Latest news with #EverythingIsTuberculosis:TheHistoryandPersistenceofOurDeadliestInfection
Yahoo
20-05-2025
- Health
- Yahoo
John Green
Credit - Lee Klafczynski—The New York Times/Redux Best-selling author John Green is on a mission to make the world suck less. At least, that was the original impetus behind his aptly-named Foundation to Decrease World Suck (FTDWS), the nonprofit he started in 2007 with his brother and fellow Vlogbrothers YouTube channel creator, Hank. However, he says, if you had told them then that FTDWS would become 'a real charity that would go on to raise real tens of millions of dollars,' they might have called it something different. Still, the name works, as it gets right to the root of what the Greens are striving to do by awarding a total of more than $10 million in grants to dozens of charities since 2012—from perennial recipients Partners in Health and Save the Children to 30-plus other organizations recommended by the participants of the brothers' annual 48-hour telethon-style fundraiser Project for Awesome (P4A). In February, the most recent P4A event raised nearly $3.8 million for an array of nonprofits. 'We used to try to have a measurement of global suck,' Green says. 'I've come to understand you can't really quantify it that way. But you can quantify what makes things better, which is more people having access to health care, education, professional opportunities, etc.' While public health issues have long been a focus of Green's philanthropic efforts, more recently, he has turned his attention to one global health crisis in particular: tuberculosis. In 2019, during an eye-opening visit to a hospital in Sierra Leone, Green saw firsthand the challenges facing patients and doctors fighting what remains the deadliest infectious disease in the world—despite being completely curable, when treated with sufficient resources. According to the World Health Organization's most recent report, an estimated 1.25 million people died from TB in 2023 alone. When he returned home from the trip, Green says he began regularly reading and writing about the topic, an undertaking that eventually resulted in his second nonfiction release, Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection. The book debuted at No. 1 on the New York Times best-seller list following its March 18 publication, with a first run of 500,000 copies. 'Tuberculosis has had such a profound impact on human history,' he says. 'This is a disease that has probably killed around one in seven people who've ever lived, and infected many more than that.' Last year, Green announced he and his family would donate $1 million annually to help fund the work being done to fight tuberculosis in the Philippines, the country with the fourth-highest burden of TB globally. This commitment is part of a larger project Green is involved with that will see a coalition of government agencies and public health advocates provide over $100 million in funding for comprehensive TB care in Ethiopia and the Philippines over the next four years. In 2023, he also publicly rallied his nearly 3.9 million YouTube subscribers to petition Johnson & Johnson to lower the cost of the tuberculosis treatment bedaquiline, which the company did. Although Green is best known for his massively popular young adult fiction, particularly his 2012 juggernaut The Fault in Our Stars, he says it's his humanitarian work that makes him feel like he's using his platform in a meaningful way. As he puts it, 'What's the point, otherwise?' Write to Megan McCluskey at
Indianapolis Star
08-05-2025
- Health
- Indianapolis Star
John Green connects deadly disease to Stetson hats, svelte figures and weighted vests
Who knew tuberculosis had a connection to the development of the cowboy hat or the U.S. military or women's dress sizes? John Green; that's who. And the author was on 'The Daily Show' on May 7 spreading the knowledge in his campaign to end the world's most deadly infectious disease. The curable disease, caused by the bacteria Mycobacterium tuberculosis, resulted in 1.25 million deaths in 2023, according to the Word Health Organization. 'I'm super opposed to tuberculosis,' he told host Desi Lydic. 'I'm a little confused why everyone else isn't. It feels like it should be kind of a universally-held opinion.' The young adult genre ('The Fault in Our Stars,' 'Turtles All the Way Down') and social media (Vlogbrothers YouTube channel) star was promoting his New York Times bestseller 'Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection,' published in March. Green shared how tuberculosis tied into the development of the modern-day American cowboy hat. The maker of the Stetson had moved from New Jersey to the West to recover from tuberculosis, he said. The host challenged him to connect the disease to other trends and events. Was there a connection to Navy fighter jets falling into the water, she asked, referencing the second time in just over a week that a U.S. Navy fighter jet from the USS Harry S. Truman aircraft carrier was lost in the Red Sea. President Harry S. Truman had requested the federal government budget $200,000 to fund the development of Isoniazid, one of the most critical tuberculosis drugs, Green responded. 