Review: Vivien Horler

Everything is Tuberculosis – A history and persistence of our deadliest infection, by John Green (Ebury Press)

Around 1940 or 1941 my Aunty Thelma contracted tuberculosis. It was in the early days of World War 2, and she worked for a company that had been making compressors for the mining industry before pivoting to munitions as many British manufacturing companies did.

She was not quite 20, and having a lovely war. She was engaged to a man who drove a sports car, she had a flashy diamond ring, and according to her younger sister – my mum – was partying till late and then going straight on to work in the shell shop.

They made explosive shells in the shell shop, which was housed in an old, damp building, and she got sick.

This was more than a decade before streptomycin became available as a cure for TB, and so she was treated, as people in the UK were in those days, in a sanatorium in a place called Tehidy in Cornwall.

The ward she was in had a roof and three walls, with the fourth side open to the elements all year round. In winter they would watch snowflakes drifting on to their beds, she told me (although in truth it doesn’t snow much in Cornwall).

The patients in the ward somehow adopted a kitten, which they fed from their own plates, until it too started coughing, and was removed.

Thelma was there, bedridden, for two full years. Her engagement didn’t survive – but she did. The experience changed her life (although she always loved a party).

Millions of families around the world have TB stories, but in Europe and America they have almost disappeared. In Africa and Asian countries, not so much.

Best-selling American author and health activist John Green wrote the young adult novel The Fault in our Stars which Wikipedia describes as “one of the best-selling novels of all time”. In 2014 Time magazine included Green in its list of the 100 most influential people in the world.

This, he says, has given him a “loud, but somewhat fickle megaphone”, and these days he is using his megaphone to fight the cause of TB.

In 2019 Green and his wife Sarah visited Sierra Leone which, at the time, had the highest maternal mortality rate in the world. On their last day in the country a doctor they were travelling with persuaded the couple to join him on a visit to Lakka Government Hospital, which was supported by the global health NGO Partners in Health.

There he met a boy, Henry Reider, whom he took to be about nine and the son of a hospital worker. Henry gave Green a tour of the hospital, and Green was charmed by the boy’s enthusiasm. When he asked him how he was, Henry replied: “I am happy sir. I am encouraged.”

Later that day Green discovered Henry was 17, spindly because of malnutrition, and a TB patient. A doctor told Green Henry was on antibiotics, but the medications weren’t working well enough. “We are almost certain they will fail, and that is a big problem.”

It can take just one kid to turn a man into a TB activist. Green is now on the board of trustees for Partners in Health and spoke at the UN High-Level Meeting on the Fight to End Tuberculosis. He has also written this book.

It’s a history of TB but also a withering criticism of big pharma and how companies fight to introduce secondary patents when their first patents are about to expire, ensuring further profits despite the fact that millions of people in deprived countries are dying for lack of drugs that will work.

And there is a cure, despite the more recent complications of drug-resistant TB and multiple-drug-resistant TB. Green writes: “And so we have entered a strange era of human history: a preventable curable infectious disease remains our deadliest.”

It really is: 1.25million people around the world die of TB every year, according to Green. He quotes the unimaginable figure of 150 million people who have died of TB since streptomycin was discovered in the 1950s.

Today, Green maintains, the root cause of TB is injustice. When people can eat, and access health care, and be treated humanely, TB has no chance.

Everything is Tuberculosis was published in both the US and the UK last year, but oddly does not refer to the Trump government’s slashing of health aid budgets in Africa and elsewhere. Maybe this happened after the book went to the publishers, or maybe he is being careful.

In South Africa, according to the national Health Department, our country is on three lists of countries with high burdens of TB, and in 2023 an estimated 270 000 people developed the disease, and 56 000 people died.

In 2000, a Ugandan physician Dr Peter Mugyenyi spoke about the rich world’s refusal to expand access to HIV/AIDS drugs. He said: “Where are the drugs? The drugs are where the disease is not. And where is the disease? The disease is where the drugs are not.”

So it is with TB, says Green, because the cure is where the disease is not, and the disease is where the cure is not.