S upa , Ch is oph; Schä e ho , Ma co; Siegel, Ma in; Ho nidge, Anna-Ka ha ina
Resea ch Repo
Global heal h a a c oss oads: Policy ecommenda ions in
ligh o he Lance Global Heal h 2050 Repo
IDOS Policy B ie , No. 5/2025
P o ided in Coope a ion wi h:
Ge man Ins i u e o De elopmen and Sus ainabili y (IDOS), Bonn
Sugges ed Ci a ion: S upa , Ch is oph; Schä e ho , Ma co; Siegel, Ma in; Ho nidge, Anna-Ka ha ina
(2025) : Global heal h a a c oss oads: Policy ecommenda ions in ligh o he Lance Global Heal h
2050 Repo , IDOS Policy B ie , No. 5/2025, Ge man Ins i u e o De elopmen and Sus ainabili y
(IDOS), Bonn,
h ps://doi.o g/10.23661/ipb5.2025
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Global Heal h a a C oss oads:
Policy Recommenda ions in Ligh
o he Lance Global Heal h 2050
Repo
Ch is oph S upa , Ma co Schä e ho , Ma in
Siegel und Anna-Ka ha ina Ho nidge
Summa y
A a ime o global c isis and compe ing p io i ies,
in es ing in heal h is among he mos impac ul and
cos -e ec i e decisions go e nmen s and s akeholde s
can make. Beyond being a undamen al igh , heal h is
a ca alys o g ow h, s abili y and esilience –
pa icula ly in unce ain imes. The new Global Heal h
2050: he pa h o hal ing p ema u e dea h by mid-
cen u y (Global Heal h 2050) epo (Jamison e al.,
2024) o he Lance Commission on In es ing in Heal h
( he Commission) builds on a legacy o e idence-d i en
epo s o p o ide s a egies o making heal h a c oss-
cu ing enable o he Sus ainable De elopmen Goals
(SDGs). Global Heal h 2050 p o ides a oadmap o
u he heal h imp o emen s in all coun ies by mid-
cen u y, a guing ha by 2050 coun ies can educe by
50% he p obabili y o p ema u e dea h (PPD) in hei
popula ions. The Commission calls his goal “50 by 50”.
Ge many has solidi ied i s ole in global heal h h ough
signi ican in es men s in he heal h sec o and by
designa ing global heal h as a poli ical p io i y, as
demons a ed by i s Global Heal h S a egy and he
inclusion o global heal h as one o he co e hemes o
he Fede al Minis y o Economic Coope a ion and
De elopmen (BMZ). Gi en his poli ical p io i y, i is
essen ial o assess he implica ions o he Global Heal h
2050 epo o Ge many’s global heal h agenda,
especially as global heal h s ands a a c oss oads
ollowing he wi hd awal o he Uni ed S a es (US) om
he Wo ld Heal h O ganiza ion (WHO) and cu s o i s
global heal h p og ammes.
The e o e, he aim o his policy b ie is o build upon he
Commission’s indings and d aw om scien i ic
e idence o p o ide key ecommenda ions o
Ge many’s global heal h agenda.
Fi e ecommenda ions ha e been syn hesised ha align
wi h Ge many’s global heal h engagemen and o e
p omising s a egies o help achie e he 50 by 50 goal:
1. Sus ain o ideally inc ease unding o he Ga i,
The Vaccine Alliance, and he Global Fund o
Figh AIDS, Tube culosis and Mala ia a he
upcoming eplenishmen con e ences and
s eng hen Ge many’s global heal h leade ship
h ough s ong bila e al suppo , in es men s in
pandemic p epa edness and esponse (PPR) and
be e in e minis e ial coo dina ion.
2. Reconside non-communicable diseases (NCDs)
in u u e s a egic di ec ion o Ge man in e na ional
coope a ion by educing inancial and geo-
g aphical ba ie s o access o medicines and
add essing key NCD isk ac o s.
3. P omo e heal h axes on obacco, alcohol, and
suga -swee ened be e ages ha can se e as an
e ec i e s a egy o imp o e public heal h and
gene a e domes ic e enue.