'If it weren't for Harry Truman sending federal money, federal government taxpayer money, to fund the treatment of tuberculosis, we wouldn't have that amazing drug,' he said. How about the popularity of weighted vests? 'Not even a challenge,' he answered. 'It's trying to shrink your body. It's trying to make you smaller. And that is a result, partly of this tubercular beauty standard. When we romanticized tuberculosis, in the 18th and 19th centuries, we began to associate beauty with very frail, small bodies. So attempts to shrink the female body are at least in part a response to this tuberculosis beauty standard that goes back to the 19th century.' John Green: Best-selling author writes a love letter to the Indianapolis 500 Green, an Indianapolis resident, talked about a 2019 trip to Sierra Leone, where he got to know a youth who was trying to recover from drug-resistant tuberculosis and learned how widespread the disease was. Over the next five years, he 'fell in hate' with the disease, and the book came about from wanting to tell 'his ultimate story of survival, and also wanting to tell the story of the fact that this disease is not history; it's present,' the writer told Lydic. 'It's the deadliest infectious disease in the world, and unfortunately, as a direct result of decisions made by our government, that number is going to go up instead of going down,' Green said. 'It's been going down for the last 20 years, which is something we can be really proud of. "The U.S. has long been the most generous funder of TB response, but that's changing with the dismantling of USAID; and as a direct result, I think the estimates are that within two years, we might see two million people dying instead of over a million.' That doesn't have to be, he said. 'We can achieve cure rates of over 95%. We do that in the United States, and we should be doing it globally. And the fact that we aren't really is kind of a mark of shame on humanity.' 'Turtles All the Way Down': John Green's novel is now a movie, and the ebook is on sale. How to get it 'We know how to live in a world without TB. You search for cases, you treat every case you find, and you offer preventative therapy to folks who are near those cases. And that's how we eliminated TB in the U.S.; or nearly eliminated it. That's how we've nearly eliminated TB in many countries around the world. But that takes funding. And right now, if you think of the history of tuberculosis as a long staircase where we learn more and learn better tools and have better tools to fight the disease, right now we have the tools; we just don't have the political will. So right now, unfortunately, we've fallen down the staircase.' Green sounded hopeful, though. 'But it's easy to feel like this is the end of history. I feel that way all the time, to be honest with you. But it's not the end of history. This is the middle of the story, not the end of the story, and it falls to us to write a better end. And I really believe we can do that together. I really believe that I will live to see a world without tuberculosis.'
Yahoo
30-03-2025
- Health
- Yahoo
Author John Green meets a young tuberculosis patient
When you buy through links on our articles, Future and its syndication partners may earn a commission. Author John Green has been obsessed with tuberculosis (TB) since 2019, when he first visited Lakka Government Hospital in Sierra Leone and met a young TB patient named Henry Reider. In his latest book Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection (Crash Course Books, 2025), Green explores the history of the bacterial disease, highlighting its impact in different eras of history. And he calls attention to the present reality of TB, a curable disease that nonetheless kills over a million people each year due to stark health care inequities around the globe. In this day and age, Green argues that injustice is the root cause of TB cases and deaths, and that we can collectively choose to correct that injustice and finally snuff out the deadly disease. Related: 'We have to fight for a better end': Author John Green on how threats to USAID derail the worldwide effort to end tuberculosis At the time, I knew almost nothing about TB. To me, it was a disease of history — something that killed depressive 19th-century poets, not present-tense humans. But as a friend once told me, "Nothing is so privileged as thinking history belongs to the past." When we arrived at Lakka, we were immediately greeted by a child who introduced himself as Henry. "That's my son's name," I told him, and he smiled. Most Sierra Leoneans are multilingual, but Henry spoke particularly good English, especially