Small countries come together to move forward in the face of COVID-19

“The COVID-19 pandemic has impacted our world deeply, and small countries are no exception. But the challenges of a country of half a million people are significantly different than the challenges of a country with a population of 50 million”, said Dr Hans Henri P. Kluge, WHO Regional Director for Europe, addressing on 28 June 2021 ministers of health and high-level delegates of the 11 countries that form the WHO Europe Small Countries Initiative.

Gathering virtually, the 7th high-level meeting of the Small Countries Initiative was an opportunity for countries to share experiences on how the pandemic has impacted them and discuss ways to move forward together.

The pandemic amplified numerous concerns for small countries:

  • a shortage of health workers, often exacerbated by border closures;
  • limited bargaining power for affordable access to medicines and vaccines;
  • lack of stockpiles;
  • limited supply chain management and production capabilities,
  • dependence on larger neighbouring countries for trade, production and access to medicines and vaccines; and
  • significant economic and financial constraints.

Country priorities

At the meeting, representatives expressed their priorities, including: the safe reopening of tourism, continuation and expansion of COVID-19 immunization programmes, expansion and improvement of digital solutions and innovation in health systems, as well as joint action to increase access to medicines. Mental health issues also emerged at the forefront, alongside the need to further support the health workforce, which in small countries has found itself especially stretched.

COVID-19 calls for a rethinking of health in the policy sector and the small countries are taking the lead in finding solutions together.

European Programme of Work

The meeting statement, “Building forward for all in the face of COVID-19”, confirms the small countries’ commitments to tackling these challenges and to implementing the core principles of good governance and leaving no one behind, the objectives and pillars of the European Programme of Work – “United Action for Better Health in Europe”, the United Nations 2030 Agenda for Sustainable Development and WHO’s Thirteenth General Programme of Work, 2019–2023.

Solidarity and resilience are what characterizes successful COVID-19 responses in small countries. Specifically, small countries seek to:

  • capitalize on experiences to date to better prepare for future health emergencies;
  • advocate for the needs of small countries to WHO and other international bodies and partners;
  • ensure that equity and leaving no one behind are at the heart of COVID-19 response and recovery efforts;
  • further develop, implement and share long-term COVID-19 preparedness and response actions;
  • develop a roadmap of joint action and good practice in the implementation of the European Programme of Work.

The Small Countries Initiative brings together countries in the WHO European Region with a population of less than 2 million people. The 11 members are: Andorra, Cyprus, Estonia, Iceland, Latvia, Luxembourg, Malta, Monaco, Montenegro, San Marino and Slovenia.


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