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EF: You have worked in GHA - German Health Alliance since 2014. Could you elaborate on its evolution over the years?
RG: The GHA - German Health Alliance, with an experience of now 32 years based on its three predecessor organizations, has two distinct branches: a global health and health system strengthening focused arm, initially known as the German Healthcare Partnership (GHP) jointly established in 2010 by the German government through the Federal Ministry for Economic Cooperation and Development (BMZ) and the Federation of German Industries (BDI) and a strong medtech focused arm, the previous German Healthcare Export Group. In summary, GHA in its current set-up comprises a diverse, on-purpose very heterogenous range of currently around 120 leading actors from various sectors and areas, such as pharma, medtech, diagnostics, digital technologies, capacity building & e-learning, healthcare consulting, architects and constructors, logistics, insurance, development cooperation, NGOs, science & academia on board, among others. The change towards a multisectoral initiative has been initiated when I have been appointed as Chair of the Board in 2014 – at that time a very unique shift in the health area, especially considering that we operate under the umbrella of BDI. Health system strengthening through reliable, long-term, eye-to-eye partnerships are at the core of our organization’s DNA. With our diverse membership base, we form strategic alliances and stimulate, initiate and execute concrete projects, such as the “Applied Biomedical Engineers” capacity-building initiative in Africa, involving five member companies and a university of applied sciences along with organizations and institutions of the partner countries and GIZ. Our multi-actor based health system strengthening approach was presented at a health-related G20 event in December 2016 when Germany took over Presidency for 2017 and where it already had been considered a blueprint for multi-sectorial cooperation, intending to inspire other countries and regions to establish similar organizations leading to highly potential new cross-links and cooperations among each other.
EF: What are GHA’s priorities and agenda for this year?
RG: Especially since 2020, we have significantly expanded our development efforts and formed new strategic partnerships and alliances. Special importance and relevance have a strong cooperation of GHA with VFA, the German Association of Research-Based Pharmaceutical Companies, and Spectaris, a German industry association for the high-tech medium-sized business sector. As “Coalition for Health”, together with BMZ and GIZ (German international development cooperation agency), we strive for establishing a new concept of dedicated health partnerships. While climate partnerships and energy partnerships are continuously up-taking on the political agenda, it seems that establishing health partnerships is burdened by the complexity of biology and medicine, with health being even much more complex. In order to achieve success and contribute to transformative improvements, we are convinced that it needs an intensified multilateral health engagement while at the same time also strengthening the pillars of bilateral partnerships. Too often there is a “versus”-discussion about multilateral and bilateral engagement. What in fact is required is an intelligently established and managed matrix of both. Currently, we are focusing on certain, well selected African partner countries for health partnerships while with our exclusively international GHA, we of course also have our sights set on Asia and Latin America. Establishing long-term health partnerships will remain a top priority on our agenda also this year.
EF: How do you ensure that other countries recognize the value of your initiatives and projects, and what steps are you taking to raise awareness about the significance of your activities?
RG: The backbone of our initiatives involves creating, establishing, and maintaining trust among actors from different sectors and areas, requiring a proactive, continuous effort. This is crucial, and we can well draw on past experiences to achieve them which has an immense effect to ensure awareness and recognition of our vision, mission and values at an international scale. At GHA, for example, partnerships have been successfully established between large pharmaceutical companies and NGOs, significantly contributing towards the reduction of “traditional” reservations and mistrust between these sectors. For justified reasons, NGOs serve as watchdogs, and we are extremely pleased to have NGOs on board, delivering the most positive examples that this does not conflict with forming solid, deep partnerships with the private sector. To improve health systems while building up a modern, resilient health infrastructure and health services in a well targeted manner, needs the integration of the various activities and projects from all sectors, those already running and those yet in the pipeline, small and large projects, which need to be balanced, interconnected, and make fit together in the required systemic, holistic approach. However, already the first and extremely crucial step of professional mapping and matchmaking can be very challenging. Unfortunately, it is precisely in this step resources are often not sufficiently deployed, which then has a negative impact on the entire process of a systemic strategy. What all sectors including policymakers and governments necessarily need are common health metrics in order to assess health investments and to measure their impact on the socio-economic development, economic growth, and the resilience of health systems and also financial systems. In general, the translation from basic research and knowledge gained from fighting diseases, epidemics and pandemics towards shaping global health policies by applying scientific excellence, the power of digitalization, and AI will be one of the most important potentials and contributors to achieving SDG 3.
