Making the Case for Cross-Border Public Health Strategies: A comparativie Assessment of Covid-19 Epidemiological Trends in the Balkan Countries Across 17 Months

Sarah Cuschieri; Amy Carabott; Rebecca Caruana; Mariah Farrugia; Anthea Ferrigi; Elizabeth Grech; Anneka Pace; Tamara  Attard Mallia; Nicole Attard; Nathalie Attard; Emma Camilleri; Jeanelle Calleja; Martina Baldacchino; David Magri; Neriah mangion; Andrea Cuschieri

doi:10.18502/jbe.v8i2.10416

Sarah Cuschieri Faculty of medicine and Surgery, University of Malta, Msida, Malta.
Amy Carabott Faculty of medicine and Surgery, University of Malta, Msida, Malta.
Rebecca Caruana Faculty of medicine and Surgery, University of Malta, Msida, Malta.
Mariah Farrugia Faculty of medicine and Surgery, University of Malta, Msida, Malta.
Anthea Ferrigi Faculty of medicine and Surgery, University of Malta, Msida, Malta.
Elizabeth Grech Faculty of medicine and Surgery, University of Malta, Msida, Malta.
Anneka Pace Faculty of medicine and Surgery, University of Malta, Msida, Malta.
Tamara Attard Mallia Faculty of medicine and Surgery, University of Malta, Msida, Malta.
Nicole Attard Faculty of medicine and Surgery, University of Malta, Msida, Malta.
Nathalie Attard Faculty of medicine and Surgery, University of Malta, Msida, Malta.
Emma Camilleri Faculty of medicine and Surgery, University of Malta, Msida, Malta.
Jeanelle Calleja Faculty of medicine and Surgery, University of Malta, Msida, Malta.
Martina Baldacchino Faculty of medicine and Surgery, University of Malta, Msida, Malta.
David Magri Faculty of medicine and Surgery, University of Malta, Msida, Malta.
Neriah mangion Faculty of medicine and Surgery, University of Malta, Msida, Malta.
Andrea Cuschieri Faculty of medicine and Surgery, University of Malta, Msida, Malta.

DOI: https://doi.org/10.18502/jbe.v8i2.10416

Keywords: Coronavirus; Europe; Morbidity; Mortality; Mass vaccinations; Epidemiology

Abstract

Introduction: COVID-19 spread globally, including across the Balkans, resulting in different morbidity and mortality outcomes in different countries. The aim of this study was to review the impact of COVID-19 over 17 months with regards to pandemic progression, implemented mitigation strategies, and COVID-19 vaccination programs across the Balkan countries, while identifying any valuable pieces of information acquired serendipitously throughout the pandemic that can be implemented in future action plans.

Methods: A longitudinal ecological study was conducted across the Balkan countries from the onset of COVID-19 in these countries up until 1st August 2021. Epidemiological data was obtained from Our World in Data databases, while Ministry of Health websites for each respective country as well as local newspapers were utilized to review COVID-19-related mitigation and vaccination strategies. Comparisons of vaccination coverage, incident cases and mortality were made across neighboring countries, by converting the respective data to rates per 100,000 population for each country using Microsoft® Excel for mac (Version 16.59).

Results: More than 10 million positive COVID-19 cases and 164,470 deaths were observed across the Balkan countries up until 1st August 2021. Trends in COVID morbidity and mortality outcomes were evident across neighbouring countries. A staggered vaccination rollout was observed, with various rollout speeds, although gradual decline in both morbidity and mortality occurred.

Conclusion: Results obtained from this study strongly indicate that COVID-19 outcome for a particular country is not only dependent on the country’s own level of viral transmission, mitigations, and vaccination rates but also on neighbouring countries’ COVID-19 situation. Hence, cross-border governance action and recovery plans are recommended along with targeting vaccination hesitance.