We Have the Cure. Why is Tuberculosis Still Around?

Tuberculosis – the world’s deadliest infectious disease – could be dormant in your system for years before you realize you have it. In the U. S., it’s relatively rare; provisional data https://www.cdc.gov/tb-data/2024-provisional/index.html shows that there were just over 10,000 cases in 2024. But in other parts of the world, especially lower-income countries, the disease is spreading much more actively. Worldwide, more than 10 million people are diagnosed with an active tuberculosis infection every year. And even though modern medicine has all the tools to cure it, over a million people around the world still die from the sickness annually. Author John Green https://www.johngreenbooks.com/ thinks that’s a problem. In his book Everything is Tuberculosis, he charts the spread of tuberculosis in the past to the lessons it has to teach us in the present. Interested in more science and medical history? Email us your question at [email protected] mailto:[email protected]. Listen to every episode of Short Wave sponsor-free and support our work at NPR by signing up for Short Wave+ at plus.npr.org/shortwave http://plus.npr.org/shortwave. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

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• 0:00Speaker 00

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• 0:15Regina Barber?

  You're listening to Short Wave from NPR. Hey, Short Wavers. Regina Barber here, and our special guest today isn't a scientist.

• 0:26Speaker 02

  My name is John Green. I don't even really know what my job title is. I guess I'm a writer and YouTuber.

• 0:32Regina Barber?

  John didn't say this because he's modest, but along with his brother Hank Green, he's also supported a number of philanthropic projects, which is how he ended up at Sierra Leone a couple of years ago, a place called Laka Government Hospital.

• 0:45Speaker 02

  This little kid grabbed me by the T-shirt and started walking me around the hospital. He had the same name as my son, Henry, and he looked to be about the same age, about nine years old. He walked me all through the hospital, took me to the kitchen where people were making food, took me to the lab where people were looking through microscopes, looking for evidence of tuberculosis infection.

• 1:04Regina Barber?

  Tuberculosis, or TB, is a bacterial infection that spreads through the air when someone with an active lung infection coughs or sneezes or spits. And TB can stay dormant in a human body for a long time.

• 1:17Speaker 02

  And then finally, we made our way back to the doctors where we'd started, and they kind of shooed him away lovingly. And I said, is that one of your kids? And they said, no, he's a patient. Turned out he wasn't nine years old like I had imagined. He was 17. He'd just been so emaciated by malnutrition and then by TB that he looked much younger.

• 1:40Regina Barber?

  This disease is as old as humanity itself, maybe older. It's one that, to be honest, many think was a relic of history. But the reality John saw in Laka Hospital is that tuberculosis is still around, and it can be deadly.

• 1:56Speaker 02

  Between a quarter and a third of all living humans have been infected with tuberculosis. It's just that for most of us, the tuberculosis infection is latent. But for reasons we don't fully understand, sometimes the infection becomes active. The white blood cells can no longer control these slowly growing bacteria, and then slowly over time, people become very sick.

• 2:20Regina Barber?

  When it was finally discovered what caused tuberculosis in the 1880s, 1 in 7 people in the US and Europe died due to the disease. There are still more than 10 million people diagnosed with an active TB infection every year. But the majority of those cases are in lower-income countries, where the lifesaving medical treatment is just too costly. The spread of TB is about resources and who has them. And so even though modern medicine now has all the tools to cure it, over a million people annually still die from the sickness. In his book, Everything is Tuberculosis, John traces the history of the disease to the present day, exploring how the world's deadliest infection has shaped the course of humanity.

• 3:05Speaker 02

  Tuberculosis had a part in everything from fashion, to history, to geography, to literature, to-- I mean, the Beatles wouldn't exist without tuberculosis because Ringo Starr learned how to drum in a tuberculosis sanatorium.

• 3:22Regina Barber?

  So today on the show, we're learning more about the past and the future of tuberculosis, the scientific discoveries that made curing it possible, and what we still need to do to eradicate it completely. You're listening to Short Wave, the science podcast from NPR.

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• 4:48Regina Barber?

  Okay, let's start with some history. The illness we know now to be tuberculosis had a lot of names over the history. Consumption, I cannot say, is it?

• 4:56Speaker 02

  Thysus.

• 4:57Regina Barber?

  How do you say it?

• 4:58Speaker 02

  Thysus, like the P is silent.

• 5:00Regina Barber?

  Thysus, okay. When does it show up first in human records?

• 5:04Speaker 02

  So we have archaeological records of tuberculosis from ancient Egypt. We know that at least one mummy died of consumption. We can see evidence of it in their bones. We have evidence of tuberculosis-like illnesses that are genetic evidence that go back much, much further than that, though. And then we start to see it show up in the written record in ancient China, where people often talked about tuberculosis. And in all these cases, interestingly, it was seen as the ultimate disease that you couldn't cure. It was always seen as a disease that was almost impossible to treat effectively.

