Speech by Federal Chancellor Dr Angela Merkel at the G20 Health Ministers meeting in Berlin on 19 May 2017

Ladies and gentlemen,
Hermann Gröhe,
Colleagues of Hermann Gröhe from the G20 states and partner countries,
Director General Margaret Chan,
Representatives of international organisations,

I, too, would like to extend to you a warm welcome. To be honest, this is the only ministerial meeting I am participating in as Chancellor – perhaps also because it is the first meeting of the health ministers. I would therefore also like to bid you a very warm welcome myself.

As the host of this year’s G20 meeting in the Federal Republic of Germany, we have chosen Hamburg as the location for the gathering of the Heads of State and Government. The symbol you can see here everywhere is a maritime symbol, which is very appropriate for the port city of Hamburg. It is a reef knot, which grows tighter the more you pull on it; only then does it fully develop its connecting quality. Our slogan is: “Shaping an interconnected world”.

Firstly, I would like to thank China. China hosted the last G20 meeting. During that session we laid the foundations for today’s meeting by anchoring the topic of international health in the communiqué of the Heads of State and Government for the first time.

I would like to begin with a request to Argentina, because Argentina will be hosting the next G20 conference. We hope that the topic of health will not be forgotten but remain as prominent as it is at the moment. I think that, in an interconnected world, this subject deserves a place on the G20 agenda.

Why? It is a humanitarian issue: everyone should be able to depend on a functioning healthcare system. To this end we urgently need better cooperation – particularly in the case of infectious diseases, of course. These diseases do not stop at national borders. Growing global mobility is increasing the probability that such diseases will spread. Particularly aggressive pathogens can pose a global threat, also to economic cycles. The President of the World Bank, Kim, repeatedly points out that if the Spanish flu at the start of the 20th century – it was extremely aggressive and spread very rapidly – were to break out again today, we would probably not be adequately prepared for it.

In view of the wide range of interdependent issues, the spectrum of G20 topics has broadened in recent years. That, too, is a logical consequence of globalisation. In any case, Gross Domestic Product is not in itself sufficient to describe the inclusive growth on which we really need to be focusing. I think it makes both economic and social sense to join forces to tackle global challenges.

The starting point was the disastrous impact of the Ebola crisis just a few years ago. Many people provided help. But the help came very late, it was slow, it was uncoordinated. It would be very cynical not to learn any lessons from an event like this. Then people would say it was a serious failure on the part of politicians. When another disease of this nature broke out, if not before, people would ask: Did we do enough to prevent this? In the past few days we have heard of new cases of Ebola in the Congo.

That is why, more than two years ago, within the context of the replenishment conference of Gavi – The Vaccine Alliance, I listed the deficits that the Ebola epidemic revealed to us. Since then, we have embarked on a great deal together. Reform proposals were submitted by the United Nations High Level Commission, among others. The measures elaborated by this panel formed the basis of a report to the Secretary General of the United Nations and, in turn, formed the basis of many reform processes currently under way.

That concerns, firstly, our responsiveness in the case of health crises. To this end we have initiated changes at the level of the United Nations. The World Health Organization has set to work to develop clearly defined emergency structures – and I would like to express my sincere thanks to the Director General for this. This is very important and welcome. They now need to be implemented to ensure that we are able to act.

I myself have visited the World Health Organization. I know that a Director General can only be as good as the degree to which the member states she has in her “ensemble” so to speak are willing to cooperate. To be honest, that is no easy task, for the individual regional organisations enjoy a high level of independence. I therefore want to express my heartfelt thanks to Margaret Chan for using her powers of persuasion to considerably improve the accountability of the WHO leadership and the regional organisations to one another and for the fact that cooperation is now much better.

Just think: if there is the threat of the outbreak of a pandemic in a region, for example in Liberia and other African countries, every country knows what that means for the reputation of the entire region – and it is often very poor countries that are affected. So of course on the one hand there is the temptation not to say anything about it, because it could have devastating economic consequences. On the other hand people know that not talking about things doesn’t improve matters. I think that what has now been created in the WHO – a coordinated procedure in the event of a crisis – will play a crucial role. But that also depends on assistance being made available at a central point – that means: personnel, material and funds. In exchange, we as member states of course also expect transparency and accountability regarding how the resources have been invested. That is very important.

So firstly, we need rapid responsiveness. Secondly, we need a coordinated procedure, with the World Health Organization playing a central role. Thirdly, we need new mechanisms for quick financial assistance. In that area we have achieved something: we have the Contingency Fund for Emergencies, the CFE, at the World Health Organization, and the Pandemic Emergency Financing Facility, the PEF, which has been launched by the World Bank.

The CFE has already demonstrated its ability to function. Funds have already been used to fight local outbreaks of disease. However, the fund’s financial resources still leave something to be desired. – Health Minister Hermann Gröhe is nodding. So anyone who becomes convinced during this conference that greater resources are needed is warmly invited to contribute.

