Book Review: ‘Everything Is Tuberculosis,’ by John Green

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Tuberculosis (TB) remains the deadliest infectious disease worldwide, claiming over a million lives annually. Millions more would succumb were it not for a delicate global system dedicated to its detection and treatment in developing nations. This vital system, often bolstered by United States funding, has been significantly strained by the Trump administration's recent foreign aid reductions.

These cuts have already left hundreds of thousands of people globally without access to essential TB tests and treatments. The U.S. Agency for International Development, facing dismantling under the Trump administration, projected alarming consequences: a potential 30 percent increase in global TB cases and an influx of patients with drug-resistant strains into the United States. It is against this critical backdrop that John Green’s new book, “Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection,” becomes incredibly timely, serving as a powerful plea to readers to engage with a disease that may not directly impact their lives.

About the Author and His Approach

John Green is widely recognized for his best-selling young adult novels, such as “The Fault in Our Stars,” a poignant story about teenage cancer patients. “Everything Is Tuberculosis” marks his second nonfiction work, following his successful career as a video blogger. Alongside his brother Hank Green, he has cultivated a substantial and dedicated following of altruistic fans known as “Nerdfighters.”

Green appears to have this broad, engaged audience in mind with his expansive and accessible writing style in “Everything Is Tuberculosis.” With earnestness and empathy, he chronicles the disease’s narrative, often reminiscent of his educational YouTube video series. He describes his deep immersion in the subject, viewing TB as a profound lens into "the folly and brilliance and cruelty and compassion of humans," a sentiment reflected in the book's title. As Green himself writes, "My wife, Sarah, often jokes that in my mind everything is about tuberculosis, and tuberculosis is about everything.”

The Human Face of Tuberculosis: Henry Reider's Story

Green’s interest in TB ignited in 2019, a few years after his involvement in other global health advocacy. During a tour of a hospital in Sierra Leone, he met Henry Reider, a vibrant 17-year-old emaciated by drug-resistant TB. Their long-distance friendship blossomed after Green returned to Indianapolis, providing a central narrative for his book.

Reider’s story powerfully illustrates why tuberculosis remains so intractable in many impoverished countries. Malnutrition in childhood, a consequence of war in Sierra Leone, left him more susceptible to the disease. Despite starting standard treatment that should have cured him, his father, distrustful of the healthcare system, halted the regimen midway. Later, a cocktail of highly toxic drugs proved ineffective, while bedaquiline, a safer yet expensive medication that might have offered a cure, was tragically unavailable.

Historical Context and Global Disparities

Green also meticulously traces the history of tuberculosis, a bacterial infection primarily affecting the lungs, which for centuries afflicted both rich and poor indiscriminately. He chronicles significant medical breakthroughs, particularly the advent of effective anti-TB drugs in the 1950s, which successfully brought the disease under control in wealthier nations. For instance, the United States now reports fewer than 10,000 cases annually, with nearly all successfully cured. However, Green poignantly highlights the global paradox: “the cure is where the disease is not, and the disease is where the cure is not.”

Advocacy for Global Health Funding

Green constructs a thoughtful and reasoned argument for increased funding for TB programs in poorer countries. He presents practical justifications that could sway skeptics of foreign aid, emphasizing how such investment pays for itself many times over by preventing costly infections and boosting productivity. Furthermore, he argues it could protect countries like the United States by averting the emergence of resistant superbugs that could re-ignite TB epidemics in developed nations. Beyond practicalities, Green prefers to underscore a moral obligation to value all human lives equally.

Stories of Resilience and Systemic Challenges

Among the book’s most compelling sections are the narratives of activists, such as Shreya Tripathi, a teenage TB patient in India who successfully waged a legal battle for access to bedaquiline, which had been restricted due to concerns about overuse and resistance. Another chapter details a pioneering effort by Partners in Health, a global health nonprofit where Green serves as a trustee, to demonstrate in the 1990s that drug-resistant TB could be cured in poorer countries with adequate resources.

Areas for Deeper Exploration

Despite its strengths, the book occasionally exhibits a frustrating vagueness in attributing blame for tuberculosis's persistence. While the drugmaker Johnson & Johnson, manufacturer of bedaquiline, is briefly mentioned with Green accusing it of price gouging and patent gaming (accusations the company has denied), Green more frequently points to abstract forces like “social determinants of health,” “markets,” “our economic systems,” or "choices humans made together to deny treatment to people in poor countries." This leaves the reader desiring more specific insights into who made these choices and their precise nature.

The book also prompts questions about how the trajectory of tuberculosis compares to other infectious diseases. Readers might wonder what unique aspects make TB so intractable, and what distinguished the efforts that led to the full or near eradication of other diseases. Green's intense focus on tuberculosis means these broader comparative questions receive little attention.

Enduring Relevance

Tuberculosis is an inherently challenging subject, and Green admirably introduces readers to a disease they might otherwise remain unaware of. His book feels particularly prescient given the current disruptions to global health programs initiated by the Trump administration. As Green recently remarked in a video posted on TikTok and Instagram, where he boasts millions of followers, he wishes "the U.S. government could make my new book a little less relevant.”

BOOK DETAILS:
EVERYTHING IS TUBERCULOSIS: The History and Persistence of Our Deadliest Infection
By John Green | Crash Course Books | 198 pp. | $28

REVIEWER:
Rebecca Robbins is a Times reporter covering the pharmaceutical industry. She has been reporting on health and medicine since 2015.