Health ministry · Resilience
Health security: is Germany’s health system ready for the next crisis?
The pandemic exposed gaps in stockpiles, supply chains and coordination. Six years on, a national reserve remains unfinished, medicine shortages remain routine, and a Health Security Act has been announced but not yet drafted in public.
01 / Scope
What “health security” covers
Health security is the ability of a health system to keep functioning when demand surges or supply fails. It spans infectious-disease emergencies such as pandemics; supply shocks in medicines, medical devices and protective equipment; infrastructure failures including cyber-attacks on hospitals; and — a theme that has grown since 2022 — the role of civilian health care in defence and alliance scenarios.
In Germany, responsibility is layered. The federal government legislates on infectious-disease control (the Infection Protection Act), medicines and medical devices, and civil protection in the event of war. The Länder are responsible for disaster protection, hospital planning and investment, and the local public health offices. The Robert Koch Institute (RKI) is the federal public-health institute for infectious diseases; the Federal Institute for Drugs and Medical Devices (BfArM) monitors supply shortages. Within the EU, coordination runs through the Health Security Committee and, since 2021, the Commission’s Health Emergency Preparedness and Response Authority (HERA).
Carsten Linnemann became minister on 29 July 2026. In the Health Committee on 23 September he listed a Gesundheitssicherstellungsgesetz — a Health Security Act for periods of crisis — among the bills he intends to bring forward (hib 733/2026). That is the only health-security initiative attributable to him so far. The remainder of this page describes the inherited framework and the questions such a law would need to settle.
Five levels of crisis responsibility
Each ring has its own legal powers. In a crisis, the speed of the whole depends on how well the rings connect.
Layers of health-crisis responsibility
SourceEditorial schematic based on the Infection Protection Act, the Basic Law’s allocation of civil and disaster protection, Commission Decision of 16 September 2021 (HERA) and the WHO International Health Regulations.
Federal–Länder friction
The pandemic years showed how much depends on joint decisions between the federal government and sixteen Länder — from testing rules to hospital capacity reporting. Civil protection in case of war is a federal matter; disaster protection in peacetime is a Länder matter; hospital planning sits with the Länder; the medicine supply is federal and European. A health-security law has to work across these lines.
The Länder have pressed for speed. Andreas Philippi (SPD), Health Minister of Lower Saxony and chair of the Conference of Health Ministers in 2026, called on the federal government in October 2026 to accelerate the Health Security Act, citing the changed security situation (Pharmazeutische Zeitung, 1 October 2026).
The European layer
HERA was established as a Directorate-General of the European Commission on 16 September 2021 to assess threats, support research and production capacity and organise joint procurement and stockpiles. The European Medicines Agency’s mandate was extended to monitor shortages of critical medicines during crises. A Union list of critical medicines identifies products whose supply must be secured as a priority.
The global layer
The World Health Assembly adopted the WHO Pandemic Agreement on 20 May 2025. An annex on access to pathogens and sharing of benefits (PABS) was to be presented in May 2026; the 79th World Health Assembly extended the negotiations. The agreement can only open for signature once the annex is adopted.
The instruments and their status
Status as of 8 October 2026. Inherited means decided or begun before 29 July 2026.
- Inherited
- Under review
- Proposed
- In implementation
- In force
Health Security Act (Gesundheitssicherstellungsgesetz, GeSiG)
Announced by Linnemann in the Health Committee on 23 September 2026 as a law for periods of crisis (hib 733/2026). According to Pharmazeutische Zeitung (1 October 2026), it is to regulate health care in alliance and defence scenarios, including stockpiling of medical supplies, manufacturing capacity, patient steering, personnel, equipment and medicines, and regular exercises; no draft had been published, and cabinet treatment was expected in early 2027. The pharmacists’ association ABDA has said it is involved in the preparatory work. The content is therefore not yet public.
National Health Protection Reserve (NRGS)
Decided by the federal cabinet in June 2020 to cover the needs of the health sector for up to six months. Phase 1 — procurement of protective equipment — was completed; in 2023 the ministry reported 245 million masks in store. Phases 2 (domestic production) and 3 (permanent operation) received no budget funds after the finance ministry declined the request in autumn 2022. Whether the GeSiG revives the reserve is an open question.
Supply-shortage law (ALBVVG)
Inherited from 2023. Gives the BfArM an early-warning system for supply-relevant market concentration, a monthly list of essential children’s medicines and a stronger advisory council on supply shortages. Details on the pharmaceutical-policy page.
Critical Medicines Act
Proposed by the European Commission in March 2025. Council and Parliament reached a provisional political agreement on 12 May 2026. It promotes diversification of supply chains in public procurement, allows preference for EU production where dependence on a few third countries is high, eases financing for EU manufacturing, coordinates national stockpiles so they do not harm supply elsewhere, and lowers the threshold for joint procurement requests from nine to five member states. Publication in the Official Journal was expected towards the end of 2026.
EU framework on serious cross-border threats
Since 2022 the EU has a strengthened legal framework for preparedness planning, surveillance and joint procurement, with HERA operational since early 2022 and an extended mandate for the European Medicines Agency in crises.
Telematics stability (GeDIG)
The digital bill debated on 8 October 2026 would strengthen gematik’s control over the telematics infrastructure, which recorded an average of 25 disruptions a month in 2025. Cyber-resilience of hospitals is part of health security. See digital health.
