“[Green] I was really surprised to learn that tuberculosis is the deadliest infectious disease in the world. Even though I cared about global health, I would have bet my life that it was malaria or H.I.V., because those diseases get so much more attention. They still don’t get nearly enough attention, it must be said; people don’t pay enough attention in the rich world to problems in the global South. [..]
It’s not easy to cure, but neither was my brother’s cancer. My brother had cancer a couple of years ago; it cost about 150 times more to cure than it would have cost to cure a case of drug-resistant tuberculosis in, say, Sierra Leone. And yet nobody at any point said to my brother: “I’m not sure this is cost effective. This doesn’t make sense. We have better uses of resources.”
It’s not wrong to say that focusing on prevention is more cost-effective than treating cancer — but it’s still a good idea to treat cancer. That’s when I became outraged, I think: When I realized how we’re just not acting as if all lives have equal value.
[New York Times reporter Stephanie Nolen] It’s also really hard, right? Getting the pills to people. All the logistics, the infrastructure, but particularly the cost of those drugs. And it’s a lot of drugs. They’re hard drugs to take. They’re hard on people. Even when you can get people the meds, it’s really hard.
[Green] Yeah, it’s four to six months of antibiotics, and that’s with the newest regimens; it used to be more than that. And it’s taken every day. And those antibiotics have all kinds of side effects. And you have to take medicine even when you don’t feel bad. [..]
I have severe O.C.D. and so I take two medicines every day. Those two medicines are essential for my survival, and yet I struggle to take them. One of the reasons it’s hard is because of the stigma associated with mental illness. And TB is so stigmatized in many impoverished communities that I think people hear a similar story, like: “If you were a proper person, if you were fully integrated into the social order, you wouldn’t have gotten this disease and you wouldn’t be here.” And so it’s hard to take medicine. [..]
—
In northern Europe, in the U.S., we understood tuberculosis as an inherited disease. At the time, it was believed that you also inherited lots of other personality traits alongside tuberculosis: a certain sensitivity to the world, a creative genius, a physical beauty, especially in women, because tuberculosis made them quite frail and thin and pale-skinned.
[..] in 1882, when Robert Koch proved that tuberculosis was caused by a bacteria, it went from being this beautiful disease to sort of a body horror. Humans, who had found a way to conquer the tiger and the lion, were suddenly, it turned out, being destroyed from within by these horrifying animals you couldn’t see. And I think that contributed to the reimagining of the disease as one of filth, a disease of poverty, a disease of slums. How we imagine illness is so important. And we mostly talk about illness as a biomedical phenomenon, but how we imagine it socially is really significant. It shapes how people die of TB, but it also shapes who dies of TB. [..]
Tuberculosis does follow the paths of injustice that we blaze for it. But it’s also true that tuberculosis is a disease that anyone can get. One of the biggest stars in Bollywood has spinal TB. George Orwell died of TB. [..] It drives me crazy when people try to impose these ethical narratives on a disease like tuberculosis. Tuberculosis doesn’t care if you’re a good person or a bad person. Poverty doesn’t care if you’re a good person or a bad person.
[..] we could live in a world without tuberculosis. We know how. We reduced tuberculosis by over 99 percent in the United States and other rich countries, and we did it with a comprehensive approach where you actively search for cases. You don’t just wait until people are so sick that they’re coming into the hospital. In the U.S., we sent out all these mobile chest X-ray machines in the 1950s and ’60s in vans and gave people free chest X-rays, and then offered them free treatment and then offered their close contacts preventative care. So we know how to prevent TB with a shorter course of antibiotics. We know how to do this. We know how to live in a world without where TB is not a huge public health concern. We just haven’t done it.
The U.N. estimates it would cost about $25 billion a year. That’s a lot of money, obviously, but it’s also not that much money in the context of global health. We could be walking farther up this staircase that leads us to a world without tuberculosis. And instead we just — things are getting so much worse. And they will now get so unimaginably worse, especially with more drug-resistant tuberculosis circulating in communities. Now that so many people have seen their treatment interrupted, they’re much more likely to get drug-resistant TB. One estimate holds that drug-resistant TB will go up by about 30 percent. It’s a crisis. [..]
We treat certain human lives like they’re just not as important. I also think there’s something about the way that tuberculosis works. Maybe it’s that it’s slow-moving. Maybe it’s that it doesn’t attack a community the way a cholera outbreak or other diseases would. I do think that a big part of it is that we just don’t do a good job of including people who live at the margins, and that allows tuberculosis to thrive in the places where human systems fail.
[..] we don’t have to live in a world where TB medicines are so expensive. [..] They they’re not as good as they need to be, and they’re not as available as they need to be. So many people are responsible for lowering the price of Bedaquiline and lowering the price of the genetic tests for TB.”
Full article, S Nolen, New York Times, 2025.3.27