The past three decades have been an era of remarkable improvement in human health and well-being. Especially in developing countries, scientific advances and concerted efforts by governments and the global community have substantially reduced extreme poverty, child and maternal mortality, and the incidence of debilitating diseases such as tuberculosis and malaria. HIV is no longer a death sentence. Polio has decreased by ninety-nine per cent, bringing the world to the verge of eradicating a major infectious disease for only the second time in history, after smallpox.
Germany has made many important contributions to this progress. In 2016, the nation became one of the few to devote 0.7 per cent or more of national income for official development assistance. German aid since then has fallen shy of this UN target, but in absolute size it still ranks second in the world after aid from the United States, which gives much less relative to the size of its economy. In other ways, too, Germany has been a leader in global health and development. During its presidency of the G7 in 2015 and the G20 in 2017, Germany moved the world forward in addressing the health threats posed by potential pandemics and growing antimicrobial resistance to lifesaving drugs. Germany also has demonstrated leadership in the global community by accepting a large share of asylum seekers and refugees.
Anti-malaria measures may work well in one place and not in another because the disease is biologically and ecologically different.
But these crises remind us that more work remains. Terrible inequities must still be addressed to improve the health and wellbeing of the most vulnerable and to foster a more stable and peaceful world. An estimated five million children under the age of five will die this year, mostly in poor countries and primarily from preventable causes. Hundreds of millions of other children will continue to suffer needlessly from diseases and malnutrition that can cause lifelong disabilities. And according to World Bank estimates, more than 750 million people – mostly rural farm families in sub-Saharan Africa and South Asia – still endure extreme poverty. The global community must continue and expand the efforts that we know are effective. And we need to go further. Accelerating progress and overcoming the challenges that remain will require that we pursue new breakthroughs in science and technology, and that we make sure the benefits of these advances are applied equitably. In this, Germany and Europe as a whole can help lead the way to a better world in 2030 through policies and investments that stimulate research and development focused on addressing the world’s most urgent, unmet needs.
Why Innovation is Increasingly Urgent
For one example of such needs and how R&D can help, consider malaria. A parasitic disease spread by mosquitoes, malaria was once endemic to much of the world, including southern Europe. It continues to take a terrible toll. Some 200 million cases are recorded annually, ninety per cent of them in Africa. About 450,000 people die from the disease each year, 70 per cent of them children under five. We have made huge progress against malaria over the past fifteen years, but that progress is stalling. While we have tools that have been effective, we need new ones, for several reasons. First, because fighting malaria is a relentless race against evolution; the parasites that cause the disease and the mosquitoes that transmit it inevitably develop resistance to drugs and insecticides we use against them.
We need new tools also because we do not yet have the ones we need to end malaria. Current approaches to prevention have only temporary and local effects. Treatment regimens are too complex and lengthy, which makes it difficult for patients to comply. Anti-malaria measures may work well in one place and not in another because the disease is biologically and ecologically different. R&D is crucial, and we are seeing the results of investments made a decade ago. We have new dual-ingredient bed nets, highly-sensitive rapid diagnostic tests, and new drugs in clinical trials. Other needed innovations include single-dose treatments that are safe and well tolerated, second-generation vaccines that prevent infection or block transmission, and tools for computational modelling, simulation, and data-visualisation, which can help us tailor more effective, localised interventions. New gene-editing technologies such as CRISPR can help scientists introduce inheritable traits into mosquito populations, curtailing their ability to spread not only malaria but also Zika and dengue fever.
Polio Immunization Coverage Among One-Year-Olds
The percentage of one-year-olds who have received three doses of polio vaccine in a given year, 1983-2016.
What is true of malaria is true for many other global challenges today: advances in science and technology are key. Looking beyond global health, perhaps the most obvious example is climate change. To significantly reduce carbon emissions, we need more sources of clean, reliable energy and more efficient ways to store, transmit, and conserve it. We also need innovation to mitigate the effects of climate change on the crops of small holder farmers in Africa and South Asia, who are particularly vulnerable. Preventing a resurgence of extreme poverty and even starvation will require advances in crop to feed growing populations. By the year 2050, Africa’s population is expected to double.1
Germany as a Leader of Global Innovation
How can Germany best help to accelerate the discoveries and innovations the world needs? The country has many strengths to build on. With excellent universities and a unique system of national research institutes, Germany has long been a powerhouse in physics, mathematics, chemistry, and engineering. The federal government has consistently increased support for R&D in recent years. As a per cent of GDP, Germany’s funding now surpasses the R&D investments of the US government, although the US, Japan, and China each invest more in total. Germany’s large chemical, engineering, and automotive companies also have substantial scientific expertise and investments.
