Nolen: The first TB patient that I sat down with in Nairobi was a man who had extensively drug-resistant tuberculosis, or XDR-TB — essentially there’s a just a very slim chance that the only drugs we know about will actually cure him. We’re out of options. And he’d come in that day, like he had very optimistically every day for a week, to pick up his delamanid. And it was out of stock.
Green: Oh my god.
Nolen: And I just was, like, “This is terrible for you, Barack. This is terrible for your wife and for your five children.” They’d all been screened, and so far everybody was TB-free. But like so many people, he had been bankrupted by his infection. He’d had to send his wife and his kids back to the village because he couldn’t afford to keep them in the city.
XDR-TB is terrifying for him and for his family and all the people who care about him. But it is also terrifying for the rest of us, for this man to be going to this clinic every day and then back to this apartment building, where he lives crammed in cheek-by-jowl with 500 other people, with TB that he can no longer treat. That is very, very bad for him. But it is also very, very bad for everybody else.
Green: Yeah. I think it’s important to understand that this is a tragedy on an individual level, on hundreds of thousands of individual levels, but it’s also — I don’t know how I feel about the phrase “global health” sometimes, because I think it sounds like we’re only talking about health in impoverished communities. The truth is, this is a crisis for human health, for humans everywhere. A person was exposed to an antibiotic that was hopefully working. And then, due to a stock-out that the United States government caused, their infection now has a chance to develop resistance to that drug, in addition to having developed resistance to so many other drugs.
We could very easily end up in a situation where we don’t have any tools to fight tuberculosis. And that takes us back to the early 20th century. It takes us back to when my great-uncle died of tuberculosis when he was 29 years old. He was working as a lineman at Alabama Power and Light. His dad was a doctor, and there was absolutely nothing that his dad or anyone else could do to save his life.
Nolen: Does anyone in the U.S. get it anymore?
Green: Yeah, we’re going to have about 10,000 cases of active tuberculosis in the United States this year. In fact, the rate of tuberculosis in the U.S. is going up.
Nolen: Why?
Green: We under-fund public health care systems, and also we do a terrible job of getting the cure to the places where the cure is needed.
Nolen: Earlier you said that we know exactly how to live in a world without tuberculosis, but we choose not to. Why do you think we’ve been so content to live in that world?