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.

What’s different now from 1804 or 1904 is that tuberculosis is curable, and has been since the mid-1950s. We know how to live in a world without tuberculosis. But we choose not to live in that world.

“Where are the drugs? The drugs are where the disease is not,” Dr. Mugyenyi said. “And where is the disease? The disease is where the drugs are not.”

And because the disease spreads especially well in crowded living and working conditions like slums and poorly ventilated factories, 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.

But as a friend once told me, “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.

The infection has long exploited human biases and blind spots, wriggling its way through the paths injustice creates. 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

But the empire’s role in Sierra Leone was primarily to take Sierra Leone’s wealth, as quickly and efficiently as possible, out of Sierra Leone.

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

But history, alas, is not merely a record of what we do, but also a record of what is done to us.

Tiger got to hunt, Bird got to fly; Man got to sit and wonder, “Why, why, why?” Tiger got to sleep, Bird got to land; Man got to tell himself he understand.

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.

Lord Byron wrote, “I should like, I think, to die of consumption…because then the women would all say, ‘See that poor Byron—how interesting he looks in dying!’ ”

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.

“By the late 1980s,” Mukherjee tells us, “health budgets in many African and Asian countries were less than $5 per person per year.”

When you write a novel, you are alone in it. I wrote that book alone, sitting in airports and coffee shops and lying in bed. But when writing, there is always for me a hope that one day I will not be alone—not in this work and not in this world. It is a bit like that old children’s pool game Marco Polo, where one person closes their eyes and swims around the pool trying to tag someone else. “Marco,” the person with eyes closed says, and the other pool-goers have to answer, “Polo.” “Marco, Marco, Marco,” cries one kid, and the others reply: “Polo. Polo. Polo.” Writing is like that for me, like I’m typing “Marco, Marco, Marco” for years, and then finally the work is finished and someone reads it and says, “Polo.”

So how can I live in a world where Henry and his family are told that? How can I accept a world where over a million people will die this year for want of a cure that has existed for nearly a century?

A child born in Sierra Leone is over one hundred times as likely to die of tuberculosis than a child born in the United States.

“How many would die if everyone could access good healthcare?” he asked me, as if he seemed confused by my question. “Yes,” I said. “None. Zero. Zero people should die of TB.”

A preventable, curable infectious disease remains our deadliest. That’s the world we are currently choosing.

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.

To my brother, Hank, who told me not to let his cancer get in the way of my tuberculosis activism: I love you so much. What a privilege it is to be the tail to your extraordinary comet.

To understand the sanatorium age, I recommend two memoirs: The Baby’s Cross: A Tuberculosis Survivor’s Memoir by C. Gale Perkins, which is quoted here extensively,