4. Inc ease unding o R&D in neglec ed diseases.
Expand egional manu ac u ing, and enhance
global heal h inno a ion coo dina ion o s eng h-
en global heal h secu i y and educe dependence on
ex e nal supply chains.
5. Nepal se es as a good example o Ge many’s
bila e al heal h and social p o ec ion suppo :
ad ancing he 50 by 50 goal could be achie ed by
s eng hening na ional heal h insu ance, add essing
clima e isks, expanding heal h axes and enhancing
pha maceu ical access h ough he A ow
mechanism.
IDOS POLICY BRIEF
5/2025
IDOS Policy B ie 5/2025
2
Public backg ound: Lance Global
Heal h 2050 Repo
The Global Heal h 2050 epo p o ides a comp e-
hensi e o e iew, ein o cing he a gumen ha
in es ing in heal h yields s ong e u ns and
p omo es b oade de elopmen . The Commission
concludes ha subs an ial imp o emen s in
human wel a e a e achie able by mid-cen u y
wi h ocused heal h in es men s. By 2050,
coun ies could educe by 50% he p obabili y o
p ema u e dea h (PPD) in hei popula ions –
i.e., he p obabili y o dying be o e age 70 yea s
– om a p e-pandemic baseline yea o 2019. The
Commission calls his goal “50 by 50”. The 50 by
50 goal can be eached by ocusing on 15 p io i y
condi ions, eigh ela ed o in ec ious diseases
and ma e nal heal h and se en ela ed o NCDs
and inju ies (Table 1). These condi ions accoun
o ~80% o he li e expec ancy gap be ween he
bes pe o ming egion (No h A lan ic, which
comp ises Canada and Wes e n Eu ope in Global
Heal h 2050) and o he egions. The Global
Heal h 2050 epo emphasises ha na ional
go e nmen s should main ain hei ocus on public
inancing o a co e se o in e en ions ha a e ully
p epaid, highly cos e ec i e and a ailable o
e e yone, s a ing wi h he in e en ions a ge ing
he 15 p io i y condi ions. The Commission se an
in e im miles one o cu ing p ema u e dea hs by
30% by 2035 and shows ha a p ac ical pa hway
o he 50 by 50 goal is wi hin each.
Table 1: Focus on 15 p io i y condi ions
In ec ious and ma e nal
heal h condi ions (8)
Neona al, lowe espi a o y ac in ec ions, dia hoeal diseases, HIV, TB,
mala ia, childhood clus e diseases, ma e nal condi ions
NCDs and inju ies (7) A he oscle o ic ca dio ascula diseases, haemo hagic s oke, NCDs
s ongly linked o in ec ions, NCDs s ongly linked o obacco use,
diabe es, oad inju y, suicide
The epo a i es a a c i ical momen , ea i ming
he impo ance o in es ing in heal h by p e-
sen ing new e idence on i s alue o li elihoods
and economic de elopmen , as well as ou lining a
easible way o wa d beyond he SDGs. Mo eo e ,
i in es men s in he 15 p io i y condi ions succeed
in hal ing p ema u e dea hs be o e age 70 by
2050, his a ge ed ocus will se e as a aluable
miles one on he pa h o achie ing Uni e sal
Heal h Co e age (UHC). Some coun ies ha e
al eady s a ed o implemen he Commission’s
ecommenda ions. Fo example, No way’s Expe
Commi ee on Global Heal h has emb aced he
ecommenda ions o he Global Heal h 2050
epo and na ional commissions a e unde way in
se e al coun ies, including Nepal, Nige ia and
he US.
Howe e , he epo has also igge ed a deba e
on how coun ies can bes p io i ise in e en ions
a local le el (Bake e al., 2024). This discussion
also has o conside he need o assess how
clima e change could po en ially jeopa dise he
goal o hal ing p ema u e dea hs by 2050 – an
aspec ha was no sys ema ically assessed in he
epo . Ne e heless, we belie e ha Global Heal h
2050 o e s impo an insigh s o Ge many’s global
heal h agenda. In he ollowing, we ou line key
ecommenda ions o s eng hen Ge many’s
global heal h agenda and engagemen in i e
a eas. The ecommenda ions align wi h Ge many’s
global heal h engagemen and ha e been iden i-
ied as p omising s a egies o con ibu e o he
achie emen o he 50 by 50 goal.
