism had a communication with RCC, where the latter was asked, if they have received any reaction from the Albanian state regarding this protocol that they have distributed and if this protocol has been implemented, as well as whether it is being taken into account by the Albanian government.
In his answer RCC said that monitoring the implementation or taking into account this protocol is not within their competence and in the communication we had with the Ministry of Health and Social Protection we were told that in order to build anti-Covid in Albania, WHO guidelines, protocols of various hospitals in the world, video conferences have been followed online with leaders and doctors of international hospitals and conversations with teams coming to Albania from the WHO, but without giving a concrete answer, whether these protocols were used or taken into account. Some doctors say that in Albania the 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 Covidduring 2020 were in order exponentially higher than in the countries of the region or the EU.
Pandemic, but in borders with open doors
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 were allowed to cross the border, who were equipped with residence permits of the countries they were traveling to or had special reasons to move, such as for health or business reasons. This travel permit originally had as an essential condition the passing of a test PCR and then, with the start of the vaccination campaign, the vaccination certificate. However, many countries did not recognize the vaccines used in Albania, as long as some of the latter have not been recognized by the authorities Europeans apo US, further complicating the movement of citizens abroad.
At the beginning of June, Albania almost "separated" with Covid -in. The number of daily infections in the country reached only two, but the situation was reversed within a few weeks, when the number of daily infections reached 1000, due to 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 a test PCR, or the quick test. This process was in sharp contrast with the procedures put into effect 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 quarantine and health verification protocols at the entry points of the territory, the Ministry of Health pointed out that, since June 2020, the latter has issued the relevant orders for the follow-up and notification of suspected cases with COVID-19 at airports and border points in the country, and a number of subsequent orders for the amendment of the latter. However, how effective these orders have been can hardly be confirmed.
In the time frame January 2021-August 2021, more than 13 million travelers traveled to the territory of the Republic of Albania from various border points, with about 6.7 million travelers entering the territory of the Republic of Albania and 6.7 exiting the territory, most overwhelming of which have not respected any quarantine protocol, seeing that the largest number of travelers was precisely during the tourist season, the months of May-August.
Tritan Shehu, former Minister of Health, asked by ACQJ regarding the protocols applied by the Albanian state for all persons entering the territory, it was stated that "Albania had to implement the protocols of European countries regarding tourists".
About 1.1 million citizens came from Kosovo alone in the summer months. With the beginning of the tourist season, in Kosovo and North Macedonia, the number of infected people began to increase exponentially, with the peak of infections during the summer months. Although most of the tourists in Albania were from these countries, and numbers of infections and deaths in the respective countries were in continuous growth, the Albanian government did not take any preventive measures and entry to the border from these countries was free, without a vaccination certificate and without a test until the end of the tourist season.
The number of foreign citizens, according to Ministry of Tourism, entered Albania during the eight months of 2021, is 4.384.072, where 2,177,412 are Kosovar citizens and 448,370 are from North Macedonia, with only during the month of August with more than 790,000 and 110,000 travelers respectively from these countries.
When asked why there are strict travel restrictions for Albanian citizens, measures that are not reciprocal and if such a thing endangers public health, Ilir Alimehmeti, a clinical epidemiologist, said: "The documents for the border, the protocols that have been for the prevention of distribution through the borders, we have clearly noticed that they have failed everywhere, so it never happened, not even at the beginning of the pandemic, when it was easier to block the cases, it could not be done, not now that the infection is communal. This has remained more like inertia, which continues to ask for documentation, but clearly cannot block the virus, asking for pieces of paper. Even people, who have been vaccinated, can get infected, and as a result, we cannot stop this virus through these measures. I use the expression: The sun is not covered with a sieve. In this regard, no one is protected. So, it doesn't matter that to go outside, we have stricter protocols than those who find it easier to get inside. This element does not make a big difference."
According to police data, we see that during the period January-August 2021, citizens from India and Bangladesh also entered the country, respectively from India, 6034 and Bangladesh, 1347. In these countries, in this period, there was the highest peak of infected people and they have been able to enter our country freely, without any restrictions.