Germany moved the world forward in addressing the health threats posed by potential pandemics and growing antimicrobial resistance to lifesaving drugs.
With its engineering muscle, Germany is taking a prominent part in the search for new energy solutions that do not cause climate change. It has joined twenty-three other countries in Mission Innovation, a commitment to doubling government R&D investments in clean energy technologies. In the private sector, the Breakthrough Energy Coalition is working to commercialise these technologies more quickly and in more places. The coalition includes the software company SAP and its co-founder, Hasso Plattner.
Germany’s leading chemical companies contribute to global health and development as providers of tools for protecting crops and people from insects. The industrial giants Bayer and BASF have joined other global crop protection companies in an initiative, supported in part by the Gates Foundation, to renew progress against malaria through development of a new generation of mosquito controls. In the life sciences, too, Germans have a great legacy, maybe best represented by the Nobel Prize awarded a century ago to Robert Koch, the founder of modern bacteriology. The Bill & Melinda Gates Foundation has more than a dozen partnerships with German centres of excellence in biomedicine and agriculture, such as the Fraunhofer Institute, University of Heidelberg, and Friederich-Alexander University. Our largest and most ambitious partnership is with CureVac AG, a biotechnology company incubated at the University of Tübingen, where nucleic acids were first isolated, paving the way for the discovery of DNA. In the 1990s, scientists at the university discovered ways to encode information in RNA molecules. From these breakthroughs, CureVac built a unique technology platform for accelerated development of vaccines against many diseases. In 2018, the Gates Foundation expanded its partnership with CureVac with two new grants, one for development of an RNA-based malaria vaccine and another for development of a universal flu vaccine. CureVac is an exciting example of how German scientific and technical prowess can lead to world-changing breakthroughs in medicine. There are other examples, yet not as many as you would expect, given Germany’s prominent position at the front ranks of R&D in other scientific fields.
A Glass Half Full
In a recent, comparative study of the life-sciences sector, the global consulting firm BCG concluded that Germany is not yet fully tapping its potential for life-sciences innovation. It noted that the life sciences in Germany receive lower levels of government R&D funding than other fields of science and engineering. Also, that German laboratories are often ineffective at translating basic life-sciences research into product development. Experts interviewed for the study blamed this disconnect on several factors, including a scarcity of researchers and other needed talent. Per capita in 2015, universities in the United Kingdom graduated about eighty per cent more students than Germany in the natural sciences and mathematics. Although Germany produces Ph.D.’s at a comparable rate, the UK graduated fifty per cent more Ph.D.’s in biology. The study noted other issues, such as a lack of venture-capital funding and the federal government’s long-standing policy of allocating a large share of R&D euros for structural grants to national research institutes. This approach may tend to favour basic research, which is admirable as a long-term investment in new knowledge. But meanwhile we also need exploration focused on innovative solutions for the most pressing problems. Another challenge: in other countries, collaborations between disciplines and between academia and the private sector are characteristic of successful endeavours in biomedicine and biotechnology. Such alliances have not been as commonplace in the German life sciences. Tapping Germany’s full potential for life-sciences innovation could produce enormous benefits for the country’s economy. In the US and the UK, the life-sciences sector is a major job creator and driver of economic growth. A recent UK study found that pharmaceutical, medical technology, and biotechnology research companies contributed the equivalent of €34.6 billion to the national economy in 2015. They supported 482,000 jobs and paid the equivalent of €9.5 billion in taxes.
For more than a decade, the German government has pursued policies designed to strengthen German R&D. It took steps to help universities attract and keep top scientists, nurtured clusters of excellence in academia, and encouraged greater collaboration with scientists in other research organisations. With support from the German Federal Ministry of Research and Education and other public sources, a network of health institutes has been created to coordinate advanced work against specific challenges, such as metabolic, infectious, and neurodegenerative diseases. Germany could still do more to attract scientists from other countries. Further steps could unleash more innovation. Germany could still do more to attract scientists from other countries. State governments could consider creating venture capital funds to support R&D enterprises. As in the UK, there has been discussion in Germany of creating a government agency to support strategically targeted, advanced research – modelled after the US government agency that gave rise to the Internet, among many other transformative technologies. At the G20 Summit in Hamburg last year, Germany committed to creating a hub for international collaboration against one of the greatest global health threats, antimicrobial resistance. These ideas are worthy and potentially very useful in strengthening Germany’s position at the forefront of discovery and innovation in global health and development. Many friends of Germany – myself very much included – would welcome and support the nation’s further efforts to play an even larger role. Whether the world continues its progress of the past three decades may depend to a great extent on the new knowledge and tools that Germans can help create between now and 2030.