S eng hen key mul ila e al
mechanisms and bila e al
engagemen
In Global Heal h 2050, he Commission pu s
s ong emphasis on ma ke shaping and pooled
p ocu emen o d i e p ices down o key
medicines. I ecommends ully esou cing Ga i,
The Vaccine Alliance, and he Global Fund o
IDOS Policy B ie 5/2025
Figh AIDS, Tube culosis and Mala ia (Global
Fund) a hei 2025 eplenishmen s o ensu e ha
hei ma ke -shaping powe o p io i y in ec ions
can be ully le e aged. Ga i p o ides accines o
majo childhood diseases, while he Global Fund
p o ides 28% o all in e na ional inancing o HIV,
76% o all in e na ional inancing o ube culosis
(TB), and 62% o all in e na ional inancing o
mala ia p og ammes. I also in es s in esilien and
sus ainable sys ems o heal h (RSSH), which a e
adi ionally an impo an a ea o Ge many. Ga i’s
app oach o pooling demand om mul iple
coun ies had a ma ke shaping e ec which
ans o med he ma ke o accines. Likewise,
h ee-qua e s ($1.5 billion) o he $2 billion ha he
Global Fund in es s e e y yea o key d ugs and
heal h p oduc s is pu chased h ough a pooled
p ocu emen mechanism (Global Fund, 2024a).
F om a pe spec i e o scien i ic e idence, bo h
mechanisms ha e p o en e ec i e in comba ing
communicable diseases and imp o ing child
heal h (Boyce e al., 2021; Dyks a e al., 2019;
Jaupa e al., 2019).
Wi h €1.3 billion, he Ge man go e nmen is he
hi d-la ges dono o he Global Fund in he
cu en alloca ion pe iod 2023–2025. I is also he
hi d-la ges go e nmen dono o Ga i, including
he €1.3 billion con ibu ed du ing he COVID-19
pandemic. Despi e he p og ammes’ p o en
posi i e impac , signi ican educ ions in he con-
ibu ions o Ga i and he Global Fund a e planned
by Ge many. This would imply a signi ican
weakening o i s mul ila e al suppo o global
heal h and would jeopa dise Ge many’s commi -
men o he heal h- ela ed SDGs. The Global
Heal h 2050 epo emphasises ha ull unding o
bo h mechanisms will be c i ical o main ain hei
ma ke -shaping powe o deli e key commodi ies
o coun ies a a o dable p ices.
S ong suppo o Ga i and he Global Fund will
also be c i ical o deli e new heal h ools. Fo
example, wo mala ia accines we e ecen ly
app o ed, and h ee TB accines a e cu en ly in
la e-s age ials. In addi ion, he scien i ic jou nal
Science elec ed Lenacapa i as i s 2024
B eak h ough o he Yea . Being e ec i e in bo h
ea men o HIV and as a p e-exposu e p ophy-
laxis, Lenacapa i may educe global in ec ion
a es, and he eby ee up esou ces o com-
ba ing ube culosis and mala ia (Science, 2024).
The Global Fund’s abili y o in es in o he Ge man
p io i ies, such as RSSH, also hinges on he
success o he eplenishmen .
In line wi h Ge many’s suppo o he Lusaka
Agenda o a be e in eg a ion o he global heal h
a chi ec u e (Le ine e al., 2024), Ga i and he
Global Fund need o iden i y and exploi po en ial
syne gies a ising om a g owing o e lap be ween
hem, o example h ough new echnologies such
as mala ia accines and po en ially upcoming TB
accines. While coun ies ha e o assess and
p io i ise he op imal mix o in e en ions, he
di e en unding p ocesses and pe iods o Ga i
and he Global Fund make he de e mina ion o he
bes mix o in e en ions in an e icien way
di icul . Be e in eg a ion o he mul ila e al mech-
anisms is also needed o educe he bu den o
ecipien coun ies, which cu en ly s ill ace high
ansac ion cos s and a imes lack he necessa y
capaci y and leade ship o ansla e he p o ided
suppo in o op imal impac .
