An Iron Fist Joins the Malaria Wars - New York Times

He's a breath of fresh air," said Amir Attaran, a biologist and lawyer at the University of Ottawa who has accused the W.H.O., the World Bank and the Global Fund to Fight Aids, TB and Malaria of squandering millions on old, useless drugs.

"You need to talk tough," he added. "There has been absolute incoherence on fundamental issues."

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Dr. Attaran, a longtime W.H.O. critic, also praised Dr. Kochi for being one of the first at the agency to realize that AIDS could be treated in Africa with standard regimens of cheap drugs and simple blood tests, instead of Western-level care costing tens of thousands of dollars a year.

In the 90 days before his deadline expired, Dr. Kochi met with generic drug-makers, many of whom are trying to shift from duplicating Western drugs to researching new ones. He told them, he said, that they would face a public relations fiasco if they made malaria worse.

Caroline Jansen, a member of the family that owns Dafra Pharma, a Belgian company that supplies about 25 percent of Africa's private market for malaria drugs, said her company had agreed to stop selling monotherapy and was developing pills mixing artemisinin with lumefantrine, amodiaquine and other drugs.

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Whether he can enforce that remains to be seen. The malaria market in poor countries is a mess: many tiny shops sell pills without prescriptions, and counterfeits are common. Chloroquine is still widely sold because it reduces fevers as aspirin does; patients briefly feel better, but then die of anemia

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In April, Dr. Kochi targeted the Global Fund, through which rich countries buy AIDS, malaria and TB drugs for poor ones. He accused it of ignoring W.H.O. rules forbidding artemisinin monotherapy and buying from suppliers that fail W.H.O. standards. In May, he displayed the reply he got, which he dismissed as "excuses — a lot of 'but, but, but ' " In June, he announced that the fund had changed it policies

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Senator Tom Coburn, a conservative Oklahoma Republican who took up malaria as a cause and has demanded that taxpayer dollars be spent on drugs and nets rather than consultants, said he was "very impressed" on meeting Dr. Kochi.

"He's not abrasive compared to me," Senator Coburn, who is also a doctor, said. "A million people are going to die this year. What's more important — having a politically correct strategy or a public health strategy that works

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Dr. Kochi got his start in public health in 1975 when the Japanese Health Ministry asked for a volunteer to run a tuberculosis project in Afghanistan, and later worked in Myanmar. For interviews, he dresses informally: tie, jeans, no public-relations assistant. His biggest drawback may be his accent — he can make an off-the-cuff impolitic crack in idiomatic English, but then has to go through the agony of repeating it three times to be understood.

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Dr. Lee, he said, gave him two orders: "Fix malaria, and don't create a Unmalaria." (The second reference was a joking dig at Unaids, the United Nations agency that is W.H.O.'s partner in fighting Aids and rival for funds, experts and glory.)

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