WHO’s head of Universal Health Coverage, Dr. Peter Salama, has died suddenly at the age of 51.

The Australian-born medical epidemiologist was known as an eloquent global health advocate, who dedicated his career to combatting the world’s most difficult and dangerous diseases and strengthening fragile health systems in states weakened by war and civil unrest.

After joining WHO in 2016 as executive director of Health Emergencies, Salama oversaw the winding down of a massive Ebola epidemic in West Africa, only to be confronted two years later in 2018 with the re-emergence of the deadly virus in the Democratic Republic of Congo (DRC).

But he was well-prepared. During the 2013-2016 outbreak, Salama had overseen UNICEF’s response as Regional Director for the Middle East and North Africa. Over three years, that epidemic killed over 11,000 people, leaving behind ravaged economies and societies in Sierra Leone, Liberia and Guinea.

Lessons learned from West Africa, along with a potent new vaccine, helped Salama and the WHO team work with the DRC health authorities to contain the outbreak there more effectively. Although the DRC outbreak is still simmering in bursts and flames, fuelled by continued civil unrest in eastern DRC, its death toll has been much lower, and the virus has not lept significantly to other countries.

“Pete embodied everything that is best about WHO and the United Nations – professionalism, commitment and compassion,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, in a statement. “Our hearts are broken.”

In 2019, during a WHO internal reorganization, Dr Tedros nonetheless moved Salama out of his natural turf in Emergencies, appointing him Executive Director of WHO’s new flagship programme on Universal Health Coverage (UHC).

The new UHC programme is of premier strategic importance, although the transfer also came amidst a series of internal staff complaints within the Emergencies team. While these were primarily targeted at other staff, the waves also touched Salama. Mike Ryan was appointed executive director of the Emergencies Programme, a position he holds today.

Salama, meanwhile, took on his new mission in Universal Health Coverage with gusto, using it as a platform to advocate for the inclusion of the world’s poorest and left-behind populations.

A talented orator, Salama was outspoken about both the challenges and the need to boost weak health systems, particularly in conflict regions, improving both their preparedness as well as routine care, issues with which he had grappled since the early days of his career.

He linked persistent health inequalities with the problems faced by fragile states. In one keynote address to a Geneva gathering of pharma manufacturers in December 2018, he said the following:

“While we have made tremendous progress tackling some stark global health inequities, there is a major fault-line that we have hardly begun to address. In recent decades it is not necessarily the poorest countries that have fallen behind the most, it is those countries or parts of countries that are facing conflict, insurgency or are fragile due to other reasons.

“In fact, more than three-quarters of the major outbreaks we see at WHO occur in these 20 or 30 places. Think, plague in Madagascar, wild polio on the Afghan-Pakistan border, yellow fever in Angola, cholera in Yemen, diphtheria among Rohingya refugees in Bangladesh, measles in Venezuela, meningitis in north-eastern Nigeria or Ebola in DRC. Conversely when we review our global goals under the Sustainable Development Framework, we see that the same set of countries accounts for more than 50% of most of the unmet targets – whether for under 5 mortality, maternal mortality or under-immunized children. Most of our global health battles will be won or lost in these countries.”

The huge outpouring of response over Salama’s death from nearly every major global health institution, as well as national health ministries, was testimony to the high regard he commanded for his work on some of the world’s most challenging diseases and health issues.

“Peter was a loyal and committed health advocate and multilateralist. He brought depth and strength to WHO. He will be missed,” tweeted Lancet Editor, Richard Horton.

He was, “an amazing person and a relentless champin for the universal right to health for every child,” said UNICEF’s global director of communications, Paloma Escudero.

Before joining WHO, Dr Salama was Regional Director for the Middle East and North Africa at UNICEF, an organization that he joined in 2002, with his first posting in war-torn Afghanistan.

He is still remembered there. Suraya Dalil, Afghanistan’s minister of public health, said: “Dr Peter Salama worked with UNICEF Afghanistan in 2002-3 and immensely contributed in the construct of an equitable health care including the Basic Package of Health Services. His legacy to make the world a better place will continue in our continued collective work,”

Salama also served as UNICEF’s Representative in Ethiopia and Zimbabwe (2009–2015), Chief of Global Health and Principal Advisor on HIV/AIDS in New York (2004–2009).

He also worked in the past with Médecins Sans Frontières and Concern Worldwide in several countries in Asia and sub-Saharan Africa. And he also spoke and published widely on health issues related to war and conflict zones, vaccine-preventable diseases, and HIV/AIDS.

Given the importance of UHC to the WHO strategic agenda, the search to find a replacement of Salama’s stature will be a difficult one, observers said. WHO’s ambitious aim is to extend affordable, accessible and quality health care to everyone across the world by 2030, in line with the UN High Level Declaration of September 2019.

More than that, the global health leaders said that they will miss the human touch of a man whose work touched the lives of so many millions somehow.

“Dr Peter Salama’s last mission was in Somalia where he wanted to change the health systems making it fit for UHC,” tweeted the WHO office in Somalia today. “He dreamt of a society where everyone everywhere can access health care without any financial hardship. He dreamt of a health system which is devoid of inequality and social disparity. His dream was to transform and build the health system of Somalia that can ensure Health For All.

“He was immensely touched to see how the work of WHO can immensely impact the lives of millions. We will miss him but would carry forward his dream into a reality.”

Salama, who was reported to have died of a heart attack, is survived by his wife and three children.

Image Credits: WHO , WHO.