To Spur a Virtuous Cycle

Everything Is Tuberculosis by John Green (Crash Course Books, 2025)

Reviewed by Sarah Selden

In September and October of 2023, Pantone’s Instagram comment section was, rather strangely, filled with cries accusing the color-matching company of valuing “profit over people” and insisting that it was #timeforfive. This “cyberprotest” came after author and internet personality John Green posted an Instagram reel voicing his rage that Danaher, Pantone’s parent company, was charging between 200% and 500% profit margins for their life-saving rapid tuberculosis tests in the world’s poorest countries. He, along with Doctors Without Borders, charged the company to lower the price of each test to $5, hence the hashtag #timeforfive. Green’s followers, known as Nerdfighters (because they fight to decrease “world suck,” or whichever global issue their community finds most pressing at the moment, not because they fight nerds), descended on Pantone’s various posts in full force, making it known that they would not stop flooding Pantone’s comment section until Danaher agreed to lower the prices.

Pantone has since deleted the majority of the posts in question, but not before Danaher signed a deal with USAID, Partners in Health, The Global Fund, and the Stop TB Partnership to lower test prices in middle and low-income countries to the point that they would make no profit on sales. Lowering the prices of these tests by just $2 was estimated to save The Global Fund, a nonprofit committed to fighting global health issues and test provider, millions of dollars annually, giving access to tests to millions more people and saving millions of lives.

This is not the only time Green has enlisted his followers to use their voices to demand that a big company do their fair share in the fight against tuberculosis. In July of 2023, an incensed Green created an Instagram reel explaining that Johnson & Johnson was set to renew their patent for bedaquiline, a drug used to treat multi-drug-resistant tuberculosis. Green argued that Johnson & Johnson had already made an exorbitant profit and that renewing the patent would continue to make it unreachable in low and middle-income countries. The PR war with the company ended when Johnson & Johnson bowed to Green’s demands without acknowledging him or the public outcry. The tuberculosis page on their website now reads, “In 2023, Johnson & Johnson granted the Stop TB Partnership’s Global Drug Facility (GDF) a license that enabled GDF to tender, procure and supply generic versions of SIRTURO® for the majority of low- and middle-income countries (LMICs). The Company also confirmed its intent not to enforce bedaquiline patents in 134 low- and middle-income countries.”

Since Green has turned his attention toward ending tuberculosis worldwide, many have been surprised to find out that he is, in fact, the same John Green who wrote the bestselling young adult novels Looking for Alaska, The Fault in Our Stars and Turtles All The Way Down. Now, he is also the author of Everything is Tuberculosis, which is inspired by his longtime partnership with various nonprofits that focus on healthcare access inequalities around the world.

“Decreasing world suck,” as Green and his brother put it back in the early 2010s, has always been part of his M.O. He and his brother Hank (of YouTube fame) have hosted the annual Project for Awesome, a multi-day campaign,  since 2007,  and have raised over $3.5 million for charity. They have also recently started a not-for-profit business called Good.Store, where they sell sustainably sourced and fair-trade items. All profits from these enterprises go to Partners in Health. Through his involvement with Partners in Health (PIH), Green paid a variety of visits to Sierra Leone, where the organization supports six major health facilities.

Green first became aware of the fact that tuberculosis still kills over a million people each year in 2019, when a doctor friend invited him to visit the TB hospital in Lakka on his way to the airport. It was there that Green met Henry, a happy, good-natured child that Green assumed was there to cheer up patients. He also assumed that Henry was around nine years old, the same age as his own son (also named Henry). He was astonished to find out that Henry was, in fact, 17, and only appeared so young because he was fighting an aggressive form of multi-drug-resistant tuberculosis on top of malnutrition.

Henry’s story captured Green’s attention, and his new book Everything Is Tuberculosis is in part a memoir of his experiences getting to know Henry and his mother and figuring out the best way to help him. The snippets of Henry’s life, from his diagnosis at age six, to the series of events that brought him to the hospital in Lakka—where TB patients typically go to die—are interspersed with chapters about the disease’s history, prevalence, and impact on our culture globally.