EF: Collaboration and communication between borders are key; can you elaborate on the importance of a global health approach?
RG: Global health starts at home, as it is correctly said. One dynamically increasing challenge that underlines this and demands much more attention is AMR, antimicrobial resistance. Fighting AMR, a silent but deadly “disease”, requires a comprehensive approach also encompassing animal health, consumers, and the food industry. In this regard, a solid One Health approach is the best possible prevention. This was recently discussed in an impressive manner at a Symposium at the Nobel Forum organized by Karolinska Institutet in connection to the Swedish EU presidency while highlighting that health intrinsically always is global health. Human health is inextricably linked to plant and animal health, to environmental and planetary health. In an interconnected world, this convergence requires global thinking and solution sets with regional action and local implementation – all in equity. To improve health outcomes, we must thus listen much better to the pain points of countries and communities, and prioritize their specific challenges and demands so that we can closely work together to establish resilient health systems with non-discriminatory access to health services. At the same time, we must exercise caution when using the term 'health security' as it may create the impression to rather serve the interests of wealthy countries. Although health security is important, it is only one part of our broader mandate. We must demonstrate that we work based on principles of human rights, equity, solidarity, inclusion, and equal partnerships.
EF: How does the GHA create the frameworks and policies to go into the different countries with projects? How do you translate German experience and knowledge into the world?
RG: Our organization boasts nearly 120 member organizations, which is a valuable asset. We strive to maximize the effectiveness of our ten current GHA working groups, each focusing on different topics and regions. It is also imperative that we form partnerships with major international organizations, such as UNAIDS, which is an excellent example of how to engage local communities. We maintain close collaboration with the UNITE Parliamentarians Network for Global Health, a group of approximately 300 parliamentarians from 100 countries, about half from each, the Global South and the Global North. For almost ten years, we have partnered with the World Health Summit, an internationally leading conference in global health. Bringing global health to the realm of trade and economy is mandatory. Our goal is to identify how GHA and its members can make the best possible and most sustainable contribution in this sense, and how this can be made effective while remaining financially feasible. We assist our members in accessing new markets, countries and partnerships, and we seek to discover the nexus between foreign trade and development cooperation, as they often overlap and yield high potential results which I could also see confirmed from the example of our own diagnostic company.
EF: You mentioned initiatives working with UNITE, UNAIDS, etc. Could you elaborate on GHA’s role in the World Health Summit?
RG: The World Health Summit (WHS), established in 2009, is a highly effective and crucial backbone for international health engagement. Our partnerships with organizations such as UNITE and UNAIDS have been in fact mainly stimulated by the WHS and our presence at the WHS annual conferences and regional meetings. The WHS is a forum where stakeholders and actors from all sectors and many countries exchange ideas, network, and build confidence. As GHA initially has been a purely private sector-based initiative until 2014, using the unique WHS platform helped us gain the trust of other organizations. In 2014, triggered by the Ebola epidemic in West Africa, we started to collaborate with the WHS, while having established a multisectoral action group on Ebola. At the time, it was challenging for the German government and other interested parties to locate and bundle German actors to address the Ebola crisis by supporting the three affected countries. We provided mapping and matchmaking services to bring players together and to share information with institutions that lacked an overview of the situation. Professor Detlev Ganten, WHS Founding President, at that time, invited me as a speaker to the Opening Session “Ebola: A Wake-Up Call for Global Health”, which was my first personal interaction with the WHS, right away in front of about 1,500 delegates. From that point on, partnerships with organizations such as UNAIDS and UNITE were quickly established. This was also leading to joint panels and workshops of UNAIDS, UNITE and GHA at every WHS between 2014 and 2022. UNAIDS has a further remarkable role as it has initiated the Health Innovation Exchange (HIEx), which is building an important bridge between innovators, implementors at the highest level, e.g. Ministers of Health, and investors. The HIEx is a brilliant platform that together with its partners also provides highly interesting overviews of ongoing innovation in various fields. All in all, WHS is the fundamental nucleus and most important platform of German global health engagement, and many of the achievements of other pillars in this area would not have been possible without it.
