Global Health

By hosting the World Health Summit and the Grand Challenges Annual Meetings of the Bill & Melinda Gates Foundation in October 2018, Berlin increasingly assumes leadership in the area of global health. By doing so, the city dedicates efforts to a commitment supported by several international decision makers from politics, economics and civil society.

In this context, Global Perspectives Initiative (GPI) met with several international players to discuss Germany’s role in global health. In the course of the 68th Lindau Nobel Laureate Meetings a key issue paper was developed, involving Nobel laureates Prof. Peter Agre and Prof. Aaron Ciechanover. With the support of Dr. Georg Kippels, member of the German parliament and the subcommittee on global health, these aspects were further investigated in a political briefing in Berlin. Among the participants were Prof. Jeremy Farrar, Prof. Peter Agre and Prof. Stefan Kaufmann. The results of the briefing and important quotes are summarised below.

Cross-sector cooperation is needed
“If we bring together science, innovation and the civil society, the challenges of global health can be solved” stated Prof. Jeremy Farrar, director of the Wellcome Trust. By arguing, “we all benefit from efforts that improve the health situation worldwide”, he reaffirmed, that improving global health it is not aid for developing countries, but instead a service for the whole international community. Nobel laureate Prof. Peter Agre agreed, “This is about us. The overall concept of global health benefits everyone individually.” In order to improve health, it is important to recognise the increasing convergence in science and how economies function and operate nowadays. Prof. Agre sees enormous potential in Germany, taking on a leadership role. The country should use its profile more intensively in order to improve knowledge transfer and the cooperation between the separate industrial and economic branches of the health sector. Germany’s well-developed structures could be useful in developing new global health concepts.

Prof. Ilona Kickbusch added that global health is about knowledge transfer that enables the creation of sustainable and affordable health systems. How important this approach is reveals the Bill & Melinda Gates Foundation by focussing on the development of health systems and improving access to primary health care.

The work at the basis remains important
The debaters also considered a prioritisation of global health problems and regions as well as a decision on which measures to be applied as necessary. In order to find out which approaches are viable and which are not, comprehensive work at the basis is needed involving the people on the ground. Engaging with the local level is not only required to build trust, but also to align the methods and structures to actual needs. Edith Phalane, PhD candidate at the North-West University argues: “Sometimes we think too much as innovators. We cannot neglect the basis and we have to understand what people really need.” She considers education and capacity building as key: “If we want to equip Africa properly, we have to keep our word.” Prof. Stefan Kaufmann, director of the department “Immunology” at the Max Planck Institute for Infection Biology argues that “we have to be careful that we do not prefer one thing over another. Complexity has to be considered.” He concluded that an inclusive holistic scientific approach could encounter this complexity. Prof. Ilona Kickbusch criticises the marginal share of social science research involving global health and calls for a greater involvement of anthropologists. “We have to understand the motivation of people and their fears. This includes, for instance, an understanding why some people do not want to be vaccinated.”

New incentives for European business models
Discussions on new investments and future business models to tackle global health issues absorbed a lot of time. Deutsche Welle (DW) journalist Nils Zimmermann noted that the implementation of new ideas is often hindered by financial, logistical and organisational restraints. Furthermore, in contrast to United States or China, the European venture capital scene is risk averse. Does Europe need a public venture capital fund to create new business models around the global health issue? Prof. Jeremy Farrar believes that long-term investments would not work in Europe. Venture capital is designed short-term with exit strategies after three years. In the past 30 years Europe failed to create new sustainable business models. Prof. Farrar pleads for changing the incentive systems for businesses in Europe, which could also implicate the prevention of company takeovers by the United States. Apart from economic benefits for Europe, this would lead to a stronger demand for global health initiatives from Europe.

According to the participants, innovation in the health sector is dominated by Blogbusters, drugs that are created for the general public and therefore generate most revenues. Prof. Jeremy Farrar argues, “if we reduce the risks around investments in the development of drugs, the return rate ranges between three and five per cent. This is not the previous 20 per cent profit but prevents the zero per cent profit for new developments.” In Germany, there exists a true potential for these types of innovations that were so far neglected. The problem is not new but changing the incentive structures could facilitate the necessary progress. Prof. Peter Agre asks “Germany is known for investing in “big things”, but what happens with the discoveries of smaller- sized research projects?” Prof. Gérard Krause, head of the epidemiology department at the Helmholtz Centre for Infection Research, warns that economic objectives should not impact moral obligations. “What if the economic motivation is not high enough anymore?” he warns.

It does not work without politics
Despite the important role of the private sector, the need for new cultures of innovation and a higher risk affinity – without the active participation of politics, global health initiatives would have a much smaller impact. Prof. Jeremy Farrar commented, “The public sector should not outsource too much responsibility to private initiatives. In the past 40 years, the private sector has heavily involved the business sector. Here the public hand has to grow stronger again, to promote efficiency and to guarantee access and affordability.”

An important instrument in Germany is the subcommittee on global health. Dr Georg Kippels, member of this subcommittee and performing a moderating role argues, that a challenge is to work flexible on overlapping issues and to overcome the boundaries of historically evolved political departments. He claims that we have to think the term “Global Health” in a broader sense, as it includes much more than only health care. It entails education, nutrition and many other topics. Health is part of everything.

The political will is crucial for success in the area of global health, commented Prof. Ilona Kickbusch. There are high investment flows, but we do not utilize them well enough, because we underestimated how complex human life is.

It is certain that Germany has adopted a leading role in global health. Now it is important to make use of its potential, to extend its strengths and to set the course for future developments. To come back to Prof. Jeremy Farrar: “If we do not merge the three things (science, innovation and the civil society) each sector will fail individually to address global health.”

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