Population exposed to polluted air is less resistant to COVID‐19, and air pollution can lead to aggravation of coronavirus symptoms, as shown by the research conducted since the beginning of the pandemic.

For years, the Western Balkans has been one of the regions with the worst air quality in Europe. Its cities frequently top the lists of world’s most polluted cities. When poor air quality is coupled with the global COVID‐19 pandemic which to a great extent marked the past two years and is still ongoing, this results in an additional increase in respiratory disease and higher mortality rates.


Since the very beginning of the global pandemic, research and studies have emerged that point out the increased number of COVID‐19 cases and deaths in regions with low air quality. However, in order to clearly establish that air pollution contributes to the risk of death from COVID‐19, long‐ term epidemiological studies are needed that would take into account many factors, and such scientific papers are still being developed.

Research from China, England, USA, Germany, the Netherlands, and Italy have thus far shown that increased air pollution can cause a higher number of infections, as well as higher COVID‐19 mortality rates1 . Research in Germany shows that a higher PM10 concentration also raises mortality in COVID‐ 19 patients aged over 80, by 30% in men, and 35% in women2.

When comparing this data, one can conclude that air pollution increases COVID‐19 mortality rates, by 15% globally, and by 19% in Europe.3
The main cause of air pollution is particulate matter (PM), and an increase in its concentration of 1 microgram per cubic meter increases COVID‐19 mortality by 11%4. During the pandemic, 78% of those infected originated from five regions with the highest rates of air pollution.

Air pollution is the most important factor influencing the severity of disease and mortality from COVID‐19. The number of hospitalizations increases by almost 100 percent in the event that the concentration of PM 2.5 is increased by 20%.

Particulate matter reaches the smallest parts of the lung tissue and causes damage to blood vessels. High air pollution rates lead help COVID‐19 spread in the lungs, causing more severe inflammation and the formation of small blood clots.

Unfortunately, there are still no relevant studies and research with regard to the Western Balkans region, which prevents us from presenting concrete data. One can presume that the data would not differ in the case of this region, and even argue that they would be worse. Even without the impact of the COVID‐19 pandemic, polluted air in the region annually causes more than 30,000 premature deaths.


How can a better epidemiological situation and cleaner air be achieved in the Western Balkans?

The number of scientific studies on the connection between air pollution and COVID‐19 is growing daily. In order to react properly, one’s decision needs to be based on valid information. Therefore, it is necessary to prepare at least one, and possibly several studies that would analyze the link between air pollution and COVID‐19 in the Western Balkans. Such research must be precisely planned and performed, so that adequate conclusions and proposed measures can be made.

When proposing measures, it is necessary to take into account the state of the Western Balkan countries’ health care systems. During the pandemic, the effects of lacking hospital beds, the immigration of doctors and medical staff, a shortage of respirators and other equipment, as well as an overall lack of investments, became apparent throughout the region. At the time when they are also affected by the COVID‐19 pandemic, the pressure on these fragile health systems often exceeds their limits. Hence, a greater degree of participation of health sector representatives in decision‐ making processes is needed to ensure the timely integration of health measures into environmental policies.

Western Balkan countries’ governments must react and increase their efficiency in enforcing environmental laws and decisions in order to achieve greater health and economic benefits for all citizens. Coal‐fired power plants in the Western Balkans alone are responsible for the economic damage in the form of health costs, estimated at €1.9‐3.6 billion annually, paid by the citizens of the Western Balkans.

COVID‐19 will eventually become a thing of the past, but we must prevent air pollution from remaining the old "normal". Timely reaction includes the integration of measures to improve air quality into public policies and COVID‐19 recovery plans, in line with commitments from the Green Agenda for the Western Balkans, which have been accepted by all countries.

We need to develop regional multisectoral policies that will imply improving the environment and public health, because such problems require a common, regional solution.


1 Isphording, Ingo E. and Pestel, Nico, Pandemic Meets Pollution: Poor Air Quality Increases Deaths by COVID-19 (2020). CESifo Working Paper No. 8495, Dostupno na: SSRN: https://ssrn.com/abstract=3680352

2 Pozzer A,Dominici F,Haines A,Witt C,Munzel T.Lelieveld J, Regional and global contributions of air pollution to risk of death from COVID-19, Cardiovascular Research(2020),116:2247-2253, Dostupno na: https://academic.oup.com/cardiovascres/article/116/14/2247/5940460

3 Bhandary N., Air pollution a co-factor in COVID-19 mortality

4 X Wu, R C Nethery, M B Sabath, D Braun, F Dominici, Air pollution and COVID-19 mortality in the United States: Strengths and limitations of an ecological regression analysis, Sci Adv.2020:6,4,novembar 2020. Dostupno na: https://pubmed.ncbi.nlm.nih.gov/33148655/


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