'We have to fight for a better end': Author John Green on how threats to USAID derail the worldwide effort to end tuberculosis

Did you know that tuberculosis (TB) brought us the Adirondack chair? TB patients used to recline, completely immobile, upon that now-iconic piece of furniture on the orders of their doctors. TB also brought about the cities of Pasadena, California, and Colorado Springs, Colorado, which were founded as places for TB patients to seek fresh air. And did you know that before penning "Sherlock Holmes," Sir Arthur Conan Doyle debunked a supposed cure for TB that had been overhyped in the press in the 19th century?

In "Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection" (Crash Course Books, 2025), John Green recounts these unsung ways in which TB shaped history. He also highlights how public perception of the disease has shifted through time. TB was once seen as a romantic condition that rendered people with the illness "beautiful," "waiflike" and "sensitive," but the illness later became seen as a stigmatizing disease of poverty.

And while we now have a cure for TB, "the disease is where the cure is not," Green notes, paraphrasing a Ugandan doctor who said the same about HIV/AIDS treatments. Annually, there are more than 10 million cases of TB and 1 million TB deaths worldwide, and most of these cases and fatalities occur in low- and middle-income countries.

Green is one-half of the vlogbrothers on YouTube, co-creator of the educational series Crash Course, and author of the bestselling books "The Fault in Our Stars" (Penguin Books, 2012) and "The Anthropocene Reviewed" (E. P. Dutton, 2021), among others. Live Science spoke with him about his latest book, its featured subject, TB survivor Henry Reider, and the uncertain future of efforts to end TB worldwide.

Nicoletta Lanese: In the book, you say that you initially thought of TB as a disease of the past — of "19th-century poets." How was it to have that idea dispelled through writing the book?

John Green: If you'd asked me in 2018, "What are the biggest infectious health problems facing the world," I would have said, "I don't know, malaria, HIV, typhoid, cholera." I would have been so far down the list before I said tuberculosis, even though it turns out tuberculosis is the deadliest infectious disease in the world and sickens over 10 million people every year.

To some extent, that's been a throughline throughout history — when Robert Koch was declaring that he'd discovered that TB was infectious, he almost seemed defensive. He said, "I know we're more afraid of cholera and plague, but actually tuberculosis is a much bigger deal."

I just had no idea that tuberculosis was a crisis until I visited a TB hospital in Sierra Leone in 2019. … [There] I met a young boy named Henry Reider, and that kind of changed the course of my life.

NL: Henry is a big focus of the book. For those who haven't read it yet, could you share a bit about him?

JG: Henry and I met at that hospital in Sierra Leone, and when we arrived, he just grabbed me by the T-shirt and started walking me around the hospital. He seemed to be about the same age as my son, who was 9 at the time, and he also shares a name with my son. They [now] call each other "the namesakes."

He walked me all around the hospital, showed me the lab, showed me the wards where patients were staying. I was really astonished by how many people were sick and how sick they were. And we finally made our way back to where the doctors were, and they sort of shooed Henry away and I said, "Whose kid is that?" And they said, "He's a patient, and he's one of the patients we're most concerned about."

It turns out, he wasn't 9. He was 17 — just he'd been stunted by malnutrition and by TB.

He and I have become really good friends and through the process of reporting this — like, I'm not a good reporter. I don't know how to have a distance between the reporter and the subject, as I try to acknowledge in the book. He inspired the book in many ways because I think if I hadn't met Henry that day, I probably wouldn't have become obsessed with tuberculosis.

NL: And how is Henry doing now?

JG: He's very excited about the book. He's a junior at the University of Sierra Leone, Sierra Leone's best university, and he's studying human resources and management and doing really, really well.

However, it is also true that like so many people whose lives are marginalized, his life is made much more fragile by the recent cuts to USAID, and his life is made much more challenging by the recent cuts to USAID. That's been a constant topic of conversation between him and me over the last few weeks.

Related: 'It is a dangerous strategy, and one for which we all may pay dearly': Dismantling USAID leaves the US more exposed to pandemics than ever

[Although Henry has now been cured of TB], Henry also has other health problems, and he has some long-term consequences from having lived with such serious tuberculosis. Like a lot of people, he depends upon USAID-funded medication in order to survive, and that funding has been canceled.

