Alexander Boxler - Managing Director, German Health Alliance (GHA), Germany

EF: Could you begin with a brief introduction to the German Health Alliance as a global partner in healthcare?

AB: The GHA is a member-based organization aligned with the BDI. The organization comprises 120 members, including companies, NGOs, development corporations, consulting firms, and academic institutions.  

At the GHA, we believe in the power of collaboration and its synergies, so we bring together diverse actors from multiple fields and regions worldwide. Representing stakeholders from different sectors makes GHA a unique organization. NGOs have great networks in many countries, which some companies lack. When companies collaborate with NGOs it usually leads to good results. Government support is also necessary, and the GHA includes partners such as GIZ and KfW. Our task is to support our members in building international partnerships in health. We focus on world regions, Latin America, Africa, Asia, China, Eastern Europe, etc., and topics including global health, market access, and development cooperation. We work with organizations such as the WHO, GAVI, and OECD Business. While the BDI covers a European and a national level, GHA operates at an international level.  

We focus on two main pillars:

1. The Political dimension: creating visibility at a political level for certain areas. When engaging with Health Ministers, we often observe intense competition for limited resources. The decision to invest in a new bridge rather than a prevention program is an example of this challenge. While a bridge can be seen when completed, the benefits of a prevention program are less tangible and only become evident in its absence."

2. The Practical dimension: building platforms and support with project initiation, .  Our working groups in Africa, Asia, and other regions offer German actors’ opportunities to form international partnerships with our partners abroad. We have organized successful conferences, such as the German - African Health Forum and the German – East European and Central Asian Health Forum, which have been attended by Health Ministers from various countries. These events always involve our German partners. Additionally, we participate yearly in several trade fairs such as MEDICA & Arab Health in Dubai which is particularly important for our MedTech members.

Germany remains an important player in the healthcare industry, with over one million people employed in the sector, making it comparable in size to the automobile industry - one of the largest sectors in Germany. The health industry alone generates an economic footprint of 165 billion euros. The GHA health space is unique since it comprises besides some big companies also a vast number of small and medium-sized companies, many of which specialize in specific areas. These companies are not widely known but compose the backbone of the German health industry. These specialized businesses create high-end products, and they collaborate with us as they may not have the resources to promote their technology on a national and international level. Many of our members are currently exporting about 60% of their products to international markets. However, times are changing with the current geopolitical situation and China's competition – especially since the Chinese government is supporting and defining its health industry as a key area. Turkey is emerging as a country of increasing international importance in the health sector. And the COVID-19 pandemic has brought to light logistical challenges, and now there are additional hurdles, such as inflation and high energy prices, which are expected to further complicate matters. ‍

EF: How do you balance the needs and define priorities, considering you represent stakeholders from different sectors: industry, NGOs, academia, etc.?

AB: Finding a balance with the many members in our network can be challenging. However, we all agree that our vision is Shaping health for all. This means that the GHA improves access to health for people worldwide.  

We strengthen Germany's role in global health as an essential component of international cooperation and foreign trade, and our networks and partnerships contribute to value creation in Germany and beyond.

GHA`s role is to support our members with their international health projects and open platforms for their topics. We strive to maintain strong connections with all our members. Communication is key in finding solutions, and while the COVID-19 pandemic initially forced us to shift to virtual communication, we are now returning to in-person meetings, especially for certain events where face-to-face interaction is essential for effective problem-solving. Recently there was a case where an NGO needed to buy a diagnostic machine. They were thinking to purchase a Chinese product, but since the NGO leader got to meet a diagnostic machine manufacturer in one of our meetings, they decided to go for the German product. We have defined the areas in which we are active, and through our 10 working groups, we cover a wide range of topics. We place great importance on personal contact to gather feedback from our members. We understand that smaller companies may have different priorities from larger ones, who may require different services.

This year one of our priorities is the recovery of the Ukrainian health sector. We want to position German players in the reconstruction of the Ukrainian health sector, providing support and opportunities to the Ukrainian government and technology partners. Ukraine has created a huge recovery plan for the health system, and to that end, we are working very closely with them. We are in conversations with approximately fifty member companies interested in engaging –some of whom are already supporting Ukraine. As conversations are underway, the question remains as to who will finance the recovery once the war ends.  

