hen I think of Germany’s chancellor, Angela Merkel, one memory sticks in my mind. We were in a small but public venue. She was, as she is now, fighting for re-election at the height of what’s often been portrayed as a devastating migration crisis. During the question-and-answer period, she said that Germany had created 3 million jobs in the last 12 months, and that 1 million of them had gone to people who had migrated to Germany.
Her statement struck me. I couldn’t imagine many global leaders saying that in such a public way — or with such pride, believing that this was a real achievement. Merkel demonstrated tremendous humanity and courage. With Germany’s migration issues, she knew it wouldn’t be popular with everybody, yet she was willing to state it. I thought that showed amazing integrity.
So it hasn’t been a surprise to see the Group of Twenty (G20), this year under Germany’s leadership, making big health pledges of global rather than national benefit. Establishing national action plans to fight antimicrobial resistance, investing in pandemic preparedness, pushing for universal health care, combating climate change — these proposals, if realized, will improve millions of lives worldwide.
Of course, we’ll have to wait and see exactly how the G20 goals develop, but at this point I’m confident they’ll be fulfilled and have a lasting impact. Merkel’s messaging on health has been very consistent over the past three years. She may sometimes be portrayed as a cautious politician, but in making a series of bold and courageous speeches on these topics, I believe her government is planning to provide leadership and commit to these issues.
The G20 under German leadership has also been very focused. While Merkel and her ministers have talked about universal health care, drug resistance, migration, epidemics — and in particular the Coalition for Epidemic Preparedness Innovations, which is creating new models for funding vaccine development — they haven’t tried to build in everything. This suggests there’s a real intention to see through what’s been promised.
On top of this, there’s growing evidence that Germany is committing to global health for the long haul. It’s almost doubled its financial support for the World Health Organization over the last 10 years, and it used the G20 to launch a new global research and development body, the Global Antimicrobial Resistance Collaboration Hub.
This is significant, particularly the timing. It’s highly likely that Germany’s plans for the G20 predate the political shocks of the past year — the trend towards nationalism and away from globalization — which have made the backdrop for implementing them more uncertain. This only seems to have strengthened Merkel’s resolve. As many countries are becoming more inward-looking, Germany’s stepping up its role in this area is most welcome.
As it does this, stewardship of the G20 passes to Argentina. Presiding countries must do things that are essential for them, their region and their partners, and to which they can bring their own perspective and passion. It would be fitting, then, if Argentina led the way on middle-income health issues, particularly those affecting South and Central America.
South America was the epicenter of the Zika global health emergency, so Argentina may choose to retain a focus on epidemic preparedness. Argentina could also choose to fight the challenges facing countries as they move toward high-income status, as many in Central and South America are doing. Problems that need addressing include how to provide universal health care and affordable access to it, how to afford drugs as subsidies are potentially removed, and how to handle the double burden of infectious and noncommunicable disease within a single health care system. As poor countries shift to become middle- and high-income countries, they can lose their voices as they rise. Argentina, in its new position on the world stage, can change this.
Keeping health at the highest political level will be essential in the next G7 presidency, too. It would be good to see Canada support the initiatives developed by previous presidencies and also provide leadership on other great challenges of our time — such as climate change and its impact on health today. Mental health is another potential area of focus. Here, the science is starting to come together to inform interventions that can transform lives, and there’s a growing appreciation that if you improve mental health, you improve so many other things over and above the individual: family life, communities, and, of course, the inevitable economic gains that accompany well-being.
To make a success of their countries’ presidencies, Mauricio Macri, Argentine’s president, and Justin Trudeau, Canada’s prime minister, will need to lead with the same values, courage, and integrity that Merkel has shown. In these uncertain political times, there remains great value in international partnerships, multinational structures and organizations, and a shared commitment to equity, solidarity, and public good — as well as taking on a small number of things and committing to getting them done.
Regardless of what direction they choose to take, both will undoubtedly encounter the most significant outcome of the recent G7 and G20 meetings: that global health has been pushed up the agenda. Five to 10 years ago, health might have gained only one line in a communiqué. Today it’s firmly on the political agenda at the highest level. This elevation can only be positive; now we must all deliver.
Jeremy Farrar, M.D., is the director of the Wellcome Trust, a global charitable foundation.