From the observations made in the field, on the coast during the tourist season, it has been noticed that in the bar-restaurant premises and in other public spaces, no protocol has been implemented to prevent the spread of COVID-19, despite the fact that such protocols have been in force throughout time. It has often been the local and central authorities themselves that have organized and allowed events with the participation of hundreds of thousands of citizens, violating the orders and regulations issued by them.
Photographs of various events, organized or allowed by the local and central government in the municipalities of Tirana, Vlorë and Sarandë, on the social networks of these institutions or organizers
Asked about the possible connection between the increase in infections at the end of the tourist season and the correlation between infections in Kosovo and North Macedonia and those in Albania, epidemiologist Alimehmeti pointed out that the reason for the increase in the number of infections was the variant Delta. "If we look at this epidemiologically and compare it with the region, that is, with Kosovo and North Macedonia, which at the same time have the largest number of tourists in Albania, we will see that they were at the highest epidemiological curve 2-3 weeks before us , while we came to this point 2-3 weeks after them. So, the peak in Kosovo and North Macedonia was on August 25, while in our country on September 8-10. So, about 2 weeks ago, which means that potentially in Albania the infections have come from massive arrivals from Kosovo and North Macedonia. Would we have been able to stop him through the control? I'm afraid not. We could have just pushed it back a bit in time, but no, we weren't going to stop it", - says Alimehmeti.
At the beginning of September 2021, at the end of the tourist season, the government imposed austerity measures for all travelers who entered the Albanian territory, with requests for tests PCR and vaccination certificates, including citizens of Kosovo and North Macedonia. However, the damage was done. From 5 infections per day during the first months of summer, in September Albania reached infection records with more than 1000 infections per day and with deaths gradually increasing in the following weeks. The following months showed a gradual and slight decrease in the number of infections, but the low numbers of summer 2021 are not expected to be reached at least until the end of winter or the increase in the number of vaccinated citizens.
Albanians travel to Europe, but at exorbitant costs
At a time when travelers in almost all the world are obliged to generate only one vaccination certificate, Albanian or foreign travelers who have to travel outside the Republic of Albania, beyond the travel costs that are normally applied, have added costs for regarding the verification of their status as non-infected with COVID-19. In case of travel to many European countries or beyond, they are obliged to submit a test to the border authorities PCR or fast, at a price many times higher than in Europe, regardless of their vaccination status.
From a simple check on the web, it is clear that fast tampons in Europe are sold in the supermarket at a price of 1-3 Euros, while in Albania they cost more than 20 Euros at specific pharmacies, or at testing points at airports, or border points. Often, in Europe, if a person is insured, tampons PCR are included in the free medical service, while in Albania, except in cases where a person is suspected of being infected with COVID-19, this service is only offered by private clinics in the country. This fact was also confirmed by the Ministry of Health ACQJ, stating that for trips abroad, the medical administration does not provide the tampon service PCR, but only in cases of suspected infection. Even in these cases, this swab performed by the family doctor cannot serve as proof of travel.
Various citizens, interviewed by ACQJ, near the border points of Han i Hoti, the port of Durrës and near the airport of Rinas, state 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 even students.
SV, a student in Austria, who is forced to travel to Albania from time to time to meet family members, when asked if the tampon practice and its price in private is justified, says ACQJ: "It is not justified, because it is a relatively expensive price, especially when we refer to Albania, which is a transitional developing country. While in other European countries the test is done for free, even the doctors near the house can assist."
ACQJ during 2021 conducted an observation of the tampon service market PCR for trips abroad to the cities of Tirana, Durrës and Shkodra, during the month of June and during the month of October 2021. What is noticeable is that, in most cases, the price of this service, not only has not followed the trends of reducing the cost of his, but is fixed in most operators at one price, which raises suspicions of anti-competitive practices and price fixing. The Ministry of Health itself has set a price ceiling on tampons PCR at the end of 2020 and has been one STATEMENT of laboratories on fixing a common price in the same period, which raises suspicions of a silent, illegal agreement between these operators.
Asked by 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 any administrative investigation for possible anti-competitive practices, the Competition Authority has stated that no complaint has been filed with it and this institution itself has not undertaken any investigation mainly on these statements of the operators and the fact that the prices in the relevant market are almost the same.
