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

by John Green

Stokes was placed in a sanatorium in Asheville, North Carolina, one of many American cities that functioned as a tuberculosis colony of sorts.

Still, over a million people died of tuberculosis in 2023. That year, in fact, more people died of TB than died of malaria, typhoid, and war combined.

Anyone can get tuberculosis—in fact, between one-quarter and one-third of all living humans have been infected with it. In most people, the infection will lie dormant for a lifetime. But up to 10 percent of the infected will eventually become sick, a phenomenon we call “active TB.” People are especially likely to develop active TB if they have a weakened immune system due to other health problems like diabetes, HIV infection, or malnutrition.

At the time, I knew almost nothing about TB. To me, it was a disease of history—something that killed depressive nineteenth-century poets, not present-tense humans. But as a friend once told me, “Nothing is so privileged as thinking history belongs to the past.”

Several cities, including Pasadena and Colorado Springs, were essentially created for consumptives and their families.

In the Austro-Hungarian Empire, it was illegal at the time to put teenagers to death, but the government didn’t need a firing squad to kill them. All three would be dead before the end of the war, and all from tuberculosis.

TB affecting the spine, known as Pott’s disease, is a common and terribly painful cause of a hunched back (the fictional hunchback of Notre Dame suffered from Pott’s disease).

But of course people are not just their economic productivity. We do not exist primarily to be plugged into cost-benefit analyses. We are here to love and be loved, to understand and be understood. TB intervention is an exceptionally good global health investment, but that is not why I care about TB.

We cannot view “health” absent the “social determinants of health,” or else we end up in situations seen all the time with TB, wherein people are, to cite just one example, unable to take their medicine because they don’t have enough food in their stomach.

And this is why I would submit that TB in the twenty-first century is not really caused by a bacteria that we know how to kill. TB in the twenty-first century is really caused by those social determinants of health, which at their core are about human-built systems for extracting and allocating resources. The real cause of contemporary tuberculosis is, for lack of a better term, us.