• 5:40Regina Barber?

  Right, right, for thousands of years, until the late 1800s, when there's this big scientific advancement, and then the focus becomes like, how do we find a cure? Can we make a vaccine? What was that advancement?

• 5:54Speaker 02

  So in 1882, Robert Koch, the great German physician, discovered that tuberculosis was definitely caused by a bacteria. He isolated the bacteria. He could point to it. He could tell people about it. This was huge news. It was such big news that they printed like a special supplement of the British Medical Journal. Robert Koch had more recently announced that he not only had he discovered what caused tuberculosis, he discovered a cure, which he called Tuberculin, which was like sort of material taken from within patients who had tuberculosis, and it caused an immune response, much like the early vaccines for anthrax or cholera did. Robert Koch was like, oh, I also have a vaccine on my hands because when I take

• 6:36Speaker 02

  this tuberculin, or I give it to my mistress, or I give it to my two assistants, we all get sick. And that's what was seen as definite evidence for the fact that this must be a vaccine. But also Koch went even further and said, not only does this prevent TB, it cures TB in patients who have it because it causes all their tubercular tissue to like slough off or whatever. And this small town doctor, living in the south of England, Arthur Conan Doyle, saw this.

• 7:07Regina Barber?

  And he's a physician, I think we need to say.

• 7:09Speaker 02

  Yeah, oh, I should say that he was a physician. So Arthur Conan Doyle is today remembered as the author of Sherlock Holmes, at the time was better known for being a doctor. He hadn't even written the Sherlock Holmes stories when this is all happening. And he was so moved by reading this account of Robert Koch's discovery, that the very same day, he was like, I have to get to Germany, I have to get to Robert Koch, I have to investigate this, this is so amazing. Like, he left his practice that day.

• 7:35Regina Barber?

  So he leaves his, he leaves his doctor's practice, and he just like?

• 7:38Speaker 02

  He leaves his doctor's practice.

• 7:40Regina Barber?

  Yeah, gets in a boat.

• 7:40Speaker 02

  He goes to Germany, he knocks on Robert Koch's door, Robert Koch isn't there, the butler answers. Big bummer that Arthur Conan Doyle and Robert Koch never got to meet. Anyway, then Arthur Conan Doyle goes around and starts interviewing people because all these people have come from around the world to Berlin to try to be cured of their tuberculosis with this magical serum, tuberculin. And as Conan Doyle starts interviewing people, he slowly realizes two things. One, this is not a cure for tuberculosis. And two, this is also probably not a vaccine for tuberculosis. And he understands that people were having an immune reaction because they'd already been infected with TB. Now, today, we still

• 8:24Speaker 02

  use tuberculin, but we use it to test for TB, to test whether or not you've been exposed to the bacteria.

• 8:30Regina Barber?

  Yeah, and it's not a cure.

• 8:32Speaker 02

  It's not a cure, sadly.

• 8:33Regina Barber?

  Or, or a vaccine. So and then in the 1940s, a cure finally was found. Like, who found it? How did it work?

• 8:42Speaker 02

  So, so many people found it working together to find new, novel antibacterial compounds that we now call antibiotics. The first really significant one in the fight against TB was streptomycin, but we needed many different drugs to cure TB because it's a hard disease to cure. It's not like curing a typical bacterial infection. We're talking about months and months, even years of daily antibiotic treatment, multiple antibiotics taken in combination with each other over long periods of time in order to really be cured of the disease. Because one of the main ways antibiotics work is they work when the bacteria are dividing. And that doesn't work very well

• 9:22Speaker 02

  with tuberculosis because it divides so rarely and so slowly. And so by the late 1950s, you really could say that tuberculosis was curable. We could live in a world without tuberculosis, starting in the late 1950s. And in many parts of the rich world, we really did kind of start to.

• 9:41Regina Barber?

  And but I will say that, you know, you have this, you know, cocktail of antibiotics that can, that can cure people with TB. But then you have TB actually evolving, like many, like many bacteria do, and become strains that are drug resistant. Can you talk about those strains and how they developed and what happens when you get infected with those strains?

• 10:05Speaker 02

  Well, they began to happen very, very quickly, unfortunately. And while many cases of TB can still be effectively treated with the drugs that we developed in the 40s, 50s, and 60s, increasingly, there are strains of TB that are resistant to some of those first line antibiotics. And that was the case for my friend, Henry. That's why the doctors were so concerned about him, because he developed resistance to those first line antibiotics. And then he also developed resistance to the second line antibiotics. And as one of his doctors put it to me, that's the point where you put the stethoscope down.

