The Invisible Killer
Tuberculosis remains the deadliest infectious disease, claiming 1.25 million lives in 2023 alone, surpassing malaria, typhoid, and war combined.
TB is both a form and expression of injustice.
Everything Is Tuberculosis
"TB in the twenty-first century is not really caused by a bacteria that we know how to kill. TB in the twenty-first century is really caused by those social determinants of health, which at their core are about human-built systems for extracting and allocating resources."
As a longtime fan of John Green's poignant storytelling, I was captivated by his latest non-fiction work, Everything Is Tuberculosis. This isn’t just a book about a disease; it’s a profound narrative weaving personal stories with historical insights, exposing the deep-rooted injustices that sustain tuberculosis (TB) in our modern world. Green, known for his emotionally charged novels, turns his empathetic lens to a global health crisis that kills over a million people annually despite being curable since the 1950s. Through the eyes of patients like Gregory, Stokes, and Henry, Green unveils the stark disparities in healthcare access and the systemic failures that perpetuate this silent epidemic.
Historical Shadows
From 19th-century slums to modern conflict zones, TB thrives in conditions of poverty and neglect, a disease tied to industrialization and inequality.
The paradox of modernity—progress alongside pestilence—remains a central theme in the story of TB.
Personal Battles
Stories of patients like Henry in Sierra Leone highlight the human toll—stigma, isolation, and the fight for treatment in under-resourced settings.
To them, I am not a person.
Systemic Failures
Despite a cure existing for decades, access remains uneven, with millions dying where infrastructure and resources are scarce.
The cure existed, yet for millions, it remained out of reach, a cruel irony that defines the modern TB crisis.
Hope and Resistance
Innovations and activism offer glimmers of hope, from new drugs to advocacy for affordable treatment, pushing against systemic barriers.
When treatment works, it feels like magic.
The Invisible Killer
Unveiling the Silent Epidemic
Tuberculosis, as John Green starkly illustrates, is not a relic of the past but a persistent killer, taking 1.25 million lives in 2023. This staggering number—more than malaria, typhoid, and war combined—reveals a crisis often invisible in wealthy nations. Green's introduction of Gregory and Stokes, two young men battling TB in a Siberian hospital, sets the tone for a narrative that’s as much about numbers as it is about faces.
TB Mortality in 2023
Key Insight with Emphasis
TB is both a form and expression of injustice. This powerful statement encapsulates Green’s argument that TB isn’t merely a medical issue but a social one, thriving on poverty and systemic neglect. His data-driven approach, paired with personal anecdotes, makes the scale of this injustice palpable.
Deeper Reflections
Green doesn’t shy away from the grim reality: over a billion deaths in the last two centuries, and even now, a curable disease continues to ravage communities where resources are scarce. His exploration isn’t just statistical; it’s deeply human, focusing on the lived experiences of those like Gregory, whose stories mirror millions. This section of the book forces us to confront why we’ve allowed 150 million to die post-cure discovery, a question that lingers long after the page is turned.
Historical Shadows
Tracing TB Through Time
Green masterfully traces TB’s history, linking it to industrialization and societal shifts. From the 19th-century slums of Europe, where railroads symbolized progress yet spread contagion, to war-torn Sierra Leone, TB has always exploited human vulnerabilities. Green’s narrative shows how crowded urban conditions and conflict create perfect breeding grounds for the disease.
Industrial Revolution
Railroads expanded, connecting cities but also spreading TB through crowded slums and urban poverty.
19th Century
Sierra Leone Civil War
War displaced families, crowded them into camps, and severed access to care, fueling TB’s spread.
1991-2002
Modern Era
Despite cures, TB remains deadly in under-resourced regions, a legacy of historical inequities.
2023
Key Insight with Emphasis
The paradox of modernity—progress alongside pestilence—remains a central theme in the story of TB. Green’s poignant observation highlights how advancements often come at a cost, with TB as a brutal reminder of inequality baked into progress.
Deeper Reflections
This historical lens is not just a backdrop but a critical framework for understanding TB today. Green connects the romanticization of TB as a “poet’s malady” in the 19th century to modern stigmas, showing how cultural narratives shape health responses. His detailed accounts of how wealth couldn’t shield the rich from infection—but could buy them time—mirror today’s disparities where geography often dictates survival. It’s a chilling reminder that history isn’t past; it’s present in every untreated case.
Personal Battles
Human Stories at the Heart
Green’s storytelling shines brightest when he centers individuals like Henry, a young patient in Sierra Leone whose battle with TB is both heartbreaking and inspiring. Through Henry’s eyes, we see the physical toll of the disease—emaciation, isolation in hospital wards resembling prison cells—and the emotional weight of stigma and abandonment.
Key Insight with Emphasis
To them, I am not a person. This haunting quote from a TB survivor captures the dehumanization faced by patients, often shunned as contaminants rather than humans needing care. Green uses this to underscore the social pathogen of stigma, as deadly as the bacillus itself.
Deeper Reflections
Henry’s story, woven throughout the book, isn’t just a case study; it’s a call to empathy. Green details the hunger that drives patients to abandon treatment, the lack of food funding in hospitals, and the shame that isolates them from families. These personal battles reveal the intersection of TB with domestic struggles, poverty, and societal neglect, making every statistic a story of real pain and resilience. It’s impossible not to feel the weight of Henry’s hope and despair as Green narrates his journey.
Systemic Failures
The Cure That Isn’t
Perhaps the most infuriating revelation in Green’s work is the existence of a cure since the 1950s, yet its inaccessibility for millions. In places like rural Sierra Leone, clinics lack drugs, staff, and infrastructure, forcing patients to choose between medicine and food. Green exposes these structural failures with raw clarity, showing how TB persists not due to a lack of science, but a lack of will.
Key Insight with Emphasis
The cure existed, yet for millions, it remained out of reach, a cruel irony that defines the modern TB crisis. This statement cuts deep, highlighting the gap between medical possibility and practical reality—a gap filled with systemic inequity.
Deeper Reflections
Green’s critique of global health systems is unflinching. He discusses initiatives like DOTS (Directly Observed Therapy Short-course), which saved millions but also stigmatized patients and failed to address drug-resistant strains. His examination of cost-effectiveness as a barrier—where life-saving drugs like bedaquiline are priced out of reach—reveals a market-driven health landscape that prioritizes profit over lives. This section is a powerful indictment of how we’ve chosen not to live in a world without TB, despite knowing how.
Hope and Resistance
Small Victories, Big Fights
Amid the bleakness, Green offers glimmers of hope through stories of innovation and activism. From Henry’s recovery—described as “magic” when treatment finally works—to advocacy by survivors like Phumeza Tisile, who fought to lower drug prices, this section showcases resistance against systemic odds.
Key Insight with Emphasis
When treatment works, it feels like magic. This beautiful reflection captures the rare triumph of recovery, a fleeting moment against a backdrop of failure, yet a reminder of what’s possible with equity and effort.
Deeper Reflections
Green celebrates virtuous cycles—where health, education, and economic stability reinforce each other—as seen in community programs reducing transmission. He details the drop in bedaquiline’s price after activist efforts, a 60% reduction making treatment accessible to more. Yet, he tempers this optimism with reality: magic doesn’t scale without infrastructure. His call to action is clear—support research, reform systems, and prioritize the marginalized. This section left me inspired yet acutely aware of the work ahead to ensure no one dies of a curable disease.