Finally, Ge many also in es s in pandemic
p e en ion and esponse (PPR) (a co e p io i y
o Ge many), which aligns wi h Global Heal h
2050. The Commission es ima es ha he e is a
48% chance in he nex 25 yea s o a pandemic
ha kills a leas 25 million people. Ge many’s
cu en bila e al suppo helps o s eng hen he
esilience o heal h sys ems. Ge many is a key
con ibu o o he Coali ion o Epidemic P epa ed-
ness Inno a ion (CEPI), he Pandemic Fund and
WHO’s Con ingency Fund o Eme gencies (WHO
CEF). Howe e , all hese mechanisms emain
unde unded.
O e all, we ecommend ha he incoming Ge man
go e nmen akes he ollowing ac ions:
1. Main ain o ideally inc ease unding o Ga i
and he Global Fund a hei 2025 eplenish-
men con e ences, and p o ide comple-
men a y bila e al suppo . Ga i and he Global
Fund a e pi o al o achie ing he 50 by 50 a ge ,
IDOS Policy B ie 5/2025
as hey play an impo an ole in shaping global
ma ke s o heal h echnologies and con ibu e o
he s eng hening o heal h and immunisa ion
sys ems. S ong suppo o hese mechanisms is
c i ical o p omo e equi able access o heal h ools
and ensu e con inued p og ess owa ds he heal h
SDGs. (This is no o diminish he impo ance o
o he Ge man-suppo ed heal h unds, such as he
Global Polio E adica ion Ini ia i e (GPEI).) Mean-
while, al hough Ge many signi ican ly inc eased i s
bila e al heal h unding du ing he pandemic, he
unding almos d opped back o p e-pandemic
(2019) le els in 2023 (OECD DAC, 2025). Going
o wa d, i is essen ial ha bila e al suppo , bo h
echnical and inancial, be main ained a leas a
cons an eal e ms. This ensu es ha heal h
sys ems a e s eng hened h ough ailo ed, mul i-
sec o al solu ions, enabling hem o abso b mul i-
la e al esou ces. In addi ion, bila e al suppo
should p io i ise he poo es coun ies and
complemen mul ila e al e o s o s eng hen
heal h ou comes.
2. Encou age mo e in eg a ed app oaches
be ween Ga i and he Global Fund. The
Ge man go e nmen should exe i s in luence
upon he wo mul ila e al mechanisms o p omo e
s onge collabo a ion ollowing he Lusaka
Agenda. We ecommend p omo ing he c ea ion
o a o mal mechanism dedica ed o ensu ing
in eg a ed app oaches ha simpli y implemen a-
ion o coun ies and op imise alue o money.
The mechanism can build on ini ial e o s o
inc easingly wo k oge he (Global Fund, 2024b).
Alignmen a ound unding cycles and eligibili y will
be c i ically impo an .
3. Expand he in e na ional leade ship o
global heal h. The Commission emphasises he
need o s onge suppo o WHO’s co e unc ions
(Jamison e al., 2024). Recen changes in he
in e na ional sys em, especially he unding gap
caused by he US go e nmen ’s wi hd awal om
WHO ( he US con ibu ed ~16% o he WHO’s
o al e enue in he 2022–2023 biennium
(Williams, 2025)), wa an esolu e ac ion. I will be
mo e c i ical han e e ha Ge many, as one o
WHO’s la ges suppo e s, ex ends i s unding o
compensa e o his subs an ial inancial de ici .
The e is also need o con inued in es men in
PPR h ough bila e al p og ammes and global
mechanisms such as he WHO CEF. Second, we
sugges s onge in e -minis e ial coo dina ion.
S onge collabo a ion be ween minis ies (BMG,
BMZ, AA and BMBF) is equi ed o u he
s eng hen Ge many’s leade ship in global heal h
(F anz e al., 2024). In line wi h his app oach, we
ecommend ha Ge many in es s mo e in
domes ic c oss-sec o ial capaci y o s eng hen
coo dina ion be ween minis ies and o he s ake-
holde s. The planned e alua ion o he Ge man
go e nmen ’s Global Heal h S a egy in 2025 will
be an oppo uni y o o malise his collabo a ion.
