Why ‘Fault in Our Stars' author John Green is obsessed with tuberculosis

Telegraph

25-04-2025

Several years after an encounter that turned him into a self-professed tuberculosis nerd, John Green's son came home from school with a question. Did the best-selling author realise that the disease played a small role in the onset of the First World War?
'I was like respectfully, if that were true I would already know,' said Green, who is best known for young adult novels such as 'The Fault in Our Stars'. 'But I looked it up, and he was so totally right.'
It turned out that three of the assassins who plotted Archduke Franz Ferdinand's death – a crucial if chaotic moment in the build-up to war – were suffering from tuberculosis (TB). Historians have posited that they were prepared to die for their cause partly because they knew already that their days were numbered.
The tidbit is one of Green's favourites, but as his obsession with TB has grown, so too has his collection of anecdotes. Did you know that Ringo Starr first discovered percussion while recovering from TB in a sanatorium? Or that cowboy hats were created for the midwest sun after a hat-maker in the 1850s moved in search of cleaner air for his struggling lungs?
'I think we do underestimate the extent to which, not just tuberculosis but disease in general, has shaped human history,' said Green. 'Think of how different the world could be if Alexander the Great hadn't died of typhoid or malaria when he was still a young man… [or if] Louis XVI's son hadn't died of tuberculosis as the French Revolution was beginning.'
But while the intriguing history of the world's deadliest infection may have informed the title of Green's latest book, 'Everything is Tuberculosis', it was never the driving force for writing.
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Instead, the story began with Henry Reider, an 'uncommonly charismatic' patient in Sierra Leone. The pair first met in 2019. Green was in the west African country on a trip related to maternal mortality when he visited a TB hospital – at the time, he had no idea that the curable disease still kills upwards of 1.2 million people every year, and infects another 10 million.
'I thought that TB was a disease of 19th century poets, not a disease of the present,' Green said, in his first interview with a British newspaper about the new book.
'Then I met this kid who looked to be about the same age as my son, who was nine at the time, and who had the same name as my son, Henry.'
But as Green toured the Lakka Government Hospital with Reider, he was in for a series of shocks. Henry Reider was not nine but 17 – he'd been stunted from severe malnutrition in childhood – and his experience with TB was 'devastating'.
Reider's father, distrustful of the health care system, had halted his son's treatment part way through a months-long course of drugs, allowing the infection to develop drug-resistance. Later, when the usual toxic cocktails of drugs failed him, bedaquiline – a safer treatment regimen that involves few tablets over a shorter period – was deemed too expensive.
'It was infuriating to me. You or I would receive the kind of personalised, tailored treatment that Henry was told was unaffordable without hesitation or question,' said Green. 'Meeting Henry and spending that afternoon with him really reshaped my understanding of illness.'
Reider's story forms the backbone of 'Everything is Tuberculosis', where Green argues that injustice is behind the continued presence of TB – a bacterial pathogen formally identified in 1882, but which has been killing people for centuries longer.
Although the airborne disease can infect anyone, today it is largely a disease of poverty. The World Health Organization (WHO) estimates 1.25 million people died from TB in 2023 – 81 per cent of fatalities were in south Asia and Africa, compared to just 1.4 per cent in Europe.
This has impacted everything from investment in vaccine and drug development, to the accessibility of expensive treatments and specialist doctors for patients. But it wasn't until Green spoke to a renowned TB doctor that the implications hit him: even with today's imperfect tools and knowledge gaps, the disease could be wiped out..
'I asked him, how many people would die of tuberculosis if everyone had the kind of health care that I have? And he said: 'none, zero'. And that shocked me, it means that every death from tuberculosis is optional.'
Drawing attention to this reality felt essential for Green. Still, he was unsure how the book would land.
'Every time I try to market the book, I feel almost apologetic – like I have to explain that it's a non fiction book about tuberculosis,' he said.
'[But] it feels like a natural progression, in the sense that I've been interested in illness for a long time… I wrote about cancer in 'The Fault in Our Stars', I wrote about OCD in 'Turtles All the Way Down'. And you know, this is also a book about a smart teenager who loves poetry.'
He hardly needed to be concerned. The response has been 'wildly unexpected': since it was published last month, 'Tuberculosis is Everything' has topped the New York Times bestseller list for non-fiction for a fortnight, while Green's US book tour sold out within days.
Green isn't entirely sure how he captured the public imagination, but he wonders if part of the explanation lies in the timing.
The book was published after Donald Trump's administration slashed the foreign aid budget and closed the USAID agency – an unprecedented move with huge ramifications for global health, including the fight against tuberculosis.
The US contributed roughly half of all international donor funding for TB last year, according to the WHO, which last month warned that efforts to curb the disease are now 'in peril' as health workers funded by USAID have been laid off, testing and surveillance services halted, drug development paused and access to treatment curtailed for millions.
'I never imagined that the cuts under the Trump administration would be this severe, and that they would lead to this scale of mass death. I was a little naive, I think,' said Green. 'It is absolutely devastating… it's a massive failure of global resource allocation, and a mark of shame on all of us.'
He added that it is disappointing to see the UK also reduce its aid budget, from 0.5 per cent of gross national income to 0.3 per cent in 2027.
In West Africa, Reider has recovered from TB, completed exams at the University of Sierra Leone, and launched a YouTube vlog. But Green fears for other patients – Reider's hospital is among those hit by the US aid cuts, and TB is not the only disease affected.
'A friend in Sierra Leone who has HIV called me and said: 'Look, there's two weeks left of medication, and after that they don't know'. I said Sarah [Green's wife] and I will make sure you and your mom have access to HIV medicine, of course. And he said: 'Thank you, but what about everyone else?
'The truth is, there is no way for individuals and philanthropy to set up and act at the scale that governments are acting. And so that question – 'what about everyone else?' – is a question that haunts me. I think it should haunt us all.'
But although Green is less optimistic about the promise of eliminating TB than when he finished writing the book, he has retained a sense of hope that the outlook can change – especially because cheaper diagnostics, better treatments and promising vaccine candidates are in the pipeline.
'If you think of the fight against tuberculosis as a very long staircase, we've walked a long way up that staircase since Hippocrates told his students not even to bother treating tuberculosis, because it would make them look like bad healers,' said Green.
'In the last eight weeks, we've fallen down the staircase and that's devastating. But when you fall down a staircase, you get up and start walking up the staircase again.'