Meanwhile, Ersida Teliti, Executive Director of the Albanian Consumer Center, says the opposite regarding this issue. In an interview for ACQJ, she says that in fact her center has sent a complaint to the Competition Authority due to the increase and fixation of the price of tampons. "In fact, we have sent the complaint of some customers, who wrote to us at the address of the center via Instagram-it, where they complained about the determination of the price by the Ministry of Health, where theoretically, although it is an issue related to traders and since we focus on the protection of the consumer and human rights, we initiated this very complaint with the Competition Authority." - she says.
In the complaint dated 28.12.2020, addressed to the Competition Authority, based on the numerous denunciations, MSC has asked the latter to launch an in-depth investigation and place under market monitoring all entities that offer the tampon service PCR, and the initiation of the investigation and the placing under monitoring of the entities that provide the analyzes for COVID-19and PCR, D-dimer, blood tests, etc., where an increase in prices is found.
Teliti states that "the focus of the complaint, although in fact it seemed to affect and violate the traders, in reality at the end of the day it is a matter of the consumer, focused exactly on the making of tampons in two, three or four entities formalized through an order of the Ministry of Health. This would in fact lead to a direct distortion of the competition, the impossibility of having reductions or other price changes in favor of the consumer, but, in the conditions when in fact no one is influenced and does not even examine the quality or the way of making them, effectiveness in results, whether fictitious or not, would directly affect the consumer.”
Although the complaint has been filed with the Competition Authority for a year and has been continuously followed up by MSC, no response has been received from the latter and no administrative investigation has been initiated on this matter. For Ersida Teliti, the liberalization of the service is the only way to protect the consumer's interest, a position that was also expressed by Tritan Shehu, who says that "the liberalization of all tests, the liberalization of laboratories and the implementation of WHO protocols are the only effective steps to manage the situation".
According to Mr. Shehu, "in Albania there has been a great lack of tampons, not doing tampons means not being diagnosed, because COVID is diagnosed by the tampon and if the tampons were not done... The reduction in the number of tampons leads to the concealment of cases and their tracking . This is a big problem, which Albania continues to have, and in general, the policies that have been followed with the testing are also a problem. Instead of liberalizing rapid tests, they are kept centralized and blocked for pharmaceutical companies and are not allowed to be brought into Albania. This is a big problem, it is a deeply wrong, centralist policy that seeks to hide the reality in Albania."
Such a problem has also been noticed by the High State Control, in its report performance audit for the management of the pandemic by state institutions, in which he found a series of violations by state authorities, among which was precisely the impossibility of the Institute of Public Health, as the only institution responsible for national surveillance and investigation of infectious diseases, in issuing of the results of relevant tests for the purpose of documentation and/or travel abroad of citizens.
ISHP, in June 2020, addressed the Ministry of Health with a request that the testing for COVID-19 for the purpose of documentation to be carried out in laboratories outside ISHP, which are certified by the latter. Following this request, the Technical Committee of Experts decided to allow molecular testing, PCR FOR SARS-COV-2, in non-public laboratories for administrative needs, recognized by the Ministry of Health, in violation of the legal provisions according to the HLSH, because the certification of these laboratories cannot be carried out by the Ministry of Health, but by the General Directorate of Accreditation.
At the same time, KLSH has found legal violations, both in performance and in terms of subsidizing and compensating medications or tests for COVID-19, for how long these procedures have been an excessive financial burden for citizens, who have an administrative need, required by the Albanian state, in case teachingand employment in the state administration or for trips abroad for those who pay health contributions. More than a month has passed since the release of this report of the High State Control and until today there has been no change in the travel procedures outside the territory of Albania. Most European countries and beyond still require verification of a tampon PCR, regardless of the vaccination status and the state has not yet found a mechanism, which does not burden the pockets of travelers.
While the WHO warns that Europe will face a severe pandemic situation until the spring of next year, in Albania those who have to travel face the highest prices in the test region PCR. The country also faces many infected people who try to recover at home and arrive at the hospital when doctors have little to offer.
Albania is already facing the fourth wave of Covidand the number of infected and victims remains high, compared to Kosovo, which a few weeks ago seemed to be losing the war with the virus. As of this writing, only 33% of adults have received both doses of the vaccine. Vaccination skepticism has many reasons, one of which is doubting what authorities say.