for a kid his age, which made it possible for us to have a conversation that could go beyond my few halting phrases of Krio. I asked him how he was doing, and he said, "I am happy, sir. I am encouraged." He loved that word. Who wouldn't? Encouraged, like courage is something we rouse ourselves and others into. My son Henry was 9 then, and this Henry looked about the same age — a small boy with spindly legs and a big, goofy smile. He wore shorts and an oversized rugby shirt that reached nearly to his knees. Henry took hold of my T-shirt and began walking me around the hospital. He showed me the lab where a technician was looking through a microscope. Henry looked into the microscope and then asked me to, as the lab tech, a young woman from Freetown, explained that this sample contained tuberculosis even though the patient had been treated for several months with standard therapy. The lab tech began to tell me about this "standard therapy," but Henry was pulling on my shirt again. He walked me through the wards, a complex of poorly ventilated buildings that contained hospital rooms with barred windows, thin mattresses, and no toilets. There was no electricity in the wards, and no consistent running water. To me, the rooms resembled prison cells. Before it was a TB hospital, Lakka was a leprosy isolation facility — and it felt like one. Inside each room, one or two patients lay on cots, generally on their side or back. A few sat on the edges of their beds, leaning forward. All these men (the women were in a separate ward) were thin. Some were so emaciated that their skin seemed wrapped tightly around bone. As we walked down a hallway between buildings, Henry and I watched a young man drink water from a plastic bottle, and then promptly vomit a mix of bile and blood. I instinctively turned away, but Henry continued to stare at the man. I figured Henry was someone's kid — a doctor, maybe, or a nurse, or one of the cooking or cleaning staff. Everyone seemed to know him, and everyone stopped their work to say hello and rub his head or squeeze his hand. I was immediately charmed by Henry — he had some of the mannerisms of my son, the same paradoxical mixture of shyness and enthusiastic desire for connection. Henry eventually brought me back to the group of doctors and nurses who were meeting in a small room near the entrance of the hospital, and then one of the nurses lovingly and laughingly shooed him away. "Who is that kid?" I asked. "Henry?" answered a nurse. "The sweetest boy." "He's one of the patients we're worried about," said a physician who went by Dr. Micheal. "He's a patient?" I asked. "Yes." "He's such a cute little kid," I said. "I hope he's going to be okay." Dr. Micheal told me that Henry wasn't a little boy. He was seventeen. He was only so small because he'd grown up malnourished, and then the TB had further emaciated his body. "He seems to be doing okay," I said. "Lots of energy. He walked me all around the hospital." "This is because the antibiotics are working," Dr. Micheal explained. "But we know they are not working well enough. We are almost certain they will fail, and that is a big problem." He shrugged, tight-lipped. There was a lot I didn't understand. After I first met Henry, I asked one of the nurses if he would be okay. "Oh, we love our Henry!" she said. She told me he had already gone through so much in his young life. Thank God, she said, that Henry was so loved by his mother, Isatu, who visited him regularly and brought him extra food whenever she could. Most of the patients at Lakka had no visitors. Many had been abandoned by their families; a tuberculosis case in the family was a tremendous mark of shame. But Henry had Isatu. I realized none of this was an answer to whether he would be okay. RELATED STORIES —10 of the deadliest superbugs that scientists are worried about —'It is a dangerous strategy, and one for which we all may pay dearly': Dismantling USAID leaves the US more exposed to pandemics than ever —Massive tuberculosis outbreak sickens dozens in Kansas He is such a happy child, she told me. He cheers everyone up. When he'd been able to go to school, the other kids called him pastor, because he was always offering them prayers and assistance. Still, this was not an answer. "We will fight for him," she told me at last. Editor's note: This excerpt, from Chapter 1 of "Everything is Tuberculosis," has been shortened for the purpose of this reprinting. Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection In "Everything Is Tuberculosis," John Green tells the story of Henry Reider, a tuberculosis patient he met at Lakka Government Hospital in Sierra Leone. Throughout the book, he interweaves Henry's story with scientific and social histories of how tuberculosis has shaped our world — and how our choices will shape the future of Deal
Vox
19-03-2025
- Health
- Vox
More than 1 million people die of tuberculosis every year. They don't have to.
covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017. Tuberculosis is no longer the threat it once was in the US and Europe, but the disease is still killing more than 1 million people worldwide every year. Gamma-Rapho via Getty Images Humanity's battle against tuberculosis has been one of slow and imperfect progress. The disease no longer kills one in seven people in the US, as it did in the 19th century. But look elsewhere and its burden is still terrible: TB killed more than 1.2 million people in 2023, likely making it once again the deadliest infection on Earth, after it was briefly supplanted by Covid-19 during the pandemic. And as John Green, the YA author, YouTuber, and author of the new book Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection, told me in an interview: 'That number is about to go up.' As part of its evisceration of US international aid, the Trump administration is ending funding for its global TB programs. The US is the world's largest single funder of tuberculosis treatment, and the spending cuts quickly interrupted medical care for TB victims. And any delay in treatment can lead to worse outcomes for patients and makes it more likely the bacteria will evolve to resist antibiotics. 'All of this is a direct result of the decisions made by the US government,' Green told me. 'Allowing tuberculosis to spread unchecked throughout the world is bad news for all humans.' There may be as many as 10 million additional TB cases by 2030 because of the cuts, depending on how deep they ultimately are, according to one initial estimate. An additional 2.2 million people could die in that worst-case scenario. It's difficult to know what's happening on the ground, as ongoing lawsuits try force aid funding to resume and the Trump administration itself has given conflicting information at times. One TB program director told The Guardian last week their funding had still not resumed despite receiving a reassurance from the administration that it would. The funding freeze is not only a threat to people in the developing world who live with tuberculosis as an ever-present threat, Green told me — it also poses a risk to the US itself. Right now, Kansas has 68 active TB cases, one of the largest US outbreaks in recent history. One estimate from the Center for Global Development finds that US TB cases will rise in parallel with cases in the rest of the world. That won't just increase health care costs — it will increase the risk that TB will become more drug-resistant and therefore deadlier to people around the world, including in the US. I spoke with Green about the history of one of humanity's oldest infectious diseases, the threat posed by the Trump administration's cuts, and what concerned people can do in response. Our conversation is below, edited for clarity and length. What is the state of tuberculosis right now? Why do people in the US and other wealthy countries often think of it as a disease of the past, a problem that has been solved? I used to think of it as a disease of the past as well. I thought of TB primarily as the disease that killed John Keats, and then we figured out a solution to it, so now it's not a threat anymore. But in fact, tuberculosis is still the world's deadliest infectious disease. It kills over 1.2 million people per year. That number is about to go up. It sickens about 10 million people per year. Around a quarter of all living humans have experienced a TB infection. Now, the vast majority of those people will never become sick. They'll have what we call latent TB, where these clumps of white blood cells form what are called tubercles to surround the bacteria and keep it in check. But in about 10 percent of people who experience a TB infection, they will become sick. We understand some of the risk factors for developing active TB disease. They include malnutrition, other health problems like diabetes, or HIV infection. But we don't fully understand why some people develop active TB and others don't. You call the disease 'weird' in your book. What is weird about TB? The weirdest thing about TB is the cell wall that the bacteria builds. It builds this really thick, fatty cell wall. That takes a long time to build, so TB has an extremely slow growth rate compared to other bacteria; in some cases, hundreds of times slower. That means that it sickens us slower because it takes a long time to overwhelm the body's defenses. This is one of the reasons why tuberculosis used to be a narratively convenient disease, a disease that was the subject of so many books. It was a narratively compelling disease because it tends to take a life slowly over the course of months or years, rather than all at once like a disease like cholera or the black plague. Classically, we understood death as something that occurred very early on in life because about half of people died before the age of 5, or something that occurred late in adulthood, in your 50s or after. Tuberculosis killed so many people in their 20s and 30s that it was called the robber of youth. But it also killed people early in childhood and late in adulthood. It killed indiscriminately. To some extent, it still does. I mean, 218,000 kids are going to die of tuberculosis this year. What's so frustrating to me is that all of those deaths are unnecessary because we've had a cure since the 1950s. This disease has been with us forever. It was even glamorized to an extent in earlier generations. But then there was a transition when it became more stigmatized — it became associated with being dirty and poor. How