Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection

by John Green

We are powerful enough to light the world at night, to artificially refrigerate food, to leave Earth’s atmosphere and orbit it from outer space. But we cannot save those we love from suffering. This is the story of human history as I understand it—the story of an organism that can do so much, but cannot do what it most wants.

I started writing about TB because I wanted to understand how an illness could quietly shape so much of human history. But along the way, I learned that TB is both a form and expression of injustice.

tuberculosis has come to be seen as a disease of poverty, an illness that walks the trails of injustice and inequity that we blazed for it. The world we share is a product of all the worlds we used to share. For me at least, the history and present of tuberculosis reveal the folly and brilliance and cruelty and compassion of humans.

“Nothing is so privileged as thinking history belongs to the past.”

Looking at history through any single lens creates distortions, because history is too complex for any one way of looking to suffice.

Of course, tuberculosis doesn’t know what it’s doing, but for centuries, the disease has used social forces and prejudice to thrive wherever power systems devalue human lives—an

In general, colonial infrastructure was not built to strengthen communities; it was built to deplete them.

Once, when Isatu talked to me about her childhood, the interpreter used the word “woven.” “Myself and my friends were woven.” I do not know what it’s like to grow up in a safe and stable village in southern Sierra Leone, but I know the joy of feeling woven into the social fabric, feeling a part of the world rather than apart from it,

We would like to imagine that we captain the ships of our lives, that human history is largely the story of human choice.

“Death is natural. Children dying is natural. None of us actually wants to live in a natural world.”

I want to pause here to note a defining feature of humans, which is that we like to know why things happen, especially why really bad things happen. And if a reason is not immediately apparent, we will find one.

There were simply too many cases for consumption to be understood as a disease caused by immorality or weakness. Something had to be done—if not about the disease, then at least about our imagining of it.

Imagining someone as more than human does much the same work as imagining them as less than human: Either way, the ill are treated as fundamentally other because the social order is frightened by what their frailty reveals about everyone else’s.

much of what some imagine as dichotomous turns out to be spectral, from neurodivergence to sexuality, and much of what appears to be the work of individuals turns out to be the work of broad collaborations.

We love a narrative of the great individual whose life is shot through with major events and who turns out to be either a villain or a hero, but the world is inherently more complex than the narratives we impose upon it, just as the reality of experience is inherently more complex than the language we use to describe that reality.

But then as now, tuberculosis does not travel primarily through paths forged by race, except insofar as human power structures force it to.

Framing illness as even involving morality seems to me a mistake, because of course cancer does not give a shit whether you are a good person. Biology has no moral compass. It does not punish the evil and reward the good. It doesn’t even know about evil and good.

We tend to solve the problems we pay the most attention to,

Why must we treat what are obviously systemic problems as failures of individual morality?

somehow we always seem to blame the patient for noncompliance, rather than blaming the structures of the social order that make compliance more difficult.

Yes, illness is a breakdown, failure, or invasion of the body treated by medical professionals with drugs, surgeries, and other interventions. But it is also a breakdown and failure of our social order, an invasion of injustice.

We cannot view “health” absent the “social determinants of health,”

Ultimately, what I needed was not just a tetanus shot but an entire set of robust systems to work perfectly in concert with each other—a phenomenon that ought not be a luxury in our world of abundance, and yet still somehow is.

We cannot address it only with comprehensive STP programs. We must also address the root cause of tuberculosis, which is injustice. In a world where everyone can eat, and access healthcare, and be treated humanely, tuberculosis has no chance. Ultimately, we are the cause. We must also be the cure.