The same goes for the PEF, which is due to be launched this summer. We are going down a very interesting path there. Can states insure themselves against the risk of epidemics? That would mean they would then not have to appeal for help but could, in the event of a crisis, fall back on their insurance instead of being forced into the role of supplicant. Now I know that raises a lot of theoretical questions – the World Bank can tell a tale or two about that, too: Is it possible to assess how great the risk of a pandemic outbreak is in one of more than 190 countries, and how high would the insurance have to be? Nonetheless, I believe it makes sense to examine these questions in order to then provide real security for affected countries.

Ideally, of course, the insurance would not be needed. That is why we need, fourthly, strong healthcare systems. Margaret Chan and Hermann Gröhe have talked about this aspect. As G20 states, we have a responsibility to work on this in our own countries as well as to provide support for those nations which are not yet themselves in a position to improve their healthcare systems. For it is in the interests of us all that certain diseases do not spread in the first place or can at least be identified at an early stage.

That is why the 2030 Agenda for Sustainable Development is so important, citing the right to universal healthcare as one of its 17 goals. That in turn goes hand in hand with economic issues. The engagement for strong healthcare systems generates new jobs and employment. People remain in good health for longer. They can participate in the work process more reliably. Investment in healthcare systems also means investment in economic systems and improves the prospects of all countries, particularly the emerging economies and developing countries.

In order to make process with regard to the 2030 Agenda goal, we need to coordinate our activities as closely as possible. We therefore need to agree on a basic outline of what exactly is necessary at grassroots level, what existing structures ought to be developed, how treatment and medication can remain affordable for people and how to better organise training for medical personnel.

I believe that the paper “Healthy Systems for Universal Health Coverage” provides a good response to this and a good basis for developing a joint understanding of how we should proceed. I would like to thank all those who have worked with us on fleshing out this paper. In this context I would particularly like to thank the WHO, the World Bank and Japan, as well as all the German staff, of course. I invite all of you to get involved in the Universal Health Coverage Partnership.

Good cooperation between industrialised and developing countries is also vital for the research and development of new means and methods of prevention, diagnosis and treatment of diseases. The industrialised countries have a special responsibility for medical advancement. They have the research capacity that poorer countries lack. That is my fifth and final point.

The CEPI initiative has been in place since the beginning of the year. This stands for “Coalition for Epidemic Preparedness Innovations”. It is a coalition of public and private partners, including individual states and the European Union as well as foundations and enterprises. Of course it will take time for new medicines or vaccines to be distributed. The initiative also needs more funds. But I think in principle we are going in the right direction. I really want to convey to all those involved my heartfelt thanks for their tireless commitment – above all our colleagues from Norway and India at this point. I encourage all those considering whether to participate to get involved. Every contribution helps.

You see we are sticking to the principle: “There is no free lunch in this world.” You are constantly being asked to take part in something. But it’s for a good cause.

The fight against antimicrobial resistance depends, among other things, on the research into and development of new agents – the second point, which the previous speakers already mentioned. The development of new antibiotics – as Margaret Chan just explained very effectively, is on the one hand an arduous and cost intensive undertaking, but it is also urgently needed. That is why it is all the more important that we closely coordinate our activities in this area. We need to do more so that the substances we have remain effective in the future. To this end we need a responsible approach to antibiotics to prevent resistance from spreading more quickly and aggressively than it does already. I trust that in their communiqué the health ministers will give us, the Heads of State and Government, a clear mandate.

The interesting thing is that this applies both to human medicine and to agriculture. The interdependence between humans, animals and nature is quite evident. That is why the G20 agriculture ministers agreed on an action plan at the beginning of the year. We consider this a very positive achievement. We want to build on it. For I believe that if we make progress on these issues, we will also promote acceptance of the G20 process in civil society, because people will realise that we are working on behalf of their health and their lives.

Health is in any case an interministerial topic. That is also reflected in our civil society dialogue forums. I have already received many helpful recommendations on health issues from the Dialogue Forum for the Science and Research Community, in which our countries’ national academies are cooperating. Only yesterday a G20 business event on health took place.

Ladies and gentlemen, will we live up to our responsibility for global health? Have we done enough? You as health ministers have found your own way of getting closer to the answer. I’m almost a little bit sad that I can’t be there to see it, because you plan to perform a simulation. I’m very interested to see what the outcome is. I hope this will allow us to visualise the issue in such a way that we can then present it to the Heads of State and Government to see where we stand and what still needs to be done. The results of this simulation will interest us as much as the results of your discussion. I therefore wish you an intensive exchange and hope you gain good results and useful experiences in the practical exercises.

I have read that anyone who wants to can visit the Reichstag this evening and enjoy the view over Berlin. That is something else I can recommend. We usually sit down below and look up into the dome. You will probably be able to look down today from the dome and see where we give our speeches. Be that as it may, welcome to Berlin and to Germany! All the very best, and enjoy your stay.