“If you’d told me when The Fault in Our Stars was published that a decade later, I’d be writing and thinking almost exclusively about tuberculosis,” writes John Green in Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection (Crash Course Books, March 18), “I would have responded, ‘Is that still a thing?’”

Too many of us are in the same boat, unaware that a disease vanquished in the United States nearly 75 years ago still kills well over a million people a year, almost all of them in Africa. But there are a lot of other things most of us don’t know about tuberculosis—it killed all three Brontë sisters, Eleanor Roosevelt, and George Orwell; it had something to do with the beginning of World War II, the statehood of New Mexico, and the invention of the cowboy hat. These stories and many others are all told in Green’s engrossing second work of nonfiction. He recently discussed the book with us over Zoom from his home in Indianapolis; our conversation has been edited for length and clarity.

So where did this title come from? Is everything really tuberculosis?

My wife Sarah has been joking for years that, in my mind, everything is about tuberculosis and tuberculosis is about everything, so I called the book Everything Is About Tuberculosis. Then my longtime editor misread the title, writing me to say, “I really enjoyed Everything Is Tuberculosis.” That was much better.

Honestly, though, I don’t think that we can understand the history of humans without considering this disease that’s killed one out of every seven of us who ever lived.

Tell us about Henry Reider, the inspiration for the book.

I met Henry in 2019 when I toured Lakka Government Hospital in Sierra Leone. He has the same name as my son, and a lot of the same mannerisms, and he looked to be about the same age, maybe 9. He took me all around this tuberculosis hospital, and eventually we made it back to the doctors who were meeting to talk about a few cases they were concerned about. One of the nurses shooed Henry away, and I learned that he was one of those patients. His particular strain of tuberculosis did not respond well to second-line drugs. In Sierra Leone, that was almost a death sentence.

He had already spent years of his life continually hospitalized. He lost hearing in one ear due to the side effects of a medication he didn’t even need to be on. And he was no 9-year-old—he was 17, stunted by both malnutrition and the disease.

For most of the book, his treatment is going so poorly, I was terrified that he was going to die. Is it a spoiler to say he made it?

I don’t think he’d want it to be a mystery. He’s a remarkably resilient young man, now a student at the University of Sierra Leone.

His story recalls another in your book, of a young woman from the early 20th century who spent her entire childhood in a sanitorium.

That was very common. Little kids who drank raw milk and got bovine tuberculosis would often end up hospitalized when they were 2 or 3 years old. I write about a young Massachusetts girl who lived there until she was 16. She had no memory of loving touch in her life, had no idea what it was like to be home with a family. When streptomycin was introduced, she reentered the world.

Wasn’t the sanitorium completely useless as a treatment for tuberculosis?

People disagree over that. Rest and nutrition are good treatments for tuberculosis, but the sanatorium emphasized control over care, something we see again and again in the history of TB.

The sanatorium limited chains of infection, but it was very inhumane. Patients were told they couldn’t stand up on their own. Often they weren’t allowed to have visitors, because it was seen as too exciting to their nervous systems. They were told not to read, not to write, not to do handicrafts, not to cook.

And yet tuberculosis was somehow seen as very glamorous!

In medical textbooks there were poems, odes to the beauty of consumptive women. Men were thought to experience a great creative flowering when they were suffering from tuberculosis. Percy Shelley wrote John Keats saying, “This consumption tends to strike people who write great verses, as you have done.”

To some extent its beauty standards are still with us. We still idealize pale skin. We still idealize rosy cheeks and high cheekbones and waifish bodies.

Don’t you think it’s weird? Aren’t these symptoms of imminent death?

It makes psychosocial sense. In the late 18th and early 19th centuries, a third of all people in England were dying of TB. You couldn’t stigmatize it away. It was killing the rich, the poor, the foolish, the brilliant. There was nothing to do with it other than to find a way to make it socially acceptable.

Are you concerned about a resurgence of tuberculosis given the new regime in Washington?

Though tuberculosis certainly could become a resurgent threat in the U.S., this isn’t the reason we should care about it. It’s already the world’s largest infectious disease. When the needs of markets don’t align with the needs of the social order, we sometimes choose markets. That’s the problem.

Once I became interested in tuberculosis, I began to hear from activists and to understand how much cost was a barrier to diagnosis and treatment. There’s this incredibly effective drug called bedaquiline that has historically been way too expensive, because Johnson & Johnson had a monopoly on it. I’ve worked in concert with Doctors Without Borders and others to get J&J to back down from attempts to make their patent eternal. And the price of bedaquiline has dropped by about 70% in the year and a half since they did. When I started writing the book, 1.5 million people died of tuberculosis every year, and by the time I finished, it was 1.25 million. That progress is real.

Do you think this tuberculosis study will feed your fiction writing in any way?

Oh, that’s an interesting question. I mean, probably in ways that I don’t see or understand. After writing two nonfiction books, I do miss writing fiction and feel called back to it, so that’s what I’m working on now.

Your next book will be fiction?

I think so, but if you had asked me after my previous book, I would have said the same. I never imagined I would go down this rabbit hole with TB.

You mention that your OCD played a role in this project.

As I say in the book, mental illness is often romanticized as bringing on creative expression, but my own experience of OCD is very different from the way it’s portrayed in Sherlock Holmes. My own experience is that there are very few, if any, upsides to living with mental illness. When I’m unwell, I’m unable to write at all. 

I do think that it’s probably not a coincidence that so much of my life and my writing have been oriented around my long-standing fears around contamination and infectious disease. I’ve written a lot about illness both because I’m fascinated by it and because I think it’s a bit weird that we don’t write and talk about it more.

Marion Winik hosts The Weekly Reader podcast on NPR.