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.

mind everything is about tuberculosis, and tuberculosis is about everything. She’s right.

But as a friend once told me, “Nothing is so privileged as thinking history belongs to the past.”

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.

Or perhaps at a neighborhood Halloween party, I’d confront a ten-year-old dressed as a cowboy: “Did you know tuberculosis helped give us the cowboy hat?”

“The beauty of women is greatly owing to their delicacy, or weakness.” One romantic word to describe the beauty standard—delicacy—followed by a stigmatizing one—weakness.

People who are treated as less than fully human by the social order are more susceptible to tuberculosis. But it’s not because of their moral codes or choices or genetics; it’s because they are treated as less than fully human by the social order.

So why wasn’t Henry on bedaquiline? Although most of the money that went into developing bedaquiline came from the public (much of it from the U.S. government), the drug was owned and patented by Johnson & Johnson, which had a monopoly and therefore absolute control over the price. A course of bedaquiline can be produced profitably for $130,[*5] but 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.

Johnson & Johnson would later say, “It is false to suggest—as some recently have—that our patents are being used to prevent access to SIRTURO (bedaquiline), our medicine for MDR-TB.” But I would challenge them to look into Isatu’s eyes and tell her that J&J’s price gouging had nothing to do with a medicine funded primarily by the public being unavailable to the most vulnerable members of that public. In fact, many people have died waiting for bedaquiline.

“Shreya’s lungs were destroyed. Bedaquiline along with other medications was able to kill the TB germ, but nothing could be done to make the cells of her lungs healthy again: only scars remained.”

But I hear Shreya, and Henry, and so many others calling to me: Marco. Marco. Marco.

He wasn’t just falling behind his peers; he was saying goodbye to the world at the age of eighteen.

He knew it was a silly thing to think about, especially if he was dying, but he’d never had a pair of new shoes. His feet had always been in shoes already molded to someone else’s gait.

Henry had only contracted TB because of choices humans made together to deny treatment to people in poor countries.

Health inequities are caused by poverty, racism, lack of medical care, and other social forces.”

I understand this anger, this lack of trust in medicine. I understand. Maybe if it was my child, I would do the same thing.”