Germany - Global health
At a glance
Germany has shown strong leadership on global health through its G7 and G20 presidencies
Germany was the third-largest donor to health in 2016 (the latest year for which multilateral and bilateral data is available) among the donors of the Development Assistance Committee (DAC) of the Organisation for Economic Co-operation and Development (OECD). According to OECD data, Germany’s total ODA to health in 2016 was US$1.3 billion. This represented 4% of total ODA in that year, which is below the DAC average of 8% for health, making Germany 20th-largest donor in relative terms. 47% was channeled to multilaterals (a much higher share than to other sectors) and 53% of funds were provided bilaterally.
Between 2016 and 2018, Germany’s bilateral health ODA grew by 23% from steadily from US$674 million in 2016 to US$827 million in 2018. Germany’s bilateral development financing focuses on Asia, the Middle East, and North Africa, with health specifically focused on sub-Saharan Africa. The largest share of bilateral health investments in 2018 were in infectious disease control (33%), health policy and administrative management (17%), basic health infrastructure (13%), and reproductive health care (10%). While funding for infectious disease control and health policy and administrative management has been steadily increasing since 2014, funding for basic health infrastructure and reproductive health care has declined. Health is a priority issue in 10 bilateral partner countries of the Federal Ministry for Economic Cooperation and Development (BMZ) (Bangladesh, Cambodia, Cameroon, Ethiopia, Malawi, Nigeria, Pakistan, Zambia Tanzania, Togo, Ukraine, and Usbekistan).
In addition to bilateral funding to health, Germany channels around half of its health ODA to multilateral organizations. In recent years, key recipients of Germany’s multilateral funding to health have included the The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and Gavi, the Vaccine Alliance (Gavi). Germany contributed €725 million (US$856 million) to the Global Fund for 2017-2019 and pledged €1.0 billion (US$1.1 billion) for 2020-2022. For 2016-2020, Germany pledged €600 million (US$698 million, as converted by Gavi) in direct funding to Gavi, and €600 million (not yet converted by Gavi) for 2021-2025. Germany has further committed an additional €100 million (US$117 million) for Gavi’s COVID-19 response in 2020, 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. According to the budget draft 2021, Gavi will receive a top-up of €80 million (US$94 million) in 2021 for its COVID-19 response. Germany also pledged €55 million (US$58 million) to the Global Financing Facility (GFF) for 2021-2023.
The government identified health as a priority sector in its 2017 to 2021 coalition treaty, specifically health system strengthening (HSS), health research and development (R&D), poverty-related and neglected diseases, and international partnerships (such as the Global Fund and Gavi).
In October 2020, Germany launched a new government-wide 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 Sustainable Development Goal 3 (SDG: “Ensure healthy lives and promote wellbeing for all at all ages”). The strategy outlines five strategic priorities in Global Health, which are:
- Promoting health and prevention;
- Mitigating the health effects of climate change;
- Health system strengthening and universal health care;
- Strengthening the Global Health architecture for epidemic and pandemic preparedness; and
- 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 World Health Organization’s (WHO) role to a world pandemic center.
Under Chancellor Angela Merkel, Germany has sharpened its profile as a leader in global health, especially since 2015. Germany has made global health a priority 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 an immediate outcome, an international AMR R&D Hub was launched in Berlin.
Priority countries for bilateral cooperation on health:
In April 2018, Chancellor Merkel, together with her Ghanaian and Norwegian counterparts, suggested that the 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. In the same year, Germany was the first country to establish a formal sub-committee on global health within its Parliament. At the beginning of 2019, the ‘Global Health Hub Germany’ was launched with the aim of strengthening the link between national research institutions and domestic mechanisms to enhance the country’s capacity and expertise on matters of global health.
According to BMZ’s new ‘BMZ 2030 Strategy’ (launched in May 2020), global health, pandemic preparedness, and family planning are three out of 10 so-called ‘initiative themes’, which according to BMZ will receive special attention for selected periods of time, depending on needs. In light of Germany’s significant global COVID-19 response, Germany’s total ODA for health is expected to increase in 2020.
To date, Germany has contributed US$615 million to the Access to COVID-19 Tools (ACT) Accelerator, of which US$117 million was channeled to the Gavi-led COVAX AMC, US$168 million to the Global Fund, US$257 million to the Coalition for Epidemic Preparedness Innovations (CEPI), US$62 million to the WHO, and US$11 million to the Foundation for Innovative New Diagnostics (FIND). Germany has further contributed US$420 million in funding to the WHO’s Strategic preparedness and response plan. In early June 2020, Germany approved an additional €3.1 billion (US$3.7 billion) in funds for the global COVID-19 response (€1.55 billion (US$1.8 billion) for 2020 and 2021 each), whereby the additional €1.55 billion (US$1.8 billion) in 2020 is partly utilized to finance the pledges for the ACT-A in 2020 (e.g. Global Fund, Gavi).
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.
BMZ’s health division leads on policy development
BMZ drives the development of strategies for German development policy, including on health. Within BMZ, the responsible division is ‘Health, Population Policy, Social Protection’. It is part of the Directorate-General ‘Global Issues’. Most bilateral ODA to health is provided by BMZ (64% on average between 2016 and 2018), followed by the KfW Development Bank (19%). The Federal Ministry of Health (BMG) and the Federal Ministry of Education and Research (BMBF) each contributed 7% of Germany’s bilateral ODA to health between 2016 to 2018.
The Federal Ministry of Health (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 BMZ to issue the call on the WHO for a Global Action Plan for SDG 3.