Thi d, we ecommend ha Ge many con inues
ad oca ing o global heal h in plu ila e al o a,
such as he G7 and G20, by de eloping collabo a-
i e p oposals a ge ing c i ical heal h challenges
such as pandemic p epa edness, while pushing
o inc eased unding and sus ainable inancing o
global heal h ini ia i es (S upa e al., 2023)
S a egic app oach o NCDs
NCDs a e a majo con ibu o o p ema u e
mo ali y and he global li e expec ancy gap. In he
Global Heal h 2050 epo , he Commission
highligh s ha , acco ding o es ima es om he
WHO Global Heal h Es ima es (2021), he Wo ld
Popula ion P ospec s (UN Popula ion Di ision,
2024) and Ka lsson e al. (2024), NCDs and
inju ies om acciden s accoun o abou 43% o
he global li e expec ancy gap, while in ec ious
diseases accoun o a ound 35%. Ne e heless,
he igh agains NCDs seems o play a mino ole
in he BMZ co e heme s a egy “Heal h, Social
P o ec ion and Popula ion dynamics” (BMZ,
2023).
BMZ’s in es men s in global heal h amoun o
oughly €1 billion annually. As shown in Figu e 1,
he p ima y bene icia ies o his unding a e mul i-
la e al o ganisa ions such as Ga i and he Global
Fund, along wi h ini ia i es aimed a enhancing
basic heal hca e se ices and s eng hening
heal h sys ems (in es men s ha may also bene i
NCDs).
IDOS Policy B ie 5/2025
Figu e 1: Dis ibu ion o BMZ commi men s o global heal h in 2024
No e: The in o ma ion p o ided is based on 2023 and 2024 commi men s o BMZ’s bila e al and mul ila e al de elopmen
coope a ion. Nongo e nmen al commi men s a e no included. Commi men s in non-heal h sec o s may no be included (e.g.
commi men s ela ed o nu i ion o WASH) e en i hey also a ec global heal h o he de e minan s o heal h. Da e: 06/03/2025.
Sou ce: BMZ MeMFIS Fö de be eichschlüssel Gesundhei
Howe e , inancial suppo speci ically o he
p e en ion and con ol o NCDs has seen a
signi ican dec ease, d opping om abou €53
million in 2023 o a ound €26 million in 2024, which
ep esen s abou 2.5% o he o al annual
con ibu ions in 2024.
NCDs accoun o a la ge po ion o he li e
expec ancy gap han in ec ious diseases,
wo ldwide and in almos all WHO sub- egions.
Figu e 2 shows he ac ion o mo ali y unde 70
yea s a ibu able o NCDs o some o he BMZ
pa ne coun ies o he yea 2019. In 14 ou o he
17 coun ies, NCDs accoun o o e 50% o
dea hs in people unde 70 yea s o age. In es -
men in heal h sys ems and p ima y heal h ca e
can e ec i ely con ibu e o mi iga ing NCDs
(WHO, 2013). Howe e , i may be bene icial o
mo e explici ly emphasise he ele ance o
heal h sys ems and p ima y ca e o NDCs in
u u e s a egies o enhance e o s owa ds
achie ing he 50 by 50 goal.
Many NCDs, such as ca dio ascula diseases,
hype ension, diabe es, as hma and ch onic ob-
s uc i e pulmona y disease, a e ch onic condi-
ions ha equi e con inuous moni o ing and
a o dable medicines o e ec i e ea men . Low-
h eshold access o ambula o y heal h se ices
and subsidised medicines, a leas o lowe -
income households, a e he e o e c i ical o
p e en episodes o acu e illness, hospi alisa ion,
disabili y and p ema u e mo ali y. T ea men o
ch onic NCDs place a e y high inancial bu den
on a ec ed households, and leads o o gone ca e
and unme need because o inancial cons ain s.