did that happen? Until 1882, at least in Northern Europe and the United States, it was generally believed that tuberculosis was an inherited genetic condition. But in 1882, the German doctor Robert Koch proved that tuberculosis was in fact caused by bacteria. The moment it became an infectious disease is really the moment that our imagining of the disease changed radically. Instead of being a disease of wealth and civilization, it became a disease of poverty. The implications of this were huge because it meant that we could control tuberculosis by trying to control the bacteria that caused TB. But it also meant that we wanted much more control over the lives of people living with tuberculosis. We started to understand them very differently. We started to see people with tuberculosis as a threat to the social order. At the same time, by the middle of the 20th century, we developed vaccines and cures. How did our perception of TB continued to change — and how did race increasingly factor into it? TB had long been understood by Europeans as a racialized disease. It was widely believed in Europe and in the US among white doctors that only white people could get consumption because it was a disease of civilization. To acknowledge that consumption was common among people of color and colonized people would have been to undermine the entire project of colonialism itself. After we understood the disease as infectious, it became racialized in a different way, where it came to be argued that people of color were uncommonly susceptible to tuberculosis. Instead of believing that it was impossible for them to get tuberculosis, people started to argue that their susceptibility to tuberculosis was owing to some factor inherent to race. Now, we knew this was hogwash from the beginning. There were lots of doctors, including African American doctors and researchers, pushing back against this notion. They argued, correctly, that the actual cause of tuberculosis was crowded living and working conditions, poor pay, malnutrition — all the stuff that today we know does cause tuberculosis. But the racialization of the disease was so profound that it's still shaping who lives and dies of tuberculosis. Today, how does tuberculosis look in the United States versus a place like Sierra Leone, which you cover extensively in your book? Starting in the 1940s, we began to develop treatments for tuberculosis that were very powerful. We created combinations of multiple antibiotics that, given over the course of several months or even years, could cure tuberculosis. This disease that had always been one of the leading human killers suddenly became curable. Unfortunately, we did a really poor job of distributing this cure to the places where it was most needed. As a result, we've seen the development of extensive drug resistance for tuberculosis, and we've seen a huge amount of ongoing suffering from the disease. The Ugandan HIV researcher Dr. Peter Mugyenyi said of HIV drugs in the year 2000: 'Where are the drugs? The drugs are where the disease is not. And where is the disease? The disease is where the drugs are not.' And that's very much the case with tuberculosis as well. If you or I got tuberculosis tomorrow, even if we had a complex drug-resistant case, we would get access to the best personalized, tailored treatments of antibiotic cocktails we would need in order to cure our TB. But for someone like my friend Henry living in Sierra Leone, when he got really sick in 2019 and 2020, those drugs weren't available to him. So even though his TB was very curable, his life was at risk — not ultimately because of a lack of technology, but because of failure to get the technology to the places where it's most needed. In the book you called TB both a form and an expression of injustice. It seems to me that TB is one very striking example of a pattern of injustice that applies across a lot of diseases. Yeah. I think it's really important to acknowledge that tuberculosis is not the only disease of injustice. Hepatitis is a disease of injustice. Malaria, HIV, cancer are diseases of injustice. When my brother got cancer, one of the first things he said to me was that there was a 94 percent cure rate if you have access to treatment, and about a 5 percent cure rate if you don't. It's very hard to grapple with the fact that the real cause of a huge percentage of human death is injustice — the failures of human-built systems. There are many deaths that we simply don't have the technology or the tools to prevent. But there are many, many, many, many deaths that we do have the technologies and tools to prevent. It's important to understand that as a justice problem, as an equity problem, as a failure to appropriately apportion the resources that we as a human species have developed. It breaks my heart. It's devastating. I'm often asked whether I think people are good. Like, at the end of this book, do I think people are good? And I can't answer that question. What I can say is I think people are capable of extraordinary generosity and compassion and sacrifice. When people are proximal to suffering, they show an extraordinary capacity for giving. And when people are not proximal to suffering, when people don't let themselves become close to the suffering of others, they can act monstrously. There has been imperfect progress on global health, but progress nonetheless. But now the US government is pulling back from the global health commitments that have helped make that progress possible. What does this mean for TB specifically? The United