In the last decade, Germany has become a visible actor in global health. A Lancet Series, launched days before the Hambourg G20 Summit, examines Germany’s health system and the country’s growing financial and political interest and involvement in global health.

The Series identifies three main factors behind the shift that has brought Germany at the forefront of global health: strong governmental leadership, opportunities through G7 and G20 presidencies, and involvement in managing the Ebola crisis. The country’s global engagement particularly focuses on health systems strengthening and universal health coverage, and is characterised by commitment to protection of human rights and multilateralism, in line with the 2030 Agenda for Sustainable Development.

Although Germany’s global role is relatively new, the G20 Summit, held on 7-8 July 2017, confirmed the country’s role in setting the international political agenda for global health. The G20 Leaders’ Declaration highlights the Group’s crucial role in advancing preparedness and responsiveness against global health challenges. In the area of health crises and health systems, the Leaders’ Declaration advocates, among others, for sufficient and sustainable funding to strengthen global health capacities, including for rapid financing mechanisms and the WHO’s Health Emergencies Programme. In the area of antimicrobial resistance (AMR), which is recognised as a growing threat to public health and economic growth, G20 countries commit to advance in the implementation of National Action Plans, based on a One-Health approach, by the end of 2018. It should be noted in this regard that the first meeting of the public health and animal health institutes of the G20 on the topic of AMR will take place in Berlin in the fall of 2017.

The Leaders’ Declaration draws upon the Berlin Declaration of the G20 Health Ministers, which was adopted at the first Meeting of Health Ministers of the G20 on 19 and 20 May 2017. The meeting focused on combating global health hazards. As rapid and coordinated action are crucial in crisis response, the Health Ministers, together with representatives from the World Health Organization (WHO) and the World Bank, took part in a simulation exercise focusing on multilateral coordination, WHO’s crisis response mechanisms, and the International Health Regulations (IHR). The Berlin Declaration acknowledges the importance of carrying out such exercises on a regular basis as part of emergency preparedness efforts. It also highlights support for the WHO’s leading role in health emergencies and outbreak response, while recognising that the Organization’s financial and human resources capacities need to be strengthened.

Although under German leadership global health took centre stage at the G20, continuity must be ensured. In the current political context – with stagnating financial contributions and uncertainty regarding the commitments of the largest global health funders – there are expectations for Germany’s global health responsibilities to further grow. However, to continue this development in the era of the Sustainable Development Goals, Germany needs to address challenges related to domestic global health competencies, the fragmentation of global health policy making, and incoherencies in its policies at different levels.