IDOS Policy B ie 5/2025
Figu e 2: P opo ion o unde 70 dea hs a ibu able o NCDs
Sou ce: Au ho s’ calcula ions, based on WHO da a (2021)
We sugges he ollowing wo en y poin s o
s a egically add ess NCDs be e in he u u e:
1. Reduce inancial and geog aphic ba ie s o
he access o diagnos ics and medicines. The
diagnosis, ea men and con ol o NCDs equi es
consis en access o heal h se ices and medi-
cines. E o s o imp o e access o diagnos ics and
medicines should be e alua ed on a egula basis
o ensu e ha he esou ces spen a e used in a
meaning ul way. The Commission a gues ha
cen alised p ocu emen o a ocused se o highly
subsided d ugs can imp o e he a ailabili y and
a o dabili y o key d ugs, including o NCDs,
he eby educing p i a e ou -o -pocke expendi-
u es (Jamison e al., 2024). They p opose he
es ablishmen o he “A ow” mechanism, which
in ol es di ec subsidy o d ugs and pooled pu ch-
asing. This mechanism can be unded in a ious
ways, including domes ic esou ce mobilisa ion. A
he ime o w i ing his policy b ie , e o s we e
ongoing o es ablish such a mechanism in Nige ia
o subsidise NCD d ugs, an ibio ics and an i-
mala ials. We ecommend o e ing echnical and
inancial suppo o coun ies ha a e in e es ed in
he c ea ion o domes ic A ow mechanisms.
2. Add ess key NCD isk ac o s mo e p omi-
nen ly in u u e s a egic di ec ion. Indi idual
beha iou al ac o s such as obacco and alcohol
consump ion, physical inac i i y and unheal hy
die s a e well-es ablished isk ac o s o many
NCDs (WBGU, 2023). In addi ion o hese, he
p e alence o en i onmen al isk ac o s has also
isen signi ican ly in ecen yea s, including ai and
wa e pollu ion, exposu e o haza dous chemicals,
and u ban c owding. To e ec i ely add ess hese
NCD isk ac o s, a sys ema ic link o he holis ic
One Heal h app oach is ecommended, in eg a-
ing human, animal and en i onmen al heal h
policies o enhance NCD p e en ion (Amuasi e
al., 2022). Addi ionally, u ban planning should be
s a egically linked o NCD p e en ion, whe e
de eloping g eene , less pollu ed u ban en i on-
men s h ough inc eased g een spaces and
s ic e pollu ion con ols can signi ican ly educe
NCD a es (Zhang e al., 2023; Fazeli e al., 2022).
Simila ly, es ablishing a link be ween p omo ing
sus ainable ene gy and he educ ion o NCD isks
is c i ical. Encou aging he adop ion o enewable
ene gy sou ces, no only minimises emissions bu
also lowe s NCD a es by educing en i onmen al
s ess and mi iga ing ai pollu ion (Ka im e al.,
2024; Land igan, 2017).
Heal h axes: a p omising way o
imp o e domes ic heal h
inancing
Complemen a y iscal egula o y in e en ions
could play a c ucial ole in accele a ing p og ess
owa ds he 50 by 50 goal. Excise axes on
obacco, alcohol and suga -swee ened be e ages
p esen an e ec i e policy solu ion o add ess he
dual challenges o imp o ing heal h and closing
iscal gaps. These axes can imp o e public heal h
by educing ha m ul consump ion, he eby
lowe ing u u e heal hca e cos s, while simul ane-
ously gene a ing addi ional e enue. Fo example,
a 50% p ice inc ease on obacco, alcohol and
suga -swee ened be e ages is p ojec ed o
IDOS Policy B ie 5/2025
p e en 27.2 million, 21.9 million and 2.2 million
p ema u e dea hs, espec i ely, o e he nex 50
yea s (Task Fo ce on Fiscal Policy o Heal h,
2019). Wi h su icien poli ical will o o e come
en enched indus y in e es s, hey a e ela i ely
quick o implemen . Mo eo e , when ac o ing in
consump ion changes and subsequen heal h
bene i s, he impac s o hese axes can be
p og essi e, disp opo iona ely bene i ing lowe -
income g oups (Chaloupka e al., 2019; Ve gue e
al., 2015).
Achie ing ull popula ion co e age and p epay-
men o he ecommended in e en ions a ge ing
15 p io i y condi ions in 63 low- and lowe -middle-
income coun ies, as desc ibed in he 50 by 50
goal, equi es signi ican in es men . By 2050,
scaling up hese in e en ions o ull co e age
would necessi a e an a e age inc ease in heal h
spending equi alen o 1.1% o 2019 GDP in low-
income coun ies and 2.0% o 2019 GDP in lowe -
middle-income coun ies (Jamison e al., 2024).
