TB Persists as Deadly Disease Because We Allow It

 

My copy of John Green's latest.

The author John Green has a nifty tradition—when he has a new book coming out, he gets a bunch of paper and signs his name to thousands of sheets, which then go into the first edition of the book.

Thus, my copy of “Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection” has “signed edition” on the cover and a Sharpie Scrawled “John” on a page before the title page.

I have a J name, too, but not such a great J as John.

I recently read the book. I recommend it. But be prepared for some frustration.

Not with John, whose prose is breezy and readable, but with what he recounts. I’m not surprised that our deadliest infectious disease attacks our lungs—as the recent COVID-19 pandemic and previous flu pandemics show, our bodily oxygen interface is a vulnerable system in our anatomy.

So, why did I feel frustration? As Green reports, in 2023, more than a million people died from tuberculosis, “more than died from malaria, typhoid and war combined.”

We only have ourselves to blame for wars—they are not an inevitable part of nature that is imposed on us.

Tuberculosis, on the other hand, is natural, and it is also curable and has been for many decades. We found out how to cure this stubborn bacterial infection in the 1950s, yet it still harvests more souls than any other other human disease. Why?

“The cure is where the disease is not, and the disease is where the cure is not,” Green writes. That reality, made worse this year as America pulls back from life-saving foreign aid efforts, is a result of poor human decisions.

Anyway, one interesting aspect of Green’s book is the history of tuberculosis—how it was framed and what it meant. TB was a bit romanticized before we understood what the disease actually was. It caused sufferers to waste away, and was conflated with some rather messed up feminine body ideals—if the cultural aspiration is that women should be pale and thin, as it has been in some Western cultures, a disease that slowly causes its poor sufferers to waste away (it was once called “consumption” because the disease consumes the body) has some chic, some cool factor, in a sick (literal and figurative) way.

It was even at times associated with intelligence and education—and for many White “experts” back in the day, there was suspicion that Black people could not get TB. It was an upper class disease, or so they thought when diseases overall were way more common and hard to diagnose.

Then, as the 19th century faded in to the 20th, it became known that TB was caused by a specific germ, a bacterium. It was not genetic; it was not from character or intelligence—it was aided by crowding and filthy living conditions. Very quickly, TB went from being “cool” to being associated with the lower orders.

Finally, hooray, in the post WWII world, antibiotics knocked tuberculosis down and made it rare—in places. In others, where drugs are less available and more expensive, where modern health care does not exist—TB never went away.

Thus, we meet a young African who represents the reality of the disease. The book returns often to the narrative of a man who was a boy when Green first met him in Sierra Leone—Henry. Henry had TB, and was treated, on and off (for various reasons, medical treatment in west Africa is often on and off) over years. His case was drug resistant, and his life was endangered for years in slow, painful ways.

Luckily, Henry’s story did not end in one of the millions of deaths that TB causes each year. He eventually got effective treatment. For once, the cure and the disease were in the same place.

Yet, too often they are not. I do not think it is a spoiler to quote the very end of Green’s book, since early in the book the reader already understands the idea Green is stating is central to this text:

“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.”

We must be. We are not, yet. These days, our ability to think well of collective needs has ebbed badly. May the tide of human compassion and knowledge rise soon. If it does, Green’s book may be part of that tide. So, I encourage you to read this book. It will frustrate you, but it’s an important piece of writing.