EF: How is the GHA working towards climate change within the healthcare system worldwide? Do you have initiatives at a global level?
RG: Our primary focus is currently on strengthening health systems and infrastructure at its core, while our members are of course also highly committed to contributing to achieving the climate-relevant SDGs. GHA has worked on detailed concepts of “Green Hospitals” which are sustainable and energy-efficient hospitals. In this context, together with KfW, GHA published a large study. We recognize and appreciate other organizations’ broad experience and a clear focus on the nexus of climate change & health. Thus, nurtured by our DNA of close cooperation and based on the power of complementary assets, our strategy is to establish partnerships with such organizations and relevant institutions in specific areas to achieve our common goals more efficiently and effectively.
EF: Health is shifting to a preventative approach through early and fast diagnostics. With your experience at Sysmex Partec, could you elaborate on the importance of diagnostics and how access can be increased?
RG: Pharmaceuticals have always played a prominent role in healthcare - especially since the fight against HIV/AIDS with now more than 38 million people infected began more than four decades ago. While the prohibitive cost of antiretroviral treatment was the main burden in the beginning, after significant price reductions for ARVs, it was the missing availability of suitable and cost-effective diagnostics that limited success in this fight. And during the Ebola epidemic in West Africa with its peak in 2014, the true bottleneck has been diagnostics as, for example, blood samples had to be flown from Benin to Dakar in Senegal for required PCR-based molecular testing. But during the COVID-19 pandemic, diagnostics really has taken center stage when everyone around the globe understood the crucial importance of testing. At the time, there was significant interest in diagnostics, but now again attention and interest are waning. Thus, not only because of my experience and knowledge of this topic derived from working at Partec, since 2014 Sysmex Partec, a cellular and molecular diagnostics company within the Sysmex Corporation, I would like to advocate strongly to keep up reliable diagnostics at the core of the priorities.
EF: Could you briefly elaborate on Sysmex Partec´s footprint?
Partec originally has been a family-based enterprise established in 1967, initially focusing on cancer research, and then mid of the 1970s due to the rise of monoclonal antibodies with a raising strong arm also in immunology, which included since 2000 a strong concentration specifically on HIV/AIDS immune status monitoring, lifelong required for HIV-infected individuals. Sub-Saharan Africa has been our main focus in this context. At that time, we introduced a new diagnostic concept in Africa possible due to very high vertical integration, new component technologies in electronics, optics, optoelectronics, etc., leading to an innovative concept of, for the first time, rugged, portable, and battery- or solar-powered instruments, as well as new reagent chemistry, including lyophilized (freeze-dried) reagents eliminating the previous requirement for cold chain and cold storage. This approach, which I always like to call high-tech, low-complexity, low-cost, specially adapted technologies, involves reducing the complexity, size, and overall cost of hardware, reagent, consumables, after sales service and tech support. When we started in this field, only a small percentage of HIV-infected individuals were under diagnostically controlled antiretroviral treatment, in the year 2000 less than 300,000 PLWHA among more than 30 million. With our innovation, which would not have been possible without close cooperation with leading researchers, scientists and institutions in Africa and Asia, we could reduce the annual cost per patient by a factor of 20 from USD 180 to USD 8 only, while bringing the diagnostic services for the first time out of the big cities also to rural and remote areas. At peak, we supplied 5 million tests a year, reaching more than 100 countries, among them 50 out of 54 African countries, with alone 1,000 devices successfully placed in Nigeria, all in all leading to 40% of the total revenues achieved in Africa. This may hopefully serve as a blueprint for others to follow while underlining the immense potential which can be seen in the entire area of health when working closely with partners and countries. It somehow seems that many Germans have a sort of deficiency of not talking sufficiently, respectively, not at a justified level about their success stories. With a very science-oriented mentality, which is really very positive in general, we are usually so interested in a problem that we immediately lose interest when the problem is solved and move on to the next exciting challenge. This seems quite different to the US and Anglo culture in general, where actors seem to have a different, much more proactive and aggressive marketing of ideas. We need to improve towards a better combination of both.
