Humanity’s battle against tuberculosis has been one of slow and imperfect progress. The disease no longer kills one in seven people in the US, as it did in the 19th century. But look elsewhere and its burden is still terrible: TB killed more than 1.2 million people in 2023, likely making it once again the deadliest infection on Earth, after it was briefly supplanted by Covid-19 during the pandemic.

And as John Green, the YA author, YouTuber, and author of the new book Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection, told me in an interview: “That number is about to go up.”

As part of its evisceration of US international aid, the Trump administration is ending funding for its global TB programs. The US is the world’s largest single funder of tuberculosis treatment, and the spending cuts quickly interrupted medical care for TB victims. And any delay in treatment can lead to worse outcomes for patients and makes it more likely the bacteria will evolve to resist antibiotics.

“All of this is a direct result of the decisions made by the US government,” Green told me. “Allowing tuberculosis to spread unchecked throughout the world is bad news for all humans.”

There may be as many as 10 million additional TB cases by 2030 because of the cuts, depending on how deep they ultimately are, according to one initial estimate. An additional 2.2 million people could die in that worst-case scenario.

It’s difficult to know what’s happening on the ground, as ongoing lawsuits try force aid funding to resume and the Trump administration itself has given conflicting information at times. One TB program director told The Guardian last week their funding had still not resumed despite receiving a reassurance from the administration that it would.

The funding freeze is not only a threat to people in the developing world who live with tuberculosis as an ever-present threat, Green told me — it also poses a risk to the US itself. Right now, Kansas has 68 active TB cases, one of the largest US outbreaks in recent history. One estimate from the Center for Global Development finds that US TB cases will rise in parallel with cases in the rest of the world. That won’t just increase health care costs — it will increase the risk that TB will become more drug-resistant and therefore deadlier to people around the world, including in the US.

I spoke with Green about the history of one of humanity’s oldest infectious diseases, the threat posed by the Trump administration’s cuts, and what concerned people can do in response.

Our conversation is below, edited for clarity and length.

What is the state of tuberculosis right now? Why do people in the US and other wealthy countries often think of it as a disease of the past, a problem that has been solved?

I used to think of it as a disease of the past as well. I thought of TB primarily as the disease that killed John Keats, and then we figured out a solution to it, so now it’s not a threat anymore.

But in fact, tuberculosis is still the world’s deadliest infectious disease. It kills over 1.2 million people per year. That number is about to go up. It sickens about 10 million people per year. Around a quarter of all living humans have experienced a TB infection.

Now, the vast majority of those people will never become sick.........

© Vox