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

Published in 2025, Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection is a popular science book by American author John Green. Best known for young adult novels like The Fault in Our Stars, Green uses a blend of medical history, cultural history, and nonfiction narrative to bring awareness to the crisis of tuberculosis (TB) in the 21st century. Green is a public advocate for global health and became interested in issues related to TB healthcare during a visit to Sierra Leone in 2019.

The book argues that the current state of TB healthcare hinges on vicious choices that disadvantage marginalized communities. Green drives this argument through the story of Henry Reider, a Sierra Leonean boy who grew up with TB. As Henry’s symptoms worsened, the healthcare workers at Lakka Government Hospital raced to provide him with long-standing cures that are difficult to access because of the economic dynamics between Sierra Leone and cure-producing countries. Green explores themes such as the spiritual illness of bias, the need for empathetic thinking, and the cumulative effect of virtuous cycles.

This guide refers to the hardcover edition, published by Crash Course Books in 2025.

Content Warning: The source material and guide feature depictions of illness, death, child death, child abuse, ableism, antigay bias, gender and transgender discrimination, and racism.

Summary

In the book’s Introduction, Green says that cures for tuberculosis (TB) have existed for decades, yet TB remains the world’s deadliest infectious disease. TB cures remain widely inaccessible to impoverished communities that need them most. Everything Is Tuberculosis intends to explore the historical reasons for this predicament, arguing that the failure to eliminate TB is a form of injustice.

Green shares the story of Henry Reider, a 17-year-old patient at Lakka Government Hospital who had lived with TB since childhood. Green met Henry while visiting Sierra Leone and quickly became curious about Henry’s protracted treatment. Green began studying TB and its intersections with general history, leading him to realize how human cultures have grown around the spread and impact of TB.

Sierra Leone is a mineral-rich country, though its history as a former colony of the British Empire hindered its ability to leverage those resources toward its own development. Instead, the country’s infrastructure was built for the exportation of those resources, which are owned by foreign companies. When Sierra Leone gained independence in 1961, it could not properly develop its healthcare system. Illness spread, and the majority of its population couldn’t afford treatment alongside other necessities. Henry’s mother, Isatu, halted her education to care for her two children.

After a late TB diagnosis, Henry began standard treatment. His condition was exacerbated by his father’s decision to prematurely stop his treatment in favor of faith healing. Henry thus developed an undetected, drug-resistant strain of TB. When Henry resumed treatment, his younger sister, Favor, was diagnosed with a tumor. Because Isatu could not raise the funds for her treatment in time, Favor died—an event that traumatized Henry. Henry’s treatment was further staggered by the outbreak of Ebola in the 2010s, which decimated Sierra Leone’s healthcare system. When his strain was finally identified, Henry was moved to Lakka.

TB is an indiscriminate disease that infects people regardless of their race, social class, or gender. For much of human history, doctors did not have the expertise or tools to identify the microorganism that causes TB, Mycobacterium tuberculosis. As a result, humanity invented different causes for TB, from demonic possession to an imbalance of the four humors of the body. While the drive to understand illness speaks to humanity’s natural unease with the unknown, the imperative to understand TB drove the stigmatization of people who had it. Green argues that an alternative perspective of TB—romanticization—was a complementary strategy to stigmatization, excluding people with TB from the rest of society by placing them in a different category of “otherness.” During the 19th century, TB was so romanticized that it was viewed as a “civilized” disease by Western writers. People of color were considered to have experienced a different unnamed disease, though their shared symptoms pointed to the same illness.

By the 19th century, these perspectives of TB shifted as scientists traced the causes of TB to bacteria. Its airborne transmission drove shifts in treatment, which were largely focused on the sanitization of public spaces and air. Across North America, the scientific knowledge of TB was used to stigmatize Black people by suggesting that they were more susceptible to infection. However, the racism that drove poor living conditions in these communities was to blame for their spread.

TB was effectively reframed so that those who had the illness were perceived as morally inferior. In the present day, that stigma persists, as those who are diagnosed with TB are often abandoned by their communities. Similar judgment was seen in the rise of the sanatorium—a specialized hospital for people diagnosed with TB—which emerged as a direct response to the germ theory of disease. The inability to recover was seen as the patient’s failure to abide by the conditions of their treatment, leading to punitive measures that were intended to “correct” their behavior.

By the mid-20th century, scientists pushed further breakthroughs that resulted in the development of the RIPE protocol, the first regimen of drugs designed to cure TB. These treatments became widely accessible in wealthier areas like the United States and Western Europe, but they remained out of reach in countries emerging from colonization like Sierra Leone and India.

To address the high infection rates in these countries, the directly observed therapy (short-course) strategy (DOTS) was developed. Green argues that its continued use today exposes its limitations, which are glaring given the availability of multiple drug treatments for TB. DOTS puts the burden of treatment on the patient, often requiring them to sacrifice time and resources to get better. As in Henry’s case, patients who are unable to complete treatment develop resistance to antibiotics, which makes their strain of TB more resilient. Patients are forced to rely on other lines of drugs, which drug manufacturers like Johnson & Johnson keep out of reach through practices like price gouging, maximizing their profits in the name of cost-effectiveness.

Henry’s treatment became reliant on a highly toxic but cost-effective injectable regiment, which eventually failed and caused him to lose hearing in one ear. Henry’s new physician, Dr. Girum Tefera, struggled to find a new treatment suited to Henry. Though Henry tried to endure this transitional period, his morale deteriorated following the death of his best friend at Lakka, Thompson. Henry’s father threatened to beat Dr. Girum for keeping Henry in the hospital, so Dr. Girum asked him to try one last treatment plan for Henry’s sake. Through nonprofit support, Dr. Girum assembled an experimental treatment tailored for Henry. In a year, Henry recovered from TB.

Green frames the history of TB as a dichotomy between vicious cycles and virtuous cycles. Vicious cycles amplify the injustice of inequitable access, while virtuous cycles offer the hope of a concrete solution to people who suffer those injustices. The success of Henry’s treatment encouraged more accessible treatment throughout Sierra Leone. Henry pursued his education and became an advocate for global healthcare and social development. Green calls on the reader to be the cure for TB, acting in ways that will positively address the social determinants of health across the globe.