A second priority is China, from a market opportunity and a player in the field. Over the last few years, the market in China has been the most significant, but there are signs of change. The situation is complex because China supports its domestic industry and is building strong competitors. Furthermore, the political context is polarized. In this sense, we hope that the health sector can serve as a bridge builder.

Our third priority is to identify the markets of the future. Considering the changing dynamics in the international arena, we are exploring new options, and Southeast Asia, including Indonesia, Vietnam, and the Philippines, presents a viable possibility.

Africa also represents an interesting focus point, it is in close proximity to Europe, has a rising population, as well as significant health sector challenges, and Germany is set to provide development support in the region. We are keen to convince the German government that the health sector should be a key area of focus for development in Africa. Despite the region's difficulties, many German companies are already engaged in Africa. For instance, one of our members has a laboratory in Guinea; during the Ebola outbreak, they stayed on and worked to make a difference. Along with this one, there are many other examples of German companies with projects in Africa. In the long run, there is a lot of potential for collaboration in healthcare. Some countries are already in a better position, China is already strongly invested in the region, but Germany or European countries should participate more.  

Another interesting region for new markets is Latin America. Even though European companies have been in Latin America for more than 100 years and the culture is similar, this region is sometimes forgotten, but holds great potential. To summarize, the future market will certainly be Southeast Asia, then Africa, and maybe also Latin America.  

With the pandemic hopefully ending, it is crucial to assess the implications of this and keep in mind the impact of major political considerations. Regardless, it is important to strengthen Germany’s role in global health. In recent years, Berlin has become an international center for global health and a priority for many organizations and is even holding its own summit, the World Health Summit. The GHA is also engaged in global health, and we should all work towards maintaining Germany as a leading nation in the subject. Regarding Covid, we were lucky that the German companies had the technology to develop a vaccine, were able to provide ventilators and develop testing technology, demonstrating that Germany still has a leading role in innovation. We must be prepared for the next pandemic as it ignores borders and will certainly come. Given the complex political landscape, we need robust organizations that can function in any context. We support a strong WHO and other health organizations, and we must strengthen our pillars and cultivate international partnerships and contacts.

Strengthening the health system should be a priority of every government. The private sector is glad to offer itself as a partner.

Involving the private sector can lead to greater sustainability, as economic considerations are considered, and projects can be initiated and completed over the long term.

In addition, another priority for the future is addressing climate change and exploring the healthcare sector's role in this area. Among our members, companies have developed the concept of a Green Hospital, which employs innovative technologies and sustainable architecture to reduce energy consumption. As we move forward, it is vital to consider new materials that can further reduce energy usage.

Furthermore, we have conducted a study on systemic calls for tenders. We aim to convince organizations and institutions to revise their tender processes to include services, education, and training in addition to the product itself in order to consider the life cycle costs. We believe that with systemic solutions, a much better sustainability can be achieved.  

We have many challenges, a significant obstacle is the requirement for local content in tenders, which many countries impose. While larger companies may be able to adapt, smaller or medium-sized enterprises typically cannot establish production in a foreign country.  ‍

EF: Could you share a success story showing the success in elaborating business models?

AB: The GHA is not directly responsible for the implementation of projects; the success stories belong to our members. Before the pandemic, a collaborative effort within the GHA resulted in establishing an Applied Biomedical Engineering program in Senegal and Kenya. GHA member companies worked alongside the University of Aachen to create a bachelor's degree program that would train engineers for maintenance purposes. This initiative is a good example of how German companies can collaborate with various stakeholders to promote transfer of know-how and development in other countries. Another instance that exemplifies our approach is when a microscope was needed at a maternity hospital in Lutsk, Ukraine. I reached out to a member who has this type of microscope, and they immediately decided to donate it. Thanks to our partnerships with NGOs, logistics were possible, and we transported the microscope to Ukraine. We even have photographs of its arrival and usage. ‍

EF: Fast forward five years; looking back at this period, how would you like to be remembered, and what would you like to grow further?

AB: I would like to see the GHA grow and see even more partnerships between German companies and organizations with international partners that benefit both sides. I hope that more companies will join our organization, thereby strengthening our collective efforts, advancing our shared goals, and expanding our network. I want Germany to adapt quickly to the challenges we are facing and have favorable conditions for the further development of products, especially regarding regulation and data usage, so that our companies can grow, improve, and develop solutions and help people with these solutions.

At a global level, it is crucial for health to be viewed not only as a cost but also as an investment, leading to more investment in health and preparedness for the next inevitable pandemic.