• 10:44Regina Barber?

  But if Henry was living in a place like the US, you know, somewhat more wealthy, he could have had so much more access to care, right? Like, you talk extensively in your book about this idea of injustice, like how it falls along, you know, race and class lines. There's this line in your book where you ask a doctor, "If medicine was available to everyone, if money, like, wasn't an issue, how many people would die of TB?" What did he tell you?

• 11:10Speaker 02

  He said zero. He said zero people should die of TB. And that really helped me understand that this isn't only a science problem, right? Which is, as we're learning, the case for many things in science, right? Like, we think of these problems through a biomedical lens, and in some ways, that's easier than when we have to think of them through a social and societal lens. But when you have to grapple with the fact that even though medication was available that could save Henry's life, that medication wasn't available to him? Well, what does that say about the world we share? What does it say about the world we share that our deadliest infectious disease is tuberculosis, a disease I never thought about until I met him?

• 11:50Regina Barber?

  Yeah. And I think that global inequality is part of why it's easy for people nowadays, especially, like, you know, in quote-unquote wealthy countries, to think TB isn't really common, right? It's gone, it's in the past. Is that why you took so much care to, like, detail the history of TB in your book?

• 12:09Speaker 02

  Well, the history speaks to the present. It's only because of these historical forces and the way that they shaped who lives and dies of TB that someone like Henry can even become sick with TB in the 21st century. It's only because of the paths of injustice that we have blazed that TB is able to kind of find a way to continue making its way through humanity. You know, Faulkner famously said, "The past is never dead, it's not even past." And I feel that way very much about tuberculosis.

• 12:41Regina Barber?

  And TB isn't unique in that way, right? Like, there are other diseases, like malaria, cholera, typhoid.

• 12:49Regina Barber?

  And all of these could be eradicated today, but they haven't been.

• 12:52Speaker 02

  Absolutely. I wish that tuberculosis was the only disease of injustice, but it isn't. It definitely isn't. And so we know we can eliminate these diseases from these communities. We're literally choosing not to because of the way we distribute resources.

• 13:07Regina Barber?

  Yeah. And what's striking to me about reading your book is that in spite of like, how devastating TV has been and like how it affected Henry and you know, you personally, as you're writing this book, you can tell you don't get lost in that devastation. You end this book like going towards optimism and hope. Did that parallel like your journey as you were writing this book, learning about this history?

• 13:34Speaker 02

  It did. It definitely did because it's an overwhelming problem and it's a crisis. And it's incredibly frustrating that we have done so little to address this crisis in the centuries that it's been unfolding, and especially in the decades since the disease became curable. That's infuriating to me. And yet it is also true that since I graduated from college, tuberculosis deaths have dropped by 50%. We have to hold those competing ideas at the same time. Nihilism, hopelessness, despair, that's not how Robert Koch discovered the cause of tuberculosis. That's not how all those people working together discovered

• 14:14Speaker 02

  many treatments for tuberculosis. It's not hopelessness that gets us there. It's the belief that the world can be better, that we can share a better world, that we can make fairer systems, that we can include more people in our research and in our treatments and diagnostics. That's what gets us there. And so I had to go on that journey from being like, this is hopeless and horrible and reprehensible, which it is, to also feeling like there is cause for optimism, because I believe there is.

• 14:47Regina Barber?

  John, thank you so much for talking with us today.

• 14:50Speaker 02

  Oh, it's been a joy.

• 14:56Regina Barber?

  This episode was produced by Hannah Chin, edited by Brent Baughman and our showrunner Rebecca Ramirez. It was fact checked by Tyler Jones. Jimmy Keeley was the audio engineer. Beth Donovan is our interim vice president of podcasting strategy. I'm Regina Barber. Thank you for listening to Short Wave from NPR.

• 15:43Regina Barber?

  What happens to Henry?

• 15:44Speaker 02

  So he eventually got that kind of personalized tailored treatment, thanks partly to his incredible doctor, Dr. Jerome Tofara, who's absolutely one of my heroes. And also thanks to the Sierra Leonean Ministry of Health, which worked really hard with Dr. Tofara to make it possible. And as a result, Henry survived his tuberculosis. He's doing really well. He's a senior at the University of Sierra Leone. He's studying human resources and resource management.

• 16:09Regina Barber?

  You still keep in touch, right?

• 16:11Speaker 02

  Oh, yeah, we talk almost every day. Yeah, Henry and I talk all the time. And I talked to his mom, I saw to a lot. And they're doing really well. You know, they finally have the kind of support that they and everyone deserved to have from the very beginning.

• 16:29Regina Barber?

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