States has long been the most generous donor when it comes to fighting TB, and now essentially all tuberculosis-related funding has been cut. That's catastrophic on a number of levels. To my Republican friends and congressional representatives, I try to compare it to the 2008 financial crisis when the capital markets just froze, and it was very hard to get them to start working again. In many communities, that's what's happening as a result of this sudden, chaotic, very unpredictable, haphazardly rolled out funding freeze. Hundreds of thousands of people have seen their treatment interrupted, and we know that's a catastrophe, not only for those individuals, many of whom will die, perhaps most of whom tragically will die, but also because it means that they will develop drug resistance. Even a couple of weeks without getting access to your medication means a skyrocketing chance of drug resistance. Even if they're able to get back on treatment, the relatively inexpensive treatment that worked before may no longer work. That means more cases of extensively drug-resistant tuberculosis circulating in communities. It's also a threat to the United States. We have 10,000 cases of active tuberculosis in the US every year. We have a tuberculosis outbreak right now in Kansas. Tuberculosis anywhere is a threat to people everywhere and allowing tuberculosis to spread unchecked throughout the world is bad news for all humans. It's bad news for human health. We've made so much progress in human health during my lifetime. The year I graduated from high school, 12 million children died under the age of 5. Last year, fewer than 5 million did. It's easy to feel like that progress is inevitable or natural or somehow it was always going to happen. But it wasn't always going to happen. It happened because millions of people worked together to make it happen, because we decided collectively to value children's lives more and to work hard to protect them. Now what we're seeing is the first regression of my lifetime when it comes to overall human health. We're seeing it in the United States where life expectancy has been going down. We're about to see it globally where tuberculosis cases, by one estimate, will increase by 30 percent over the next couple of years, leading to 13 million people getting sick every year instead of 10 million and leading to hundreds of thousands more people dying. All of this is a direct result of the decisions made by the US government. I feel like it's hard for people to understand the feedback loop that's potentially in play here that can put our health at risk because diseases are spreading elsewhere. I think it's also hard for us to take the long view. I'm curious where you think that failure comes from? And have you seen anything that's sort of effective in overcoming that? I think we have to bridge the empathy gap. There's always an empathy gap between every person, right? I don't know what it's like to be you. I don't know about your joys and sorrows. And even when I do, I can only kind of situate them in my own experience. I can only relate to it through my own eyes because those are the only eyes I get to see through for the whole time that I'm here. And so there's always an empathy gap, but that empathy gap grows or shrinks based on how close you allow yourself to be to the suffering and joy of others. And so you know when my uncle gets sick, I'm going to respond to that very differently than if I hear through the grapevine that someone else's uncle is sick. And for me, the empathy gap is also a social justice gap. The further the rich world feels from someone's life, the less likely the rich world is to intervene. So for me, it's about shrinking that empathy gap everywhere we can so that we understand that the lives of other people, even other people whose lives may feel distant from ours are just as real and just as important as ours, that their joy and grief and longing and loss is as real and profound as ours is. I try to do that in the book by telling Henry's story because you can talk all day about what a great investment tuberculosis response is, and it is a great long-term financial investment. You can talk all day about how many people are dying of TB every year. All that just boils down to statistics. And the statistics don't decrease the empathy gap, at least for me. And so I wanted to tell a human story at a human scale because I feel like that's what really changes our perspective. What options are available to people like Vox readers, who want to contribute in some small way to making these problems better? It sounds meaningless and everybody says it, but it's true. When you reach out to your congressional representatives insofar as you're lucky enough to have some say in your governance, it really matters. What funding we've been able to claw back for USAID is a result of people reaching out to their senators and representatives and those senators and representatives in turn reaching out to Secretary [of State Marco] Rubio and saying, 'This is ridiculous. This can't happen.' It's really, really important that people in power hear that it is unacceptable for the United States to walk away from its long-term commitments to global health and human health, and that it's unacceptable for the United States to break its promises. They need to hear it's also bad for America. It's bad for farmers who provide food aid. It's bad for overall human health in the United States. We're seeing our own numbers of tuberculosis cases go up every year, and that will accelerate now.
