John Green Tackles An Injustice Called Tuberculosis

John Green, acclaimed author of best-selling novels including The Fault in Our Stars, has chosen to focus his latest work on tuberculosis (TB). His new book, Everything Is Tuberculosis, is set to release on March 18th, just before World Tuberculosis Day. This decision by a prominent author to address this persistent global health issue has garnered significant attention.

As a tuberculosis researcher, Madhukar Pai expresses his deep awareness of TB's devastating impact and the millions of lives it continues to claim annually. Initially, he found himself questioning Green's motivation to tackle this ancient disease, which has historically caused immense suffering. However, an encounter with Green at a Partners in Health (PIH) event provided Pai with valuable insights into Green's passion and his emerging role as an advocate for a disease that often receives limited public focus.

Green explains his interest in disease as a literary subject, citing Virginia Woolf's observation that illness has been an underrepresented theme compared to love, battle, and jealousy. He views disease as a universal experience that has historically been responsible for a significant portion of human mortality. Green is particularly drawn to tuberculosis because he sees it as a profound disease of injustice, noting that it remains curable yet continues to kill over 1.25 million people annually, highlighting a critical failure in resource distribution systems.

Pai acknowledges Green's comprehensive historical tracing of TB and its ongoing impact. He points out that TB remains the leading infectious killer globally, with potential worsening due to cuts in humanitarian aid and global health initiatives. Green reiterates his sentiment that humanity possesses the knowledge and tools to eliminate TB but chooses not to implement them. He emphasizes that effective strategies, including widespread case detection, treatment, and preventive therapy for contacts, coupled with modern diagnostic tools and shorter treatment regimens, can halt transmission.

The conversation then touches upon personal connections to TB, with both Green and Pai sharing family histories of the disease. They contrast the lack of cures in the past with the advanced diagnostics and treatments available today, including effective oral medications for drug-resistant TB. Green stresses the need to bridge the gap between where the cure is needed and where it is accessible. This requires extending treatments to underserved rural areas and improving active case-finding efforts, treating TB with the urgency of any other pandemic, rather than dismissing it due to its disproportionate impact on marginalized populations.

Green's advocacy extends beyond writing, as he actively works to improve access to essential TB tools. He has collaborated with advocacy groups and the Nerdfighteria community to lower the cost of rapid molecular tests and increase the accessibility of the drug bedaquiline. He cites the tragic case of Shreya Tripathi, a young woman from India who died while fighting for access to bedaquiline, as a potent motivator for his commitment to translating his words into concrete action and addressing the injustices in healthcare access.

The influence of the late Dr. Paul Farmer on Green's perspective is profound, particularly concerning the potential for quality TB care in resource-limited settings and the broader pursuit of global health equity. Farmer inspired Green and many others to envision greater possibilities and to understand that diseases of injustice are often rooted in human-created systems that can, in turn, be reformed. Green draws a crucial lesson from Farmer: that these diseases are not merely biological but are products of societal structures that can be reimagined and improved.

In discussing the current era of multifaceted global challenges, Green expresses optimism, viewing hope as a rational response to human consciousness. While acknowledging the discouraging nature of contemporary crises, he refuses to succumb to despair. He points to the significant reduction in child mortality as a testament to collective human effort and the power of working together to build and maintain better healthcare systems. These collective achievements, he notes, offer a powerful source of hope for addressing present and future challenges.

Pai concludes by expressing gratitude to Green for his vital global health work, philanthropy, and dedication to making the world a better place. He believes Green is revitalizing advocacy for TB and global health at a critical time, likening him to an "antidote to despair," a sentiment he attributes to Dr. Paul Farmer.