Heal h axes ha e he po en ial o gene a e
addi ional e enue equi alen o 0.6–0.7% o GDP
(Lane e al., 2022), which, i di ec ed owa d
heal hca e, could close 30–50% o he inancing
gap o achie e he 50 by 50 goal.
Ge many’s leade ship in he Addis Tax Ini ia i e
demons a es i s commi men o imp o ing ax
policy and adminis a ion in pa ne coun ies. Fu -
he mo e, he cu en p io i isa ion o s eng hen-
ing domes ic e enue mobilisa ion (DRM) as a
co ne s one o sus ainable de elopmen inancing,
makes he p omo ion o heal h axes a na u al
and complemen a y app oach o achie ing co-
bene i s. Ge man de elopmen coope a ion is
ac i ely in ol ed in a ious p og ammes aimed a
imp o ing inancial go e nance and inc easing
domes ic e enue in pa ne coun ies. The ollow-
ing ac i i ies should be conside ed o educe
ha m ul consump ion and sa egua d heal h
spending amids igh ening iscal cons ain s:
1. S eng hen heal h axes o public heal h
and e enue mobilisa ion. Suppo pa ne
coun ies in implemen ing and op imising heal h
axes on obacco, alcohol and suga -swee ened
be e ages as a key componen o DRM and public
heal h s a egies. Wi h excise ax sys ems al eady
in place in mos coun ies and 87% o he global
popula ion li ing in coun ies wi h obacco axes –
many se oo low – he e is signi ican oom o
inc easing a es and expanding co e age. To
maximise impac , heal h axes should be pa o a
mul i-sec o al s a egy, o example, aligned wi h
he WHO F amewo k Con en ion on Tobacco
Con ol, which includes measu es such as es ic -
ing a ailabili y, banning ad e ising, and p omo ing
public awa eness.
2. Enhance echnical assis ance and in eg a-
ion in o DRM s a egies. In eg a e heal h axes
in o b oade DRM ini ia i es by p o iding echnical
assis ance and capaci y building, helping pa ne
coun ies design ax s uc u es sui ed o hei
economic and policy con ex s. Wi h i s expe ise in
Good Financial Go e nance (BMZ, 2025), Ge man
de elopmen coope a ion is well-posi ioned o
suppo his in eg a ion h ough ini ia i es wi hin
BMZ and in e na ional pla o ms such as he
In e na ional Tax Compac . These e o s will
s eng hen iscal sus ainabili y while ad ancing
public heal h goals.
Inno a ion sys ems: esea ch,
de elopmen & manu ac u ing
In Global Heal h 2050, he Commission highligh s
he need o in es in R&D o neglec ed diseases,
a guing ha such in es men s s ongly con ibu e
o educ ions in mo ali y and ha hey also pay o
economically. Fo example, he p ojec ed e u ns
on in es men in la e-s age clinical ials and
manu ac u ing in India, Kenya and Sou h A ica
would be as high as $21–67 pe dolla in es ed
(Schä e ho e al., 2022). A he same ime, 80%
o he decline in he unde -5 mo ali y a e om
1970–2000 ac oss 95 low- and middle-income
coun ies can be explained by he di usion o new
heal h echnologies (Jamison e al., 2016).
Ge many made impo an commi men s o im-
po an R&D ini ia i es (e.g. he Eu opean &
De eloping Coun ies Clinical T ials Pa ne ship),
especially h ough he Ge man Fede al Minis y o
Educa ion and Resea ch (BMBF). Howe e ,
IDOS Policy B ie 5/2025
unding o R&D in neglec ed diseases d opped
om $54 million in 2021 o $34 million in 2023,
eaching i s lowes le el since 2016 (Impac Global
Heal h, 2024). Despi e his decline, s udies
sugges ha he cu en de elopmen pipeline is
likely o yield a sui e o new ools – including a
ube culosis accine – ha could ha e a d ama ic
posi i e impac on global heal h. Howe e , hese
ools will only be launched i dono s p o ide
unding o hei de elopmen . Indus y in es men s
in R&D in neglec ed diseases only accoun ed o
13% o all unding be ween 2007 and 2022. Due
o high isk and compa a i ely low p o i s, com-
panies ha e li le incen i es o engage in R&D in
neglec ed diseases. In addi ion, R&D in es men s
need o be be e coo dina ed o educe ine icien-
cies and p io i ise he de elopmen o new ools.
