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Germany eyes global health ambitions as US steps back

Germany might be on its way to filling the ..

Germany might be on its way to filling the ..

Germany might be on its way to filling the void left by the U.S. in global health. But its not going to admit it.

In the wake of U.S. President Donald Trumps confirmation that the U.S. will exit the World Health Organization — leaving a gaping financial and political hole in global health — Germany is trying to step up to the plate.

Weeks after the Trump administration formally notified the United Nations of its withdrawal from the WHO, German Health Minister Jens Spahn took to the stage in Geneva, flanked by French Health Minister Olivier Véran, and announced a €200 million increase in German funding. The cash injection would put Germanys contributions at around €500 million — an amount exceeded in the last two years by only the U.S.

Although the U.S. is an important partner to the WHO, it can be replaced, said David Heymann, an epidemiologist who headed the WHOs response to SARS in 2003. “Germany has become a very important partner in global health recently and other countries are stepping up as well,” he said shortly after Trumps announcement.

Its not just cash that Germany is funneling into global health. Its also determined to be the voice of reason in shaking up the WHO post-pandemic. A case in point: While Germany and France abandoned talks over an American proposal for reforms at the WHO, they penned their own plan to strengthen the organization.

Pitching for more WHO

The two nations recently made the pitch for a beefed-up WHO in a blueprint, reported by Reuters last week, that would give the global body more legal powers while boosting mandatory payments from member countries.

Spahn, who has continued on the path forged by the similarly-minded Hermann Gröhe (as POLITICO predicted Germany would do in 2017), isnt afraid of claiming at least some of the credit for the WHOs recent decision to launch an independent review to evaluate the pandemic response performance. The Council of the EU presidency under Berlin has been an important vehicle through which Spahn can amplify his message that the WHO could “only be as good as member states let it be.”

Back at home, Germanys new global health strategy is also being drawn up and set to be published later this year. Progress on the domestic front is already being made, argues a 2019 BMJ editorial, with Germany establishing a sub-committee on global health in the German parliament; increasing the budget for global health in several ministries; and establishing new centers for global health at some universities.

More broadly, Germany is trying to lead by example, said Anna Holzscheiter, professor of political science at the Technical University of Dresden and head of the research group on global health policy at the Berlin Social Science Center. She points to its increased contributions to the WHO and its willingness “to finance hugely unpopular areas [in the WHO] such as health system strengthening, monitoring and evaluation.”

At the same time, Germany has managed to walk the tightrope between swearing its allegiance to the WHO and criticizing it. Spahn even admitted that Trump “does have a point” on the need for reforms at the WHO. In a similar vein, what his predecessor Gröhe wants to see is the strengthening of the WHOs core capacities, including an evaluation of the 2005 international health regulations and whether there is enough progress in the implementation of this legal framework.

“You need to spend money for the fire brigade in peacetime, not only when the house is burning,” said Gröhe.

Calling for change is also in line with Germanys calls for the WHO to be strengthened, say some WHO watchers.

“Strengthening … also means that you look at the weak parts of the organization, how this can be improved,” said Detlev Ganten, founding president of the World Health Summit and former CEO of Berlins Charité university hospital.

A long time coming

As Ganten sees it, Germany has the opportunity under its Council presidency to work with the rest of Europe to exert some influence on global health. “Before the pandemic situation, global health was not considered as important as it is now,” he said.

But well before the pandemic, Germany was shoring up its clout in global health under the leadership of Chancellor Angela Merkel, with Gröhe, Merkels close confidant, being instrumental.

“Germany has a long tradition in respecting its international responsibility,” explained Gröhe on why global health became so important. “After World War II, the whole comeback of German international reputation or responsibility was in a very non-military way.”

What kickstarted Gröhes focus on global health was antimicrobial resistance and Ebola. In 2015, when the G7 met in Bavaria in Germany, the Ebola outbreak in West Africa was fresh in their minds, prompting leaders to promise support for health systems. The G7 also endorsed the WHOs action plan on antimicrobial resistance.

“It was a lot of lobbying,” he admitted, when speaking of Germanys efforts to get global health on the agenda of the G7 and G20.

Germanys Health Minister Hermann Groehe wants to see a strengthening of the WHOs core capacities | Adam Berry/Getty Images

Perhaps most significant was Germanys decision to put health policy on the G20 agenda in 2017. That year, Germany hosted a fundraiser for antimicrobial resistance research and helped draft a declaration from the G20 health ministers that put the issue center-stage, with the ministers pledging that the G20 was “well-placed to contribute to joint commitment and action in close cooperation with the WHO.”

“It had never happened in that forum before 2017,” said Caroline Schmutte, the lead of the Wellcome Trusts office in Germany. Since then, Germany has been “really continuing down the path funding and advocating for global health from the very top,” she added.

Ilona Kickbusch, an external WHO adviser and founder of the Global Health Centre at the Graduate Institute of Geneva, describes this shift as a “big reshuffle,” with the pandemic creating a space for “middle powers,” such as Germany, to move in.

All the same, experts are wary of asserting that it could be an outright replacement.

“It will be difficult to fill [the gap] … both in terms of the financial contribution and then, of course, in geopolitical terms,” said Holzscheiter.” Unlike the U.S., she argues, Germany doesnt have aspirations to be a global superpower even though its “on the best way to become” a top global health leader.

Gröhe is also cautious. Germany is a strong power and has clear global responsibility, Gröhe said, but he doesnt see it replacing the U.S. “We need an international approach,” is Gröhes assessment.

Germany hates doing things alone

What perhaps best explains Germanys reluctance to take the reins on its own is its commitment to multilateralism, which is vital for these “middle powers,” explained Kickbusch.

The countrys federal system, where power is distributed to states, has meant that multilateralism is in the “DNA of Germany,” said Kayvan Bozorgmehr, head of the department of population medicine and health services research at Bielefeld University. But he worries that this multilateral world is “increasingly under attack.”

“The question is — to which direction does this trend go? Towards stronger nationalism?” asks Bozorgmehr. “Or can we actually manage to revive the multilateral system and keep it alive and strengthen it?”

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