In this week’s World of Genomics, we explore Albania! Located in the western part of the Balkan Peninsula, Albania boasts dreamy beaches, stunning mountain scenery and a multitude of historical relics. In recent years, Albania has transformed from one of the poorest countries in Europe to an upper-middle-income country thanks to a focus on the growth of the tourism, agriculture and technology sectors. However, many aspects of Albania’s healthcare and technology policies remain outdated compared to other European countries, including advances in genomic healthcare.
The population of Albania
Albania is bordered by the Adriatic Sea to the west, Montenegro to the northwest, Kosovo to the northeast, North Macedonia to the east, Greece to the south and the Ionian Sea to the southwest.
In ancient times, northern and central Albania was inhabited by the Illyrians, while the south was inhabited by the Epirotes. Over time, several important ancient Greek colonies were also established on the coast. Modern Albania is now one of the most ethnically homogenous populations in Europe, with over 98% of the population being Albanian with a small percentage of Greeks. The two main Albanian subgroups are now the Gegs (Ghegs) in the north and the Tosks in the south.
The Albanian language, known as shqip or shqipe, is of interest to linguists as it is the only surviving member of its branch of the Indo-European language family. Following centuries of rule by foreigners, the Albanian vocabulary has adopted many words from the Latin, Greek, Turkish, Italian and Slavic tongues. There are now two principal dialects spoken in each of the main districts: Geg, spoken north of the Shkumbin River, and Tosk, spoken in the south. Outside of Albania, Geg dialects are also spoken in Serbia, Montenegro, Kosovo and North Macedonia, while Tosk dialects are prominent in the Albanian communities of Greece and Italy. Although the two dialects have differences, Albanians from different regions can understand one another with no difficulty.
Albania is a unitary parliamentary constitutional republic. While classed as a developing country, ranking 67th in the Human Development Index, Albania has improved its economy in recent years, now being classed as an upper-middle income country dominated by the service sector, followed by manufacturing. Following the end of communism in the country in 1990, the nation transitioned to a market-based economy. Albania is a member of several worldwide organisations including the United Nations, World Bank, UNESCO and NATO. It applied for membership of the European Union in 2009 and has been an official candidate for membership since 2014.
Geographic and demographic information
Summary statistics
- Land area: 28,748 km2.
- Gross domestic product (GDP):
- Total: $18.88 billion (2022 estimate).
- Per capita: $6802.80 (2022 estimate).
Population statistics:
- Population size: 2,775,634 (2022 estimate).
- Birth rate: 10.9 per 1,000 people (2023 estimate).
- Death rate: 8.7 per 1,000 people (2023 estimate).
- Infant mortality rate: 7.2 deaths per 1,000 live births (2023 estimate).
- Average life expectancy: 76.5 years (2021 estimate).
- Male: 74.1 years (2021 estimate).
- Female: 79.2 years (2021 estimate).
- Ethnicity: Albanians 98.1%, Greeks 0.9%, other 1% (including Vlach, Roma, Macedonians, Montenegrin, Roma and Egyptian) (2022 estimate).
Healthcare system
The healthcare systemin Albania is mostly public, although in recent years private healthcare has become increasingly widespread. Public healthcare is organised into primary, secondary and tertiary levels, with around 413 public healthcare clinics in the country providing primary and secondary care, and 42 public hospitals offering tertiary care. Public healthcare spending is funded partially by a state budget and by The Compulsory Health Insurance Fund (ISKSH), which takes compulsory health insurance contributions from both employees and employers. This funding equates to 3.4% of worker’s salaries, contributed equally between employees and employers, and is used to reimburse costs for prescription drugs and private hospital healthcare services for those who have health insurance. Around 13 private hospitals are now established in Albania, alongside several private multi-disciplinary diagnostic clinics and labs. Dental and pharmaceutical services are almost entirely private.
In 2013, the Albanian government pledged to implement universal healthcare, and since 2016, over 600,000 uninsured Albanians have benefitted from free doctor visits, medical check-ups and reimbursable drugs. More recently, the government has extended this coverage to include a wider range of treatments and hospital laboratory services.
The government has now initiated efforts to use technology to cut costs and improve the reach of the free healthcare offered. This includes digitisation of all patient medical records, implementation of e-prescriptions, e-doctor visits and e-examinations, alongside establishment of a national centre for healthcare information. This will significantly improve health care services in rural areas, where access to staff and amenities are reduced compared to urban areas.
Health priorities
In 2015, Albania had the highest mortality rate in Europe, at 766 deaths per 100,000 people, as well as the highest rate of death from non-communicable diseases at 672 per 100,000 people.
The most common cause of death in Albania is ischemic heart disease, followed by cerebrovascular disease and lung cancer. The top ten risk factors contributing to these overall disease burdens are high blood pressure, dietary risks, tobacco smoking, high body mass index, high total cholesterol level, alcohol and drug use, air pollution, high fasting plasma glucose, occupational risks and malnutrition.
