Germany - Global health

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Germany’s strong leadership in global health continues throughout the COVID-19 pandemic.

Germany was the third-largest donor to global health in 2020 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 2020 was US$3.2 billion. This represented 10% of total ODA in that year, which is on par with the DAC average of 10%. However, in relative terms, Germany only ranks as the 12th-largest donor to global health in 2020. Germany channeled more than half of its health ODA (68% or US$2.1 billion) bilaterally in 2020 including 31% of earmarked funding to multilateral organizations which is reported as bilateral ODA. 32% of funds were provided multilaterally.  

Between 2019 and 2020, Germany’s bilateral health ODA grew by 149%, from US$860 million in 2019 to US$2.1 billion in 2020. Bilateral health ODA focused mainly on COVID-19 control (43% of bilateral health ODA) and infectious disease control (18%). Smaller shares went to health policy and administrative management (6%), basic nutrition (6%), and reproductive health care (5%). Funding for all these areas increased in 2020.

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

In addition to its bilateral funding to health, Germany channeled 32% of its health ODA to multilaterals, which is below the DAC average of 44%, but higher compared to Germany’s contributions to multilaterals in other sectors. The largest recipients in 2020 were the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund; 18% of total health ODA), Gavi (5%), EU Institutions (5%), IDA (2%), UNFPA (1%), and WHO (1%).

Germany pledged €1.5 billion (US$1.6 billion, according to the Global Fund’s conversion rate) to the Global Fund for 2020-2022. The federal midterm financial planning foresees another €1.2 billion (US$1.3 billion) for the Global Fund for 2023-2025. For Gavi, the Vaccine Alliance’s (Gavi’s) strategic period of 2021-2025, Germany pledged US$737 million in direct funding. For the Global Financing Facility, Germany pledged US$58 million for the 2018-2023 period.

In May 2022, Germany announced to contribute €1.3 billion (US$1.5 billion) to ACT-A in 2022, exceeding its ‘fair share’ for 2022 of US$1.2 billion. As part of this, Germany pledged €400 million (US$456 million) to ACT-A’s vaccine pillar COVAX for 2022, including €350 million (US$399 million) for Gavi and €50 million (US$57 million) for UNICEF, during the 2022 Gavi COVAX AMC Summit ‘Break COVID Now’. As of June 2022, Germany has contributed a total of US$3.9 billion to the Access to COVID-19 Tools Accelerator (ACT-A) so far, making it the second-largest donor to the global initiative. Of that, Germany has contributed US$2.7 billion to ACT-A’s vaccine pillar COVAX, US$100 million to the therapeutics pillar, US$188 million to the diagnostics pillar, and US$288 million to the health systems pillar. US$596 million are pending allocations to the ACT-A pillars.

The German government identified health as a priority sector in its 2021-2025 coalition treaty, specifically strengthening global health architecture under the One Health approach, health research and development (R&D), especially in biotechnology, poverty-related and neglected diseases (PRNDs), and water, sanitation and hygiene (WASH).

Under former Chancellor Angela Merkel, Germany sharpened its profile as a leader in global health, especially since 2015. Germany prioritized global health during both its previous 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 in 2015. Under the German G20 presidency in 2017, the health ministers of G20 countries met for the first time to discuss global health issues such as pandemic preparedness, health system strengthening, and AMR. As a result, the Global AMR R&D Hub was launched in Berlin. Research on AMR and on strengthening pandemic preparedness are also among Germany’s key priorities for its G7 Presidency in 2022. During the G7 health ministers’ meeting in May 2022, a ‘G7-Pact for Pandemic Readiness’ was initiated. The pact is a global network of health experts with the goal of strengthening and aligning efforts to bolster worldwide pandemic readiness. It will work in close cooperation with the World Health Organization (WHO).

In April 2018, the former Chancellor 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 toward 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 in global health matters.

In October 2020, the German Federal Cabinet also adopted a new cross-ministerial global health strategy for 2020-2030, entitled ‘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 SDG 3 (“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 preventing diseases;
  2. Mitigating the health effects of climate change;
  3. Health systems strengthening and universal health care (UHC);
  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.

In February 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, 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 was 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.

In September 2021 the WHO and the German government inaugurated a new 'Global Hub for Pandemic and Epidemic Intelligence' based in Berlin to strengthen cooperation between countries and scientific institutions worldwide to enhance global capacity for pandemics and epidemic forecasting. Germany contributed US$100 million in initial investment to the Hub.

In response to the COVID-19 crisis, the BMZ established a new division focussing on global health, pandemic response, and One Health. In November 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 ‘Special initiative pandemic and global health, pandemic prevention, One Health’ division (division 101) generate the strategies for German development policy on health. Divisions 100 and 101 are part of Directorate 10, ‘Global health; resilience; equal opportunities’, which is overseen by the Directorate-General 1, ‘Global health; employment; transformation of the economy; digitalization; food security’. Most bilateral ODA to health has been provided by the BMZ (37% in 2020), followed by the Foreign Office (25%). The BMG contributed 23% to Germany’s bilateral health ODA in 2020, and the BMBF 10%.  

The 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 to 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