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Arata Kochi, the brilliant and temperamental maestro who orchestrated a global revolution in TB control, has been deposed as the head of STOP-TB, landing in a new post (reportedly created just for him) — that of director of HIV/ AIDS Care and Support, the World Health Organization (WHO) announced last month.
Kochi’s ouster came on the heels of a fierce fight for control of STOP-TB’s proposed global drug facility. The surprise move seemed to signal WHO’s unwillingness to alienate potential new allies in the expanded fight against TB, as well as a recognition that Kochi’s strengths had become, at least for the moment, potentially fatal liabilities.
The former head of the WHO’s prestigious Global TB Programme, Kochi had already angered many in the TB community by insisting that STOP-TB — a new WHO division aimed at expanding and increasing partnerships to fight the disease — must be controlled solely by WHO, not by a coalition effort.
This fall, Kochi made a similar bid for control of the proposed global drug facility, a strategy for raising money to ensure a steady supply of good-quality anti-TB drugs to developing nations.
The creation of the drug facility was to have been the topic for discussion at a meeting called by the Rockefeller Foundation, which, along with many other stakeholders, had grown restless with delays by STOP-TB — reputed to be consumed with internal politics aimed at consolidating its own power — in getting the facility off the ground.
Just the day before the Rockefeller meeting
was scheduled to take place, Kochi shocked Rockefeller scientific adviser Ariel Pablos-Mendez and others by getting his boss, Director-General Gro Brundtland, to pull out of the meeting. Brundtland’s no-show struck many TB experts
in the U.S. as bad manners and reportedly left Rockefeller higher-ups steaming. Kochi’s removal followed close on the heels of a subsequent WHO pow-wow in Cairo, where Kochi’s strong-arm
tactics were the topic of many a huddled conversation, and urgent talk of "the need to be more collegial" dominated formal discussion groups.
With Kochi gone, TB experts in the U.S. seem both relieved and sorrowful. "Arata was and is
a powerful and charismatic person, " says Jim Kim, MD, PhD, executive director of Partners in Health in Boston. "Even though the same qualities that helped him push forward the concept
of DOTS are now seen as unhelpful, we’ll lose something with his departure. I think we all agree that the TB community owes him an enormous debt of gratitude."
Kochi always thought "outside the box," Kim adds. His ability to do so helped enable him build a powerhouse organization from the flimsy structure he inherited when he first took over the WHO Global TB Programme.
Kochi began the remake of the program by putting together an unorthodox team, consisting of a nimble and affable publicist, Kraig Klaudt, and a streetwise economist recruited from the World Bank, Richard Bumgarner. Bumgarner and Kochi were, from the beginning, a seemingly unbeatable pair, with Bumgarner acting as designated "good cop," smoothing feathers ruffled by Kochi’s imperious demeanor.
Almost until the end, Bumgarner stood loyally by his boss, sometimes accused of low-balling cost estimates for DOTS and overstating DOTS’ ability to slash TB mortality — and thereby telling financial honchos at the World Bank exactly what they wanted to hear, which ensured the successful sale of the fledgling strategy.
It was a hunker-down, take-no-prisoners formula that meshed perfectly with the perilous times.
Even after Harvard economist Jeffrey Sachs and others began arguing that cheap interventions against "diseases of the poor" might not suffice (and might be, to boot, morally repugnant in a world awash in venture capital and excess cash), Kochi proved willing to think outside the box. As evidence mounted that HIV and multidrug-resistant TB were taking a toll that didn’t fit neatly into a DOTS-mediated quick fix, Kochi risked the wrath of his colleagues by being the first at WHO to swing over in favor of DOTS-Plus. "Let a thousand flowers bloom," he would urge, clipping his L’s into R’s in his characteristic, rapid-fire fashion.
Jacob Kumaresan was appointed interim head of STOP-TB after Kochi’s departure. Along with Ian Smith, former WHO representative in Nepal, Kumaresan is expected to win high marks for the "collegiality" his former boss may have lacking, say observers. "Jacob and Ian are among the most respected and admired people in the TB world," says Kim. "I think people will fall in step right behind them."
As to what the future holds for Kochi, Kim says he envisions a rebirth. "If he gets the same level of financial backing for HIV Care and Support as he did for the WHO TB program, I think we can look forward to something quite amazing happening in that field," he says. With talk afoot of applying the Green Light Committee concept to HIV drugs as well, Kim adds that he looks forward to seeing his old friend across the table again soon.
"I would never, ever count Arata out," Kim says. "I think he’ll probably re-emerge, like the phoenix. He may wind up playing an even more prominent role in HIV than he did in TB. I look forward to working with him."