Everything Is Tuberculosis

This is the gut-wrenching, heartrending injustice of living with tuberculosis in the twenty-first century: You live if you’re rich. And if you’re not, then you hope to get lucky.

We cannot address TB only with vaccines and medications. We cannot address it only with comprehensive STP programs. We must also address the root cause of tuberculosis, which is injustice. In a world where everyone can eat, and access healthcare, and be treated humanely, tuberculosis has no chance. Ultimately, we are the cause.

We must also be the cure.

And so we have entered a strange era of human history: A preventable, curable infectious disease remains our deadliest. That’s the world we are currently choosing.

But we can choose a different world. In fact, we will choose a different world. The world will be different a generation from now. The question is whether we will look back in gratitude at the virtuous cycles, or in horror at the vicious ones

And this is why I would submit that TB in the twenty-first century is not really caused by a bacteria that we know how to kill. TB in the twenty-first century is really caused by those social determinants of health, which at their core are about human-built systems for extracting and allocating resources. The real cause of contemporary tuberculosis is, for lack of a better term, us

, illness is a breakdown, failure, or invasion of the body treated by medical professionals with drugs, surgeries, and other interventions. But it is also a breakdown and failure of our social order, an invasion
of injustice. The “social determinants of health”—food insecurity, systemic marginalization based on race or other identities, unequal access to education, inadequate supplies of clean water, and so on—cannot be viewed independently of the “healthcare system,” because they are essential facets of healthcare.

We can understand the history of tuberculosis as a story of competing paradigms: These days, we primarily see tuberculosis through a biomedical lens—as an infection caused by a bacterium and cured by drugs designed to kill or otherwise inhibit that bacterium. Others view TB through a religious paradigm—an illness caused by spirits or demon possession and cured by religious rituals or holy tinctures. In some communities, the illness continues to be, as it long was in Europe, viewed through a hereditary paradigm, where certain families or personality types are especially vulnerable to the disease. Still others view TB through a sociological lens, as an illness caused by poverty and marginalization

We can do and be so much for each other—but only when we see one another in our full humanity, not as statistics or problems, but as people who deserve to be alive in the world

, many drugs that effectively treat multidrug-resistant strains of tuberculosis remain very expensive, and not because they are made of gold or platinum, or because we have to fly to the moon to find them. They are expensive because 1. Prices are kept artificially high by pharmaceutical companies, and 2. We are afraid that making these drugs less rare will lead to further antibiotic resistance. But as Dr. Carole Mitnick said to me once, “This is a human-manufactured problem that needs a human solution. If medications were a public good, the burden of disease would drive the priorities of the industry and TB treatment would be varied and plentiful.” And so we must fight not just for reform within the system but also for better
systems that understand human health not primarily as a market,

Patent “evergreening” is a common strategy among pharmaceutical companies to block generic competition in order to protect their prices and profits

Patent “evergreening” is a common strategy among pharmaceutical companies to block generic competition in order to protect their prices and profits