Yahoo
15-03-2025
- Health
- Yahoo
How the Other Half Suffers
Almost immediately after assuming the presidency for the second time, President Donald Trump signed an Executive Order freezing all foreign aid. In the weeks since, according to the New York Times, 'The whole system of finding, diagnosing and treating tuberculosis . . . has collapsed in dozens of countries across Africa and Asia.' The consequences of this system collapse in places like Kenya are dismal: Family members of infected people are not being put on preventive therapy. Infected adults are sharing rooms in crowded Nairobi tenements, and infected children are sleeping four to a bed with their siblings. Parents who took their sick children to get tested the day before Mr. Trump was inaugurated are still waiting to hear if their children have tuberculosis. And people who have the near-totally drug-resistant form of tuberculosis are not being treated. In the West, we often think of tuberculosis as a disease of the past, akin to the Black Death or smallpox (or, until the recent outbreak in Texas and New Mexico, measles). We remember it as 'consumption,' that pesky disease that tends to afflict characters in Dickens or Tolstoy novels and kills them, slowly but surely, after they begin coughing up blood. As a result, it's easy to forget that TB still exists. But in his new book, Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection, John Green—the YouTuber, podcaster, philanthropist, and acclaimed author of young adult fiction books including The Fault in Our Stars—reminds us that tuberculosis, the bacterial infection that has claimed the lives of as many as 1 in 7 human beings who ever lived, is still very much with us today. Tuberculosis has always been a challenge to humanity, but as Green notes, what's different now is that 'tuberculosis is curable, and has been since the mid-1950s.' Indeed, because of remarkable medical advances in the 20th century, '[w]e know how to live in a world without tuberculosis. But we choose not to live in that world.' In the United States and other developed countries, we sort of do live in that world: While there were nearly 10,000 cases of tuberculosis in the U.S. in 2023 (a distressing increase of 8.3 percent over 2019 levels), the vast majority of TB cases—Green reports that more than 2 billion people worldwide are currently infected with the bacterial disease (though in most cases the infection remains forever dormant)—occurred in low- and middle-income countries. One of those countries is West Africa's Sierra Leone, a former colony for emancipated American slaves who fought alongside the British in the Revolutionary War. Green became interested in TB after meeting a 17-year-old boy there named Henry, who suffered from tuberculosis. Henry had been receiving treatment for several years by the time Green met him, and his prognosis was bleak. The one-two punch of child malnourishment and tuberculosis—'wasting' is 'one of the cardinal features of the disease'—left him emaciated, to the point where Green initially thought the young man was around the same age as his 9-year-old son. Worse, Henry had 'yellow clouds in the whites of his eyes' due to liver toxicity, a side effect of the drugs used to treat him, and swelling in his neck indicated that TB had invaded his lymph nodes. Henry was being treated for his disease, but unsuccessfully, and it was determined that he had developed multidrug-resistant tuberculosis. This harder-to-beat version probably afflicted Henry because his father at one point insisted that he abandon professional medical treatment in favor of a faith healer. Indeed, one reason for TB's longevity is that many patients fail to take their full course of antibiotics. This is especially the case in poor countries, where the DOTS strategy—an acronym meaning Directly Observed Therapy (Short-course)—requires a course of standardized treatment of antibiotics under physician supervision. But in many of these countries, patients struggle to get to and from the hospital to obtain their antibiotics, and their often inadequate food intake makes them susceptible to the nausea that can occur if the medications are taken on an empty stomach, causing them to reject their pills. When TB patients fail to take all their antibiotics, the bacteria that remain replicate, passing on their antibiotic-resistant