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.

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

Encouraged, like courage is something we rouse ourselves and others into.

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

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.

My favorite stand-up comedy routine about tuberculosis (yes, I have a favorite stand-up comedy routine about tuberculosis) begins with Naomi Ekperigin saying that the U.S. has become so troubled that “if America was a character in a movie…this would be the part in the movie where America coughs into a rag and then pulls it away and sees blood.”

Oh boy

There’s something about the candle snuffed out prematurely that captures our imagination—it is the thought, perhaps, of the books and paintings and songs that might’ve been, or the idea that artists simply burn too bright for this world.

After all, the entire premise of colonialism relied on white supremacy, and the entire premise of spes phthisica maintained that only superior and civilized (read: white) people could become consumptive. Acknowledging that consumption was common among enslaved, colonized, and marginalized people would have undermined not just a theory of disease, but also the project of colonialism itself.

TB revealed itself to be not a disease of civilization, but a disease of industrialization;

History is often imagined as a series of events, unfolding one after the other like a sequence of falling dominoes. But most human experiences are processes, not events.

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.

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. I care about TB because of Henry.

The fearmongering around superbugs can serve a purpose—it is one strategy for getting people in wealthy communities to care about TB. It may not be at your doorstep yet, but by the time it is, it’ll be too late.

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.

TB doesn’t just flow through the meandering river of injustice; TB broadens and deepens that river.

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.”

And so we must fight not just for reform within the system but also for better systems that understand human health not primarily as a market, but primarily as a shared priority for our species.

when we know about suffering, when we are proximal to it, we are capable of extraordinary generosity. We can do and be so much for each other—but only when we see one another in our full humanity, not as statistics or problems, but as people who deserve to be alive in the world.

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.

But we no longer live in that world, thanks to the accumulation and dissemination of knowledge about the illness and how to treat it. And so we have entered a strange era of human history: A preventable, curable infectious disease remains our deadliest. That’s the world we are currently choosing.

We cannot address TB only with vaccines and medications. 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.

Henry is a human being, just as you are a human being. Consider yourself for a moment—everything you’ve overcome, everything you’ve survived. Think of the people who loved you up into your now. Think of how hard school is or was, how you were lucky or blessed to meet people you could love and who could love you. Think about how rare and precious humans are, and how many of them you get to worry for and care about. Then, if you can, find a way to multiply that times 1,250,000. That is why we must work together to end tuberculosis and all other diseases of injustice.