From Legal Approximation to Governance Capacity: Health Policy and EU Enlargement in the Western Balkans

The COVID-19 pandemic constituted a critical stress test for public governance systems, exposing structural vulnerabilities in health systems and highlighting the central role of legal and institutional frameworks in crisis management. In the Western Balkans, these challenges unfolded within the broader political context of European Union enlargement, where domestic reform trajectories are shaped by conditionality, legal approximation, and uneven institutional consolidation. This paper examines health legal preparedness in the Balkans as a governance issue located at the intersection of public health policy, EU integration, and democratic accountability, using Albania as a focal case. Health legal preparedness is commonly defined as the capacity of legal and institutional frameworks to respond effectively, lawfully, and equitably to public health emergencies. In transitional political systems such as those of the Western Balkans, preparedness cannot be assessed solely in terms of formal legislation or compliance with EU norms. Rather, it reflects the interaction between normative alignment with the EU acquis Communautaire, particularly Chapter 28 on Consumer and Health Protection, and domestic governance capacities, including institutional coordination, administrative effectiveness, and accountability mechanisms. The COVID-19 crisis exposed persistent gaps between legal approximation and enforcement, highlighting fragmented regulatory authority, limited intersectoral coordination, and underdeveloped ethical safeguards in emergency governance. The paper employs Albania as an illustrative case to explore how EU-driven legal reforms translate into practice under conditions of constrained state capacity. Despite legislative progress in public health regulation and emergency response, Albania continues to face challenges related to inconsistent regulatory terminology, overlapping competences between health and legal institutions, and weak implementation mechanisms. These shortcomings are treated not as isolated technical failures, but as manifestations of broader political and institutional dynamics characteristic of post-conflict and transitional governance contexts. At the regional level, the analysis situates Albania within the wider Western Balkan landscape, where uneven transposition of EU norms and limited functionality of cross-border cooperation mechanisms undermine collective preparedness. Although the EU enlargement framework provides strong normative incentives and financial support, the effectiveness of these tools depends on domestic political ownership, institutional interoperability, and sustained investment in governance capacity. The paper thus challenges a compliance-oriented understanding of Europeanization, emphasizing the gap between formal legal convergence and functional governance outcomes. Methodologically, the study adopts a qualitative, multidisciplinary approach combining public health law analysis with political science perspectives on Europeanization, governance, and crisis management. The paper is structured around five thematic axes: the legacy of legal systems in the Western Balkans; Albania’s structural and normative governance gaps; the role of EU conditionality under Chapter 28; intersectoral coordination during public health emergencies; and the impact of COVID-19 as a catalyst for institutional learning. By conceptualizing health legal preparedness as both a policy instrument and a test of democratic governance, the paper contributes to political science debates on EU enlargement, state capacity, and crisis governance. It argues for a shift from symbolic legal compliance toward functional resilience, anchored in institutional reform, regional cooperation, and accountability, positioning public health preparedness as a core dimension of political legitimacy and public trust in the Western Balkans.