Bo h he Lance Commission and he Ge man
Ad iso y Council on Global Change (WBGU), em-
phasise he need o build manu ac u ing capa-
ci y ac oss egions o enable low- and middle-
income coun ies o sel -p oduce hei medicines,
including hei own medical coun e measu es in a
o hcoming pandemic. Ge many s ongly suppo s
he es ablishmen o egional manu ac u ing
capaci y and con ibu es abou €790 million o he
A ican Union’s (AU) goal o p oducing mo e
pha maceu icals and 60% o he accines needed
on he con inen by 2040. (This commi men is pa
o he Team Eu ope Ini ia i e o p omo e accine
p oduc ion in A ica (MAV+), which o als €1.9
billion.) As pa o his engagemen , Ge many is
also he la ges con ibu o o he A ican Vaccine
Manu ac u ing Accele a o and p o ides bila e al
suppo o mul iple coun ies such as Ghana,
Rwanda, Senegal and Sou h A ica. The BMG and
BMZ also suppo WHO’s mRNA echnology
ans e hub in Sou h A ica. These a e impo an
con ibu ions o he c ea ion o dis ibu ed manu-
ac u ing capaci y. The lack o his capaci y was a
subs an ial ba ie in he esponse o he COVID-
19 pandemic. While he ea ly emphasis was on
building accine p oduc ion capaci y (including “ ill
& inish”; especially mRNA- accines), he ambi ion
has become b oade and oday includes ad ancing
p oduc ion o adi ional accines, diagnos ics, and
d ugs. We ecommend ha Ge many should ake
he ollowing ac ions:
1. Pu sue collabo a i e and inno a i e unding
mechanisms. Funde s, p oduc de elope s and
esea che s need o collabo a e and explo e new
mechanisms o in es ing in R&D. One conc e e
and es ed example, which is p omo ed by aca-
demics (Ridley e al., 2024) and non-go e nmen al
o ganisa ions alike, is he P io i y Re iew
Vouche (PRV) – a pull incen i e o ewa d de el-
ope s o a new heal h p oduc o an eligible neg-
lec ed o a e disease wi h a adeable ouche
ha g an s p io i y e iew o a second p oduc can-
dida e. We belie e ha a PRV should be c ea ed in
Eu ope, hos ed by he Eu opean Medicines Agency.
In oduced in 2007, he US PRV p og amme had
awa ded mo e han 60 ouche s by 2024,
con ibu ing o he de elopmen o new d ugs o
neglec ed diseases, such as Chagas and ube -
culosis. US ouche s we e sold o US$100 million
each, c ea ing a subs an ial, hough insu icien ,
inancial incen i e o de elope s. An EU ouche
would p o ide an addi ional incen i e o $100–200
million, which in es o s say would be a meaning ul
s imulus. We sugges ha he Ge man go e n-
men , spea headed by he BMBF, explo es and
p omo es he in oduc ion o an EU ouche
p og amme.
2. Global and egional R&D coo dina ing mech-
anisms should be s eng hened o p io i ise
and ad ance high-impac inno a ions. One key
s ep o Ge many would be o suppo he de elop-
men o WHO-endo sed “ a ge p oduc p o iles”
(TPPs). TPPs ou line he desi ed “p o ile” o cha -
ac e is ics o a a ge p oduc and a e c i ical o
de elope s o unde s and unme need and o
unde s o make in o med in es men decisions.
WHO main ains a TPP da abase (WHO, 2025) bu
o many disease a eas, TPPs a e no a ailable o
a e ou da ed.
3. De elop manu ac u ing s a egy and expand
suppo o egional manu ac u ing o o he
p oduc ypes. The Ge man in es men s o
egional accine p oduc ion a e impo an and
should con inue. Howe e , A ican coun ies ha e
