We Have the Cure. Why is Tuberculosis Still Around?

Short summary

This Shortwave episode traces tuberculosis from its ancient roots to today’s medical battlegrounds and the persistent global inequities that shape who survives. It follows Robert Koch’s 1882 identification of TB bacteria, explains why tuberculin was mistaken for a cure or vaccine, and shows how antibiotics in the mid-20th century finally turned TB into a curable disease in many wealthy settings. Yet drug resistance emerged, complicating treatment and underscoring that biology alone cannot solve TB; access and resources matter just as much. The narrative anchors these histories with a Sierra Leone story about Henry, a TB patient saved by a tailored treatment and strong health systems, illustrating why social justice is inseparable from medical progress. The episode also features John Green and connects past discoveries to present-day efforts to eradicate TB.

Overview

Tuberculosis (TB) is more than a medical condition; it is a historical force that has shaped societies, economies, and global inequities. This episode traces TB from ancient bones and archaeological records through the dramatic late-19th century discovery of the TB-causing bacterium by Robert Koch, to the tuberculin era, and then to the antibiotic era. It emphasizes how scientific breakthroughs happened alongside social and political contexts, and why the disease remains a marker of unequal access to care. The narrative threads together science, history, and personal experience to illustrate both progress and persistent injustice in the fight against TB.

“Faulkner famously said the past is never dead. It's not even past.” - John Green

Historical milestones

The episode explains that TB appears in ancient records and was long seen as almost uncureable until the late 1800s. In 1882, Robert Koch identified the TB bacterium, a milestone that transformed understanding and sparked efforts toward vaccines and cures. Koch’s contemporaries, including Arthur Conan Doyle, chased the possibility of a universal cure with tuberculin, a substance derived from TB patients. Doyle’s journey to Germany and his subsequent reporting revealed that tuberculin did not cure TB or function as a reliable vaccine; instead, it prompted an immune response and is now used as a skin test to detect TB exposure. The segment highlights how early enthusiasm collided with complex biology, setting the stage for modern diagnostics rather than a one-shot cure.

“Faulkner famously said the past is never dead. It's not even past.” - John Green

From tuberculin to antibiotics and resistance

Moving into the 20th century, the episode outlines how antibiotics—beginning with streptomycin—redefined TB treatment. TB requires prolonged, multi-drug regimens because the bacteria divide slowly, making eradication challenging. By the late 1950s, TB was considered curable in many parts of the world, especially in wealthier nations. However, the rise of drug-resistant TB strains emerged as a major threat, complicating therapy and demanding new drug combinations and strategies. The host connects these scientific milestones to the lived realities of patients who face barriers to access, illustrating that even formidable medical solutions can falter without equitable distribution of care.

“We know we can eliminate these diseases from these communities. We're literally choosing not to because of the way we distribute resources.” - John Green

Henry, Sierra Leone, and health inequity

The narrative turns to Henry, a TB patient in Sierra Leone who survived thanks to tailored treatment and the support of a dedicated doctor, Dr Jerome Tefera, and the Sierra Leonean Ministry of Health. Henry’s story underscores how medical advances exist alongside profound inequalities. In wealthier regions, advanced diagnostics and drug regimens can be accessible, while in lower-income settings, these resources are scarce, delaying diagnosis and reducing cure rates. The conversation uses Henry’s experience to illustrate the central thesis: TB is not only a science problem but a social justice problem, as access to care—and the systems that deliver it—profoundly shape outcomes.

“We know we can eliminate these diseases from these communities. We're literally choosing not to because of the way we distribute resources.” - John Green

Optimism grounded in science and justice

Despite the enormity of the challenge, the episode ends with a message of cautious optimism. Since the host’s college years, TB deaths have fallen by about 50 percent, suggesting that progress is possible when science, policy, and equity align. The narrative argues for expanding access, diversifying participation in research, and strengthening health systems so that cures and diagnostics reach everyone, not just those in high-resource settings. This is a call to treat TB not solely as a biomedical issue but as a shared social responsibility that requires sustained commitment, resources, and political will.

“Since I graduated from college, tuberculosis deaths have dropped by 50%.” - John Green