genes to their progeny. But rather than lay the blame for TB's sustained advantage over the human race on patients in poor countries who lack adequate health care, Green argues that 'we are in this mess first and foremost because we stopped trying to develop new treatments for tuberculosis.' Green points an accusatory finger at our market-based system of drug development, arguing that there are few economic incentives for drug companies to develop additional TB treatments for people in poor countries. When in 2012 Johnson & Johnson developed bedaquiline, which is effective against drug-resistant tuberculosis (and could have cured Henry within months), the pharmaceutical giant engaged in what Green calls price gouging: It charged $900 for a single course of treatment in low-income countries, far more than the $130 that it charges for the same treatment today. (My inner Kevin D. Williamson insists that this 86 percent price drop is actually proof that the market is working. My inner John Green, meanwhile, wonders whether we should really allow pharmaceutical companies to price life-saving drugs so highly for people who couldn't possibly afford them.) Instead of relying solely on market incentives for TB treatment, Green argues, 'We could invest more public and philanthropic money into research and development of drugs, vaccines, and treatment distribution systems.' More ambitiously, we could 'reimagine the allocation of global healthcare resources to better align them with the burden of global suffering—rewarding treatments that save or improve lives rather than treatments that the rich can afford.' It's a nice thought, but even before President Trump froze foreign aid, Green's vision seemed unlikely to manifest anytime soon. But Trump's foreign-aid cutoff still spells trouble for affected TB patients. 'If left untreated,' Green explains, 'most people who develop active TB will eventually die of the disease.' The symptoms vary, but for many patients, 'Their lungs collapse or fill with fluid. Scarring leaves so little healthy lung tissue that breathing becomes impossible. The infection spreads to the brain or spinal column.' Others 'suffer a sudden, uncontrollable hemorrhage, leading to a quick death as blood drowns the lungs.' And considering that the U.S. contributed about half of all international TB funding in 2024, it's possible that the death toll this year will exceed even the 1.25 million that it reached in 2023, the most recent year for which data are available. At the risk of being too alarmist, lackluster treatment of TB in poor countries can have spillover effects in the first world. Tuberculosis is incredibly contagious (Green notes that the average TB patient spreads the infection to 10 to 15 others per year, compared to just 1 for flu and 1.4 to 2.4 for COVID), so as fewer patients get treatment, more of their family members, neighbors, and doctors are at risk of contracting the illness. And as the infection spreads further, it could be only a matter of time before TB reaches our shores with a virulence we haven't yet experienced. Moreover, the more TB spreads, the more time it has to mutate and become resistant to the antibiotics we currently use to treat the disease. All of which is to say that funding TB treatment and prevention programs in countries like Sierra Leone seems like a wise investment that is, ironically, 'consistent with U.S. foreign policy under the America First agenda,' as the State Department put it in a press release on implementing Trump's funding freeze. But beyond the strategic benefit to maintaining our status as the world leader in TB treatment and prevention funding, there is also a profound moral case to be made in favor of doing so. The plight of tuberculosis sufferers like Henry may not register in the nationalistic worldview of people like President Trump, Vice President J.D. Vance, or Elon Musk, but that doesn't mean those patients' lives aren't worth saving. Henry ended up surviving his TB thanks to the tireless efforts of the doctor who begged, pleaded, and cajoled government authorities to get him a course of bedaquiline. It's unrealistic to expect that all TB patients could be saved this way. But if we stopped treating tuberculosis as though we left it in the rearview mirror decades ago, Henry's miraculous outcome could become much more routine.
