Germany - Global health

 

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Germany has shown strong leadership on global health through its G7 and G20 presidencies

Germany was the third-largest donor to global health in 2019 among the donors of the Organisation for Economic Co-operation and Development (OECD’s) Development Assistance Committee (DAC). According to OECD data, Germany’s total official development assistance (ODA) to health in 2019 was US$1.4 billion. This represented 5% of total ODA in that year, which is below the DAC average of 8% for health, making Germany the 19th-largest donor in relative terms. Germany channeled more than half of its health ODA (58% or US$832 million) bilaterally in 2019, including 10% of earmarked funding to multilateral organizations which is reported as bilateral ODA. 42% of funds were provided multilaterally.  

Between 2018 and 2019, Germany’s bilateral health ODA grew by 4%, from US$800 million in 2018 to US$832 million in 2019. Bilateral health ODA focused mainly on infectious disease control (24% of bilateral health ODA), basic health infrastructure (15%) and health policy, and administrative management (13%) while reproductive health care and medical services received 10% and 8%, respectively. Funding for infectious disease control, health policy and administrative management, and reproductive health care declined in 2019, while funding for basic health infrastructure increased.  

Health was a priority issue in the cooperation strategy of the Federal Ministry for Economic Cooperation and Development (BMZ) for 20 bilateral partner countries, but following strategic reforms outlined in the BMZ’s new strategy document, ‘Reformkonzept BMZ 2030’ (BMZ 2030), Germany reduced the overall number of bilateral cooperation partners from 85 to 60. Of the 60 bilateral partners, health will only remain a central focus in 12: Bangladesh, Cambodia, Cameroon, Ethiopia, Malawi, Nigeria, Pakistan, Tanzania, Togo, Ukraine, Uzbekistan, and Zambia.

In addition to its bilateral funding to health, Germany channeled 42% of its health ODA to multilaterals (a much higher share than to multilaterals than it provides in other sectors), with the largest recipients being the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund; 20% of multilateral health ODA), EU institutions (10%), Gavi (4%), IDA (4%), WHO (1%), and UNFPA (1%). 

Germany pledged €1.0 billion (US$1.1 billion) to the Global Fund for 2020-2022. For Gavi, the Vaccine Alliance’s (Gavi’s) strategic period of 2021-2025, Germany pledged €600 million (US$697 million) in direct funding. As of May of 2021, Germany has committed an additional US$354 million to the Global Fund’s COVID-19 response as well as US$968 million for Gavi’s COVID-19 response, which will be channeled towards the Gavi-led COVAX Advance Market Commitment (AMC) — a financing instrument aimed to ensure equitable access to an eventual COVID-19 vaccine. Germany also pledged US$58 million to the Global Financing Facility for 2021-2023.

The German government identified health as a priority sector in its 2017-2021 coalition treaty, specifically health systems strengthening, health research and development (R&D), poverty-related and neglected diseases, and international partnerships (such as the Global Fund and Gavi).

Under Chancellor Angela Merkel, Germany has sharpened its profile as a leader in global health, especially since 2015. Germany prioritized global health during both its G7 and G20 presidencies in 2015 and 2017, respectively. Pandemic preparedness, antimicrobial resistance (AMR), and neglected diseases were identified as priority areas in the G7 communiqué. Under the German G20 presidency, the health ministers of G20 countries met for the first time to discuss global health issues such as pandemic preparedness, HSS, and AMR. As a result, the Global AMR R&D Hub was launched in Berlin. In 2022, Germany will assume the G7 Presidency. Pandemic preparedness and prevention, health systems strengthening, research and development for infectious diseases and AMR are planned to be among Germany’s key priorities, but the September federal elections will ultimately determine strategy; the new federal government will decide on the final G7 agenda.

In April of 2018, Merkel, together with her Ghanaian and Norwegian counterparts, suggested that the World Health Organization (WHO) should convene global health actors to develop a ‘Global Action Plan’ with interim milestones towards reaching Sustainable Development Goal (SDG) 3 (“Healthy Lives and Well-being for All”)  by 2030. That same year, Germany was the first country to establish a formal parliamentary sub-committee on global health. At the beginning of 2019, the ‘Global Health Hub Germany’ was launched to strengthen the link between national research institutions and domestic mechanisms to enhance the country’s capacity and expertise on matters of global health.

