Early Warning System: Wastewater based monitoring on COVID-19, viruses, AMR, Albania

Published: 13 September 2023
Last edited: 13 September 2023
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Systematic wastewater-based monitoring is another tool to complement conventional surveillance for public health policy decisions. It helps to recognise changes at an early stage and to follow-up pandemic developments . The concentration of SARS-CoV-2 RNA in wastewater showed the trends of COVID-19 infections in the population without individual testing. Working with all wastewater treatment plant operators in Albania, GIZ Water Programme initiated in collaboration with the German Technologie Zentrum Wasser (TZW), and the Agricultural University of Tirana (AUT), the development of a wastewater monitoring system on SARS-CoV-2, other viruses, and antimicrobial resistance (AMR). This laboratory is centrepiece for wastewater-based epidemiology in Albania.


Main challenge was to interlink partners from the water and health sectors to an intersectoral and inter-ministerial working group until the Early Warning System for public health became functional for the consultancy of the Albanian Government.


East Europe
Scale of implementation
Area-wide development
Connective infrastructure, networks and corridors
Urban ecosystem and build environment
Health and human wellbeing
Not listed
One Health
Outreach & communications
Peace and human security
Science and research
Wastewater treatment
Species Conservation and One Health Interventions
Species Disease Early warning systems
Outbreak investigation and access to laboratory
One Health coordination mechanism
One Health
Animal health
Biodiversity-health nexus
Neglected tropical diseases, emerging infectious diseases, non-communicable diseases, zoonoses, antimicrobial resistance
Water, sanitation and hygiene
Vector and water borne diseases
Sustainable development goals
SDG 3 – Good health and well-being
SDG 6 – Clean water and sanitation


Tirana, Albania


Main challenge was to interlink partners from the water and health sectors to an intersectoral and inter-ministerial working group until the Early Warning System for public health became functional for the consultancy of the Albanian Government. To persuade decision makers of the benefit of wastewater based analyses and epidemiology was another challenge.


Beneficiaries apart from Albanian decision makers is the Albanian population, who can be informed about the development of health relevant topics in real-time.

How do the building blocks interact?

The technical preconditions of the microbiological laboratory and specifically trained laboratory staff on the sensitive PCR-based detection methodology of viruses and AMR in wastewater and the close cooperation with water utilities for wastewater sampling are the basis for reliable data of the virus load. AMR is a growing threat to human and animal health. Analyses and interpretation of the data are presented in regularly reports from university experts to Albanian Government Technical Expert Committee for decision-making. Involved into the process of the Early Warning System is the inter-sectoral and inter-ministerial working group consisting of AUT, Public Health Institute, Ministry of Health, National Environmental Agency. The cooperation between AUT and TZW regarding knowledge transfer, data exchange and scientific research is perpetuated.


The first microbiological laboratory in the Balkan region to detect COVID-19, viruses and AMR in untreated wastewater by PCR-technology allows Albania to be engaged in international high-level research, pandemic prevention and response. It is a source of independent information on the spread of viruses and AMR, making a significant and cost-effective contribution to public health decision-making. This information allows fast reacting to reduce health risk impacts, supporting the global surveillance of pandemics and prevention.

The TZW has developed a PCR-based detection method to trace SARS-CoV-2 in wastewater for the monitoring of infection trends and identification of hotspots: seasonally circulating viruses, emerging pathogens with pandemic potential and AMR genes. Testing wastewater on AMR genes for different drugs provide an indication of clinically relevant genes circulating in the population, location and extent of resistant bacteria entering the environment.

Due to the close collaboration, knowledge transfer of German to Albanian institutions, training of laboratory staff the Early Warning System in Albania is functional and extended over the country. Requests for international cooperation, research and exchange increased (e.g. WHO, Japan, Israel, EU). The AUT integrated the topic into its curricula; students and researchers now play an important role in the international research exchange.

Contributed by

gabriele.lames_43020's picture

Gabriele Lames Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH

Other contributors

DVGW - Technologiezentrum Wasser, Karlsruhe, Germany
Agricultural University Tirana, Albania