On the 26th of November 2019, Northwestern Albania was struck by a 6.4 magnitude earthquake with an epicentre 9.9 miles southwest of the town of Mamurras. The earthquake lasted around 50 seconds and was felt in Tirana, Albania’s capital, as well as places as far away as Bari, Taranto and Belgrade, around 230 miles northeast of the epicentre. 51 people were killed in the earthquake, with over 3,000 others injured. This was the second earthquake to strike the region within three months and was the strongest earthquake to hit Albania in more than 40 years. It was the deadliest earthquake to hit Albania in 99 years and was the world’s deadliest earthquake in 2019. Following this incident, the WHO began to work closely with the Albanian government to implement robust plans for improvements of the country’s emergency healthcare responses, mental health and psycho-social support for affected communities and steadfast plans to manage future disasters and their health risks.
As of May 2023, Albania had the lowest cumulative number of COVID-19 cases and deaths in the Western Balkans at 334,090 confirmed cases and 3604 confirmed deaths. However, the pandemic had a significant negative impact on Albania’s economy, which was still recovering from the 2019 earthquake, which is forecasted to take many years to financially recover from.
Genomic medicine capabilities
Genomic medicine is still in its early stages of development in Albania, with genetic testing and counselling currently only carried out by private companies. Albania is one of the few remaining countries who do not offer any form of widespread newborn screening by the public health authorities. A newborn hearing screening programme has been recently introduced in four Albanian maternity hospitals. However, a bloodspot screening test, such as those used in almost every other EU country, has not yet been introduced. Although this has been recommended in several reports, this has not yet been implemented by the Albanian government.
Research into some of Albania’s common diseases has unearthed some genetic data which is unique to this population. A specific Albanian patient population was discovered by genetic screening of patients with Gaucher disease, who were found to have unique genetic mutations compared to other European patients.
A β-thalassaemia screening programme was also conducted to determine the distribution of β-thalassaemia mutations and haemoglobin variants in the Albanian population. In the province of Lushnja, the frequency of β-thalassaemia carriers was high. This population showed similar mutations to those found in the east Mediterranean area, suggesting the same origin for mutant alleles during previous migrations.
These findings have raised questions around whether genomic profiling could identify other genetic predispositions in this homogenous population, including Cystic Fibrosis, which has a significantly higher occurrence rate in Albanian children compared to neighbouring countries.
The genomic medicine landscape has significant room for improvement in Albania. This area may become a healthcare priority as the country’s economy continues to improve . However, specialist genomics training or genetic counselling courses are not currently offered at Albanian universities, meaning that any specialists in these subjects would need to train outside of Albania.
Notable projects
- The Albanian DNA Project “Rrënjët”: Albanians can voluntarily register their privately-obtained DNA results to compare them with the largest Albanian DNA database, as well as with other public results from ancient and modern populations.
- The Albanian Bloodlines Project: Thefirst known attempt to document the genetic paternal lines of the northern Albanian Gheg tribes.
- β-thalassaemia screening programme: A pilot genomic screening programme for β-thalassaemia, a common disease in Albania .
Notable organisations and companies
- Albania Society of Human Molecular Genetics (ASHMG): Established in 2021, this group of scientists and specialists aims to promote and regulate Albanian human genetics research.
- Albania Gene Bank: Coordinates activities in the field of conservation and management of plant genetic resources.
- Magi Balkans: The only centre of its kind in Albania offering laboratory and diagnostic tests for genetic and rare diseases.
Notable individuals
- Merita Vila Xhetani: A well-known Albanian geneticist and genetic counsellor, she is one of the prominent private genetic counsellors in the country and president of the ASHMG.
- Mirela Lika: Head of Genetics at the University of Tirana, vice president of the ASHMG.
The future genomics landscape
Albania hosted its first international biotechnology and genetics conference in 2021, “Biotechnology & Genetics – Developments and Future Challenges” (BGIC-2021). This conference, a collaboration between the Academy of Sciences of Albania (ASH) in collaboration with the University of Tirana (UT), Agricultural University of Tirana (UBT), the University of Medicine of Tirana (UMT), with the support of the European Biotechnology Thematic Network Association (EBTNA), marked the beginning of a new era in collaboration and sharing of genetic and biotechnological research for Albanian scientists. However, a follow up event has not yet been arranged.
The future of genomics in Albania holds enormous potential as the country is currently only in its early stages of developing this area. As the public healthcare system currently does not cover genomic medicine in any form, all genomic medicine in Albania is currently carried out in the private sector. As Albania’s economy begins to recover following the pandemic and the 2019 earthquake, it remains to be seen whether genomic medicine will become a priority for public health spending.
References
Britannica. Albania. 2023. Available online at: https://www.britannica.com/place/Albania
Cullufi et al. Genetic characterization of the Albanian Gaucher disease patient population. JIMD Rep. 2021 Jan; 57(1): 52–57.
European Health Observatory: Albania. Available online at: https://eurohealthobservatory.who.int/countries/albania
Gabrani et al. Perspectives of Public and Private Primary Healthcare Users in Two Regions of Albania on Non-Clinical Quality of Care. J Prim Care Community Health. 2020 Jan-Dec; 11: 2150132720970350.
Healthcare Technologies Resource Guide. Albania. 2023. Available online at: https://www.trade.gov/healthcare-resource-guide-albania
Human Development Reports. 2023. Available online at: https://hdr.undp.org/data-center/human-development-index#/indicies/HDI
World Bank. 2023. Available online at: https://www.worldbank.org/en/country/albania/overview
World Health Organisation: COVID-19 Statistics. 2023. Available online at: https://covid19.who.int/region/euro/country/al