For Green, the story of TB is a story of both tremendous hope and tremendous injustice. Historically, it has been one of the world’s deadliest diseases; the 2019 PBS documentary, “The Forgotten Plague” shares that “by the dawn of the 19th century, the deadliest killer in human history, tuberculosis, had killed one in seven of all the people who had ever lived.” As Green introduces his research on TB’s history and continued prevalence, he writes. “For me at least, the history and present of tuberculosis reveal the folly and brilliance and cruelty and compassion of humans” (6). Everything Is Tuberculosis is Green’s exploration of these four aspects of human character in relation to TB. He first addresses humanity’s folly. Before the germ theory of disease was widely understood, much of the English-speaking world believed that TB was a genetic disease, and that those predisposed to be particularly sensitive—artists, poets, actors, and the like—were also predisposed to developing tuberculosis.

It is true that many of the most celebrated poets and artists, from John Keats to Fredrick Chopin to all three Brontë sisters—died from tuberculosis. As a result, the nineteenth century saw a great romanticization of the disease, to the point where today’s beauty standards are in many ways based on white women who suffered from tuberculosis. Green discusses how Eliza Poe (mother of Edgar Allan Poe), a famous actress in her day, was also seen as one of the most beautiful women of her era primarily because of the enlarged eyes, flushed cheeks, and emaciated body structure she exhibited due to her battle with consumption. The disease was known colloquially as “consumption” because the body appeared to consume itself as it succumbed to the spreading bacteria. The fictional, beautiful Ruby Gillis died of tuberculosis in the Anne of Green Gables books. These ideals are still reflected in today’s beauty standards.

Green then discusses humanity’s brilliance in its pursuit to cure TB. He recounts the story of the now disgraced scientist Robert Koch, who isolated the bacterium for both anthrax and tuberculosis. This completely reversed the understanding that TB was inherited, confirming it was contagious. As Koch basked in the glory of his discovery, he was quickly overshadowed by discoveries made by French doctor Louis Pasteur, who produced a vaccine for anthrax. In a jealousy-infused race to catch up, Koch also tried to develop a vaccine for TB and released a faulty prototype much too early. Like Danaher and Johnson & Johnson, Koch’s greed caused him to perpetuate one of the “vicious cycles,” as Green calls them, related to tuberculosis—cycles where both corporations and individuals pursue profit over the common good.

What is most sobering about Everything Is Tuberculosis is the systemic nature of many the vicious cycles that Green reveals—cycles that evidence humanity’s propensity for cruelty. By and large, TB was considered the “disease of the rich” in the nineteenth century, and for a long time it was mostly associated with white, affluent people. After Koch’s discovery, the public understood that those living in crowded, low-income housing were more likely to catch tuberculosis. The disease then became heavily racialized, too, as more Black Americans died of TB in the late 1800s than white Americans. However, as Green writes, “Black people were not more susceptible to TB because of factors inherent to race, they were more susceptible to tuberculosis because of racism. Because of racism, Black Americans were more likely to live in crowded housing, an important risk factor for TB. Because of racism, Black Americans were more likely to be malnourished, another risk factor. Because of racism, Black Americans were more likely to experience intense stress, and they were less likely to be able to access healthcare” (83). Green then tells the story of a Black WWI veteran, Thomas Albert White, whose TB infection turned into active disease after a chemical warfare attack in Europe. When he arrived back in the US for treatment, the government sent him to a series of tuberculosis hospitals, all of which denied him entry because of his race. He later died of TB without access to care.

The US was not the only perpetrator of injustices like this. Both Canada and the US removed thousands of Indigenous children from their homes and sent them to residential schools, a horrific injustice in and of itself. But in Canada, for every 100,000 children in residential schools, 8,000 died of TB every year--a far greater rate than that of Indigenous children not confined to these schools. These statistics, combined with the unequal access to healthcare that minorities experienced in the twentieth century, highlight the substantial injustices surrounding who was most impacted by tuberculosis.

This injustice should have been rectified in the 1950s, when scientists first discovered the cure for TB—a series of strong antibiotics that, if taken properly, could rid a patient of the disease. For the most part, this discovery largely eliminated tuberculosis in wealthy countries like the US. However, as Green highlights, the disease still has not been eliminated in much of the Global South. For people like Henry, accessing these antibiotics is difficult. Many of them must take them through a grueling RIPE protocol, which requires a daily trek to the clinic to take the pills (the antibiotics Rifampin, Isoniazid, Pyrazinamide, and Ethambutol) in front of a clinician, often without enough food, causing extreme nausea on top of normal TB symptoms.

