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

by John Green

during their monopoly Johnson & Johnson charged much more than that for a course of bedaquiline, making the drug far out of reach for the Sierra Leonean Ministry of Health. As a result, bedaquiline wasn’t available to Henry, so he received the injectables.

When did the monopoly become regulated?

But implementing this comprehensive approach to fighting tuberculosis brought down rates of TB in Bethel by 69 percent in a single year.

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.

crisis. For billions of people, the superbug era is here: Tuberculosis is a powerful bacterial infection that billions of people lack any effective tools to fight, not because those tools don’t exist, but because we’ve done such a poor job of getting the cure to the disease.

when an incurable illness spreads widely among the rich and powerful, we dramatically increase our investments in tools to treat and prevent that disease.

If TB became a problem in the rich world, attention and resources would rain down upon the illness until it ceased to be a problem for the rich, powerful, and able-bodied.

We see here that the racist dehumanization of African people is not only part of nineteenth and twentieth century history. Racism continues to distort our policies and practices. And just as with previous examples of racism, it proved to be totally false. In point of fact, a 2007 study found that Africans were more likely to adhere to HIV/AIDS treatment regimens than North Americans.

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. This difference, as Dr. Joia Mukherjee writes, is “not caused by genetics, biology, or culture. Health inequities are caused by poverty, racism, lack of medical care, and other social forces.”

His illness was a product of Sierra Leone’s centuries-long impoverishment, of a healthcare system hollowed out by colonization and war and Ebola, of a world that stopped caring about TB when it ceased to be a threat to the rich.

We live in between what we choose and what is chosen for us.

patent challenge in an Indian court asking the government to reject efforts by the pharmaceutical company Johnson & Johnson to extend their patent on the drug bedaquiline.

As we’ve seen, bedaquiline is a powerful medicine in the fight against MDR-TB, but since its first release in 2013, it was far out of reach for most people living with the disease, because J&J charged $900 for a single course of treatment in poor countries and $3,000 in middle-income countries like South Africa. And so most kids like Phumeza with drug-resistant tuberculosis could never receive appropriate treatment—not because it was unavailable, but because it wasn’t “cost-effective.”

“Education is the most important thing,” he told me once. “Not just for me, you know, but also for the nation.”

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.

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.

That choice would require sacrifices, as most choices do. We would need to reform our systems to include the impoverished as well as the rich, offering what Catholic liberation theologians called “a preferential option for the poor.” We would need to improve not just healthcare systems but also the social determinants of health—access to safe housing and adequate nutrition and reliable public transportation and so on. But this can be done—and in fact it has been done, which is why TB death is already rare in much of the rich world, although not as rare as it would be if everyone in rich countries could access good healthcare.

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.

transmission. If we spent twenty-five billion dollars on comprehensive care per year, we could drive tuberculosis toward elimination. We’d also save a lot of money in the long run—over forty dollars for each of those twenty-five billion dollars. Cutting the overall burden of TB means fewer future cases, and less expense to care for them.

But that is not the only possible future. One can also imagine tuberculosis continuing to kill over a million people every year for another century, or another ten centuries. And yes, one can even imagine that if we continue to neglect research and treatment, someday soon a strain of tuberculosis could emerge that storms the world as the disease has so many times in the past, and we return to the days when tuberculosis kills the rich and poor alike, even if never equitably.

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.