EF: What are further takeaways?
Sysmex Corporation overall has an excellent track-record working in Africa, e.g. in close cooperation with the government training a staff of 3,000 in Burkina Faso on state-of-the-art hematology instruments and even setting up and managing the entire required in-country logistics, and contributing as a partner of the GHA Strategic Alliance on “Applied Biomedical Engineers” to capacity building. Furthermore, Sysmex introduced a new innovative concept for malaria diagnostics which a few months ago has been presented to Bill Gates in Kobe. I learned a lot from these and the aforementioned experiences about what is possible and what the private sector together with the right partners can achieve on the ground, even leading to transformative improvements in health systems.
EF: What is the impact of this knowledge related to your work at GHA?
My mission was to translate all these lessons learned and experiences to my work in GHA. Private sector and international development cooperation are truly joined in the common goal to create positive effects to partner development in emerging and developing countries, leading to a robust economy and local job creation on the backbone of resilient health systems being equipped with suitable infrastructure. So, private sector activities and government cooperation development need the same to function.
EF: Could you elaborate on the role of innovation in assuring quality and access in the future?
RG: The crucial aspect is how to foster and ensure effective innovation mechanisms. Based on my experience of past successes, I have learned that innovation heavily relies on the expertise and skills of local partners and countries where we operate. Without the contribution of local experts, universities, and research institutions, we would have failed to achieve the desired results, especially in the Global South. Therefore, the expertise of our close partners forms a significant part of our innovation activities. For instance, when we ventured into HIV diagnostics, we established subsidiaries in various African regions run entirely by local experts, which was a pivotal factor in our success. Trustful and sustainable long-term collaboration of the private sector with local talents, experts and scientists, local entities and governments, is essential for precision and innovation. And it contributes to the required local job creation. To add another important point coming back to diagnostics: innovative molecular diagnostics, especially PCR-based tests, has enormous potential because – using a single platform with specifically customized protocols – is capable to address various diseases, including cervical cancer, sickle cell anemia, TB, and malaria, etc. Considering the scaling up of PCR testing capacities during the pandemic, one of the most important tasks is now that especially in the Global South these powerful solutions and tools will be used continuously, even and especially after the pandemic. Governments, the private sector, academia, and NGOs must collaborate to leverage this invaluable resource. In this context, the Foundation for Innovative New Diagnostics (FIND) in Geneva plays a crucial role. Another aspect concerns the diagnostics test regimen looking towards the next pandemic which of course is sneaking around the corner. It's not a question of if it will come, but when it will come. Biology, unfortunately, does not forbid a pathogen to spread dynamically as SARS-CoV-2 while being lethal as for example MERS with a case fatality rate of > 30% or Marburg virus disease with up to almost 90% lethality, with an average of about 50%. While there seems to be a sort of soporific confidence, or better standstill regarding the right test regimens, specifically on the suitable mix or rapid tests and PCR tests as applied in the Covid-19 pandemic, such regimen would most likely fail at a dramatic scale in such scenario of more lethal pathogens, especially because of sensitivity of rapid tests in general. So, continuous innovation is imperative.
EF: You work on many fronts in global health, GHA, and Sysmex, and you are the CEO and Co-Founder of the Virchow Foundation for Global Health. How will you continue to balance priorities and resources to strengthen collaboration?