In October of 2020, the German Federal Cabinet also adopted a new cross-ministerial global health strategy for 2020-2030, titled ‘Responsibility – Innovation – Partnership: Shaping global health together’ to serve as the basis for Germany’s engagement in global health and to ensure Germany’s contribution to the SDG3 (“Ensure healthy lives and promote well-being for all at all ages”). The strategy outlines five strategic priorities in global health:

  1. Promoting health and prevention;
  2. Mitigating the health effects of climate change;
  3. Health systems strengthening and universal health care;
  4. Strengthening the global health architecture for epidemic and pandemic preparedness; and
  5. Advancing research and innovation for global health.

Another key component outlined in the strategy is the strengthening of the multilateral global health architecture, particularly elevating the WHO to a world pandemic center.

According to ‘BMZ 2030’, global health, pandemic preparedness, and family planning are three out of 10 so-called ‘initiative themes’ which, according to the BMZ will receive special attention for selected periods, depending on need.

In February of 2021, the Federal Ministry for Economic Affairs and Energy (BMWi), the Federal Ministry of Health (BMG), and the Federal Ministry of Finance (BMF), in coordination with the Federal Chancellery, have established a new State Secretaries’ Committee and a Vaccine Production Task Force. The aim of the newly established State Secretaries’ Committee and the new Vaccine Production Task Force is to help boost investment in vaccine production in Germany and to build up reserve capacity for the next pandemic so Germany can become a global supplier. This is in line with Minister of Health Jens Spahn’s endeavor to elevate Germany’s position in the EU as a research and production location for innovative technologies such as mRNA technology.

To date, Germany has contributed a total of US$2.5 billion to the Access to COVID-19 Tools Accelerator (ACT-A), making it the second-largest donor to the global initiative. As of May of 2021, Germany has contributed US$968 million to Gavi, US$406 million to CEPI, US$220 million to UNICEF, US$354 million to the Global Fund, US$438 million to the WHO, US$24 million to Unitaid, and US$73 million to the Foundation For Innovative New Diagnostics (FIND). Germany also contributed US$429 million in funding to the WHO’s ‘Strategic Preparedness and Response Plan’.

In response to the COVID-19 crisis, the BMZ established a new subdivision titled ‘Health: One health’. Parliamentary State Secretary Dr. Maria Flachsbarth will oversee this division. In November of 2020, the BMZ also published its first One Health strategy, anchoring the climate-health-environment nexus in German development cooperation. The strategy gives special attention to the prevention and containment of infectious diseases, including neglected tropical diseases (NTDs), zoonotic infections, and AMR, and underscores the need to strengthen several multilateral organizations, in particular the WHO.

BMZ’s health division leads on policy development

Within the BMZ, the ‘Global health policy and financing’ division (division 100) and the ‘Pandemic prevention, One Health, animal health, biodiversity’ division (division 102) generate the strategies for German development policy on health. Divisions 100 and 102 are part of Directorate 10 ‘Global health; pandemic prevention; One Health’ which is overseen by the Directorate General 1, ‘Global health; private sector; trade; rural development’. Most bilateral ODA to health is provided by the BMZ (64% on average between 2016 and 2018, latest data available), followed by the KfW Development Bank (19%).  BMG and the Federal Ministry of Education and Research (BMBF) each contributed 7% of Germany’s bilateral ODA to health between 2016 and 2018.

BMG represents Germany at the WHO and works closely with the BMZ on development cooperation through the WHO. The BMG also leads on the government-wide global health strategy and worked closely with the Chancellery and the BMZ to issue a call for action to the WHO for a Global Action Plan for the Sustainable Development Goal 3 (SDG 3: “Ensure healthy lives and promote wellbeing for all at all ages”).

BMBF provides funding to global health research, including to CEPI, product development partnerships, and AMR-related funding.