The RIPE protocol is not always enough. For patients like Henry, who developed multi-drug-resistant TB, (a result of not completing the protocol initially), the disease does not always respond to the usual course of antibiotics. The RIPE protocol will not be effective if a patient has contracted a case of TB resistant to those drugs. This is why rapid tests produced by Danaher and drugs like bedaquiline are necessary. Danaher’s test can immediately determine which drugs a patient’s TB is resistant to, which means they would immediately be given an effective drug and wouldn’t experience unnecessary side effects. For many, bedaquiline is the best available, as TB is only just starting to develop resistance to it. Green’s discussion of these realities is a grave reminder of the drastic inequalities in access to healthcare between the Global North and Global South.

While Green’s unveiling of the sheer scale of these vicious cycles and their impact is certainly disheartening, what comes through most strongly in Everything Is Tuberculosis is the power of the opposite—the virtuous cycle, spurred by compassion. Above all, Green argues, it is compassion that saves individuals’ lives from multi-drug-resistant tuberculosis. He shares how a patient in India, Shreya Tripathi, sued the Indian government from her deathbed because they would not grant her access to bedaquiline, citing the exorbitant price, lack of concrete evidence it would work, and desire to avoid overprescribing the drug and thereby allowing TB to develop resistance to it. As Shreya’s case grew more severe, she knew that taking legal action likely wouldn’t save her own life, but she told her father, “she wanted her suffering to have meaning” (133). She won the case, and her compassion toward future victims of the disease in India likely saved many thousands of lives.

It is ultimately one doctor’s compassion that has saved Henry’s life from his particularly severe case of multi-drug-resistant TB. As his condition deteriorated, a new doctor came to work at the TB hospital in Lakka—Dr. Girum Tefera. Dr. Girum, as his patients call him, appealed to both the Sierra Leonean government and various nonprofit organizations to access the drugs and funding needed to tailor a treatment plan for Henry. Finally, Partners in Health came through and Dr. Girum was able to cure Henry’s tuberculosis within a matter of months. When asked about his effort, Dr. Girum told Green, “Yes, I know, it’s just one patient. There are so many patients, and Henry is just one. Why should we move mountains to save one patient? Because he is one person. A person, you understand?” (151). 

Dr. Girum’s compassion didn’t end there. Henry has continued it. After meeting Green, the two kept in touch. Green sent Henry YouTube equipment after he expressed interest in sharing his story. Once Green’s followers caught wind of it, the donations poured in, allowing Henry’s mother to purchase a home for the two of them and to finally start her business—something she had to put off to be there for her son during treatment. Today, Henry and his mother have sustainable income and have stimulated their local economy. Additionally, Henry’s openness about his status as a TB survivor is lessening the stigma around the disease. He is encouraging survivors to “go out and preach that TB can be cured” (177).

At 192 very digestible pages, Everything Is Tuberculosis is both a startling warning against what could happen if more resources aren’t devoted to fighting TB globally and a stirring call to action about what good can happen from one person’s small action—the benefits far outweigh the monetary cost. In moving away from his typical Young Adult fare and into the realm of nonfiction, he also demonstrates the power of using influence for good. His dedication to decreasing world suck is not new, but by publishing a long-form book that elucidates his efforts, he extends their reach. As TB research, prevention, and treatment funding disappears, Green is currently on a sold-out tour to promote the book. A recent Washington Post article argues that his primary purpose on this tour is to “fight despair,” and to do this, he must lean into society’s collective capacity for good that he writes so much about in Everything Is Tuberculosis. Much of his tour audience consists of his former teenage readers and Nerdfighters, there to “read anything John Green writes,” as some Instagram users have put it.  As he shares his message surrounding the folly, brilliance, cruelty, and compassion of humanity in relation to TB, he can hope that his virtuous cycle will continue.

Sarah Selden earned her bachelor's in English and secondary education at Palm Beach Atlantic University and her master's in English and American studies at the University of Oxford. She has taught English in Palm Beach County, in Spain on a Fulbright grant, and currently teaches in Littleton, Colorado.