04 / Pandemic preparedness
Learning from the last pandemic
- Jun 2020
National reserve decided
The cabinet decides to build the National Health Protection Reserve.
- Sep 2021
HERA founded
The EU creates its health-emergency authority.
- 20 May 2025
WHO Pandemic Agreement
Text adopted; annex still under negotiation.
- 10 Jul 2025
Bundestag inquiry commission
Commission on lessons from the coronavirus pandemic set up; final report due by 30 June 2027.
- Sep 2026
Health Security Act announced
Linnemann names the GeSiG in the Health Committee.
Germany has not yet completed its own reckoning with the coronavirus years. On 10 July 2025 the Bundestag set up a commission of inquiry (Enquete-Kommission) on the pandemic and lessons for future pandemic events, made up of 14 members of parliament and 14 experts. It constituted itself on 8 September 2025 and must deliver its final report by 30 June 2027. In progress · parliament
The timing matters for the minister. A Health Security Act drafted in 2026 and debated in 2027 will overlap with the commission’s conclusions. One option is to legislate now on supply and defence scenarios and adjust pandemic-specific rules later; another is to wait for the commission. Linnemann has not said how he intends to sequence the two.
Several lessons are already broadly shared across parties and professions, even where the conclusions drawn from them differ. Surveillance and reporting data reached decision-makers late and in inconsistent formats. Local public health offices were understaffed and poorly digitalised at the start. Stockpiles of protective equipment were insufficient in early 2020, and later purchases under time pressure led to costly disputes. Communication of uncertain evidence to the public proved difficult, and measures affecting children and young people — school and nursery closures — are among the most debated decisions in retrospect.
Other lessons remain contested: how far the federal government should be able to act without the Länder in an emergency, how proportionality should be reviewed, and how much permanent capacity — intensive-care beds, reserve staff, production lines — a society should pay for in normal times. These are political choices rather than technical ones, and they will shape both the Health Security Act and the inquiry’s recommendations.
Scope noteThis page describes institutional preparedness. It does not assess individual pandemic measures; that is the task of the Bundestag commission.
What a crisis law would have to settle
Derived from the inherited debate and the public statements of Länder and professional bodies. These are open questions, not the minister’s answers.
Stockpiles
Who holds reserves — the federal government, the Länder, manufacturers, wholesalers or hospitals — and who pays for rotation before expiry? The NRGS shows that a decision without a budget does not create a reserve.
Production
Which medicines and products justify subsidised domestic or European production? The Critical Medicines Act offers a European frame; national incentives must fit EU state-aid rules.
Patient steering
How are patients distributed between hospitals when capacity is stretched, and who decides — the Länder, a federal crisis staff, or the hospitals themselves?
Personnel
How are doctors, nurses and pharmacists deployed in a defence scenario without stripping routine care? Workforce limits are documented on the medical-workforce page.
Exercises
Regular drills across federal, Länder and hospital levels are reportedly part of the plan. Hospitals already run disaster plans; joint exercises across levels are rarer.
Data
Real-time capacity data — beds, staff, stocks — were improvised during the pandemic. A crisis law will need to define which data must be reported, by whom and how quickly.
Resilience costs money
Health security competes with the cost-containment agenda that dominates Linnemann’s first months.
Argument for investing now
- Reserves and diversified supply chains are cheaper to build before a crisis than during one.
- Recurring shortages of generic medicines show that the market alone does not ensure supply security.
- Geopolitical tension raises the probability of disruption to both trade and infrastructure.
- Länder and professional bodies have called for federal leadership.
Constraints and objections
- The 2027 health budget shrinks in the draft from €21.77bn to €14.33bn; new obligations need funding.
- Stockpiling obligations on companies can raise prices, which the GKV must pay.
- National stockpiles can worsen shortages in neighbouring countries if not coordinated.
- Physical reserves can be partly replaced by contracts, production capacity and data — critics of large stockpiles say needs should be defined first.
Linnemann’s stated priorities — reliable care, sound finances, more time for patients — point in both directions here. How he balances them will become visible only when the draft Health Security Act is published.
Sources & further reading
- German Bundestag — hib 733/2026, Linnemann in the Health Committee (23 Sep 2026)
- Pharmazeutische Zeitung — Philippi calls for speed on the GeSiG (1 Oct 2026)
- Pharmazeutische Zeitung — ABDA involved in drafting the GeSiG
- Ärzte Zeitung — National health reserve: build-up stalls (2 Apr 2023)
- Deutsches Ärzteblatt — National reserve to start in three phases
- Zi — Supply shortages 2025 (graphic of the month, BfArM data) (Jan 2026)
- BfArM — ALBVVG
- Council of the EU — Critical Medicines Act
- zm-online — Agreement on the Critical Medicines Act (May 2026)
- Federal Ministry of Health — International pandemic agreement
- beck-aktuell — WHO states adopt pandemic agreement (20 May 2025)
- Konrad-Adenauer-Stiftung Geneva — PABS annex negotiations (Mar 2026)
- Federal Ministry of Health — Cabinet adopts GeDIG (15 Jul 2026)
- Federal Government — Health budget 2027 debate (10 Sep 2026)
- ZDF — Bundestag sets up commission on the coronavirus pandemic (Jul 2025)
- German Bundestag — Commission of inquiry on the pandemic constituted (8 Sep 2025)