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

by John Green

Just in the last two centuries, tuberculosis caused over a billion human deaths. One estimate, from Frank Ryan’s Tuberculosis: The Greatest Story Never Told, maintains that TB has killed around one in seven people who’ve ever lived. Covid-19 displaced tuberculosis as the world’s deadliest infectious disease from 2020 through 2022, but in 2023, TB regained the status it has held for most of what we know of human history. Killing 1,250,000 people, TB once again became our deadliest infection. 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.

Some classical thinkers did even approach a germ theory of disease long before microscopy could confirm it. Around a thousand years ago, the Persian scholar and poet Ibn Sina wrote that tuberculosis and other illnesses were caused when the body was “contaminated by tainted foreign organisms that are not visible by naked eye.”

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.” The crowd erupts, because even now, when most Americans know very little about TB, they still know about the blood in the rag.

We see the profound shift from an inherited disease of intellect to a contracted disease of filth in the racialization of tuberculosis. As late as 1880, white American physicians still argued that consumption did not occur among Black Americans, who, it was claimed, lacked the intellectual superiority and calm temperament to be affected by the White Plague. But after Koch identified Mycobacterium tuberculosis in 1882, all that changed. Racialized medicine no longer maintained that high rates of consumption among white people was a sign of white superiority; instead, racialized medicine maintained that high rates of consumption among Black people was a sign of white superiority. One white doctor’s 1896 treatise asserted that African Americans were disproportionately dying of tuberculosis due to their smaller chest capacity and increased rate of respiration, for example.

Even when these explanations are cruel and dehumanizing, we embrace them—because tiger got to sleep, and bird got to land, and man got to tell himself he understand.

He prayed—Henry was a committed Christian. He thought of Isatu, thought of trying to live for her. But survival is not primarily an act of individual will, of course. It’s an act of collective will. Henry had only contracted TB because of choices humans made together to deny treatment to people in poor countries. 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.”

I often think of these interdependent systems in the context of my own healthcare. Not long ago, I was walking in the backyard, staring up at the night sky, when I happened to step on a nail that went right through my shoe and an inch into my foot. The next morning, I drove on a good road to a clinic a few minutes from my house, where I received a booster shot to eliminate the already small chance that my mishap with the nail might result in tetanus. But in order for this minor medical intervention to occur, so many systems had to work in my favor: I needed healthcare access, of course—in my case, a health insurance program that pays for basic preventative care like vaccines. I needed to live in a community with twenty-four-hour electricity, so that the tetanus shot could remain cold and not lose its efficacy. I needed a system that could efficiently and reliably transport not just the shot itself, but also the gloves worn by the nurse who did my injection. I needed to live in a community with an education system strong enough to train nurses and doctors. 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.