He and I had a conversation recently where I said, "Look, you know, we'll make sure that you and your mom have access to the medication that you need." And he said, "Thank you, but what about everyone else?"

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NL: From your description of him, that seems like a question he would ask.

JG: Yeah, he's an extraordinarily empathetic person. He's a poet. He has what used to be called spes phthisica [meaning "consumptive spirit"], the "tubercular personality." We used to think that people who had this tuberculous personality tended to be sensitive and alive to the suffering in the world and generous and beautiful and lots of other romantic ideals.

NL: In the book, you explore how the perception of TB has changed through time, starting with that romantic, idealized vision of the disease. Could you sum up what you learned?

JG: It's almost like they're two different diseases. It's almost like the disease of consumption [a past name for TB] is different from the disease of tuberculosis. Because at least in Northern Europe and the U.S., consumption was an inherited disease that was associated with being beautiful and having certain personality traits that were desirable. Tuberculosis is seen as a disease of poverty, a disease of filth, a disease of infection. They're very different diseases in the way they're imagined, even though they have the same cause and the same course.

You see this all over the history of tuberculosis, but I think you especially see it in the way the disease was racialized. It was widely believed in the 18th and 19th centuries that only white people could get tuberculosis. And then in the 20th and 21st centuries, it was believed white people were insulated from tuberculosis in some ways and that it's a disease primarily of people of color.

The way that I think about it sometimes is that Charles Dickens wrote that tuberculosis was the "disease that wealth never warded off," and, of course, now it's a disease that wealth entirely wards off.

NL: We've touched on this already, but could you expand on how USAID factors into TB efforts worldwide and what it means for that funding to be disrupted?

JG: We did have ongoing projects I would have liked to highlight. I would have liked to highlight our work in the Philippines with USAID to bring TB down to zero in specific communities to offer a blueprint for how we eliminate TB from the planet. [Beyond our own work], I'd like to highlight the work that has been done to reduce TB death by over 50% in the last 25 years. I'd like to highlight the efforts that are being made by the U.S. government and others to radically reduce the burden of tuberculosis in the most impoverished countries in the world. But we've just abandoned all of those.

The project that we've been working on in the Philippines with Partners In Health and USAID and the Philippine government will continue in some way, thanks to the generosity of the Philippine government. But it won't accomplish its biggest dreams, and that's entirely because of the decision to stop funding essentially all global health services.

I'm confused as to how all of this is happening, but I'm just also heartbroken. I'm hearing every day from people who are having to make horrible decisions about how to ration care.

Related: 10 of the deadliest superbugs that scientists are worried about

NL: And in tuberculosis, continuity of care is very important.

JG: Continuity of care is essential for curing tuberculosis. If someone has even a couple of weeks without access to their medication, it's vastly more likely that their disease will become drug resistant, which is a personal catastrophe because it means that they are much more likely to die of tuberculosis. It's also a societal catastrophe because it means there's much more drug-resistant tuberculosis floating around, having the opportunity to evolve ever more drug resistance.

I think it's important to understand that we've never done anything like this before; we've never suddenly interrupted the treatment of thousands or tens of thousands or hundreds hundreds of thousands. We don't even know how many people's treatment is being interrupted right now because we have no way to count it. … What we're doing to the future of tuberculosis is unconscionable to me.

NL: In a moment when the situation feels so bleak, is there anything bringing you hope?

JG: It's inevitable for me to feel like I live at the end of history because today is the most recent day I've ever experienced, you know, and so this feels like the culmination of everything that came before, but I don't live at the end of history. I live in the middle of history, and this is not the end of the story; this is the middle of the story, and we have to fight for a better end.

That's what gives me hope, and working with people I love. In this work, you get to work with people you care about and whose love and attention is focused in the same direction as yours, and there's a lot of comfort in that for me.

Editor's note: This interview was conducted on Feb. 28, 2025, so it may not reflect recent developments with USAID. The transcript has been lightly edited for length and clarity.

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Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection

In "Everything Is Tuberculosis," John Green tells the story of Henry Reider, a tuberculosis patient he met at Lakka Government Hospital in Sierra Leone. Throughout the book, he interweaves Henry's story with scientific and social histories of how tuberculosis has shaped our world — and how our choices will shape the future of tuberculosis.

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