It is most important to listen very carefully to those who possess knowledge of the pain points, challenges, and issues, especially on the ground, including those who deliver and implement ground-breaking solutions. Establishing out of civil society engagement, together with the Presidents of the German National Academy of Sciences Leopoldina and the Berlin-Brandenburg Academy of Sciences and Humanities, the non-for-profit Virchow Foundation for Global Health follows the insight that urging all actors and stakeholders to increase their efforts definitely must go along with highlighting, recognizing and rewarding at highest possible, well visible international level the most impressive, leading examples. Laureates of the Virchow Prize for Global Health put a face to the most successful engagement. This award thus aims to incentivize and spur great minds in their commitment to global health. In this respect, Virchow Foundation will continue collaborating with international organizations and utilizing various platforms. One Europe for Global Health (OEGH), a coalition resulting from a strong philanthropic endeavor initiated in France, now encompassing various sectors and countries of Europe, has become a significant alliance gaining more influence. Already its first declaration, the Lyon Declaration, has been presented in person to the EU Ministers of Health and Foreign Ministers during their meetings under the French Presidency of the EU Council in February 2022. This was followed by amendments elaborated in connection with the following EU Presidencies of the Czech Republic and, after the new EU Global Health Strategy had been released, in Sweden, and will be continued accordingly in Spain and Belgium. The translation from the strategy level to implementation is the biggest hurdle. Coming up with strategies is significantly simpler than executing them on the ground. Also, it needs a paradigm shift from “strengthening health systems” to “strengthening systems for health”. This is a distinct thought process that highlights whom we must include and what partnerships we need to form under a systemic, holistic view. GHA serves as a blueprint for instilling confidence and trust between various sectors while focusing on multisectoral-driven implementation. If we integrate this asset into more extensive alliances and strategic platforms, the private sector can further contribute to addressing current challenges in a more targeted manner.
EF: Five years on, how do you see Sysmex positioning itself? How would you like Sysmex to be regarded and remembered?
RG: My answer comes from my roots and our family enterprise; the dream and vision of high-tech, low-complexity, and specially adapted diagnostic technology that will be successful because undoubtedly there is a need for it. I hope it will be an example to be followed. If Sysmex continues to serve by innovation and dedication as a leading example for others, it would be a good reason to celebrate. There isn’t any conflict but only benefit for societies and communities, in combining science-driven, economically sound private sector activities with long-term sustainable and transformative development cooperation, leading to a significantly positive impact for people in countries with tremendous challenges in the required health systems and infrastructure.
EF: Is there any final message you want to share on Sysmex or its trajectory?
RG: In conclusion, it is my hope that we contribute to lowering the quite artificial high burden that arises in such scenarios in diagnostics and other areas in resource-limited settings and in remote and rural areas. The real burden is not as high as it appears, and this is a lesson we should all take up. We should be more courageous in facing the challenges because they are in fact manageable. And if more small, medium and large companies would focus on what we did, the big tasks or our time and our common goals would be so much more achievable, because we would be able to do it much more collectively with more dynamics and increased flywheel mass.
EF: What do you see as one of the most important backbones required now for global health and SDG 3?
RG: I would like to repeat what I mentioned in the joint UNITE and Virchow Foundation roundtable discussion at the WHS Regional Meeting in Washington D.C. three weeks ago: Fast and sustainable progress in global health can only be achieved by an emphasis on translation from science and research to practice, as well as by trust and global partnerships among all sectors, inspired and led by the UN 2030 Agenda Sustainable Development Goals (SDGs). It will be decisive to link global health policy shaping and public health data science under truly equitable inclusion and involvement of the Global South at all levels, while together we must consistently strengthen and expand translation from the strategy level to the implementation level – yet one of the largest and most critical gaps and thus main challenges. It is the triad of academia, policymakers and digitalization which will form one of the most effective levers in addressing global health challenges. Establishing trust in this triad and each element hereof in societies and communities will be a major indispensable task for all of us. Without that backbone functioning, we will have a dramatic long-term problem that will not help future challenges and pandemics coming up.
