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What's at Stake

2025-02-11 · letter vlog · John · 5:48 · watch on YouTube

Topic: Global development · mode: News analysis · tags: timely hook, calendar ritual, fundraising ask, heavy topic, self promotion

Drawing on his book research, John explains why interrupting months-long TB treatment is catastrophic, since untreated TB spreads and becomes drug-resistant, and argues that the US freeze on TB funding risks millions of deaths. He says only governments can respond at that scale, urges support for global health charities through the Project for Awesome, and rejects despair because TB deaths have halved in 25 years.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — Greeting, P4A fundraiser live, John's TB knowledge from four years writing his book

  • ★★ John says the Project for Awesome is this weekend and its fundraiser is already live. — 00:00:00 · Project for Awesome
  • ★★ John says he knows almost nothing about most things, like helicopters or star distances, but knows a lot about TB and its medication from four years writing a book about it. (playful) — 00:00:00 · Everything Is Tuberculosis, tuberculosis

00:00:29 — How TB treatment works and why interrupting it spreads disease and drug resistance

  • ★★★ John sets out to explain what is likely to happen when TB medication and diagnostics that are already paid for rot in warehouses because of US government stop-work orders. — 00:00:29 · tuberculosis
  • ★★ John explains that TB is curable but not easy to cure: the bacterium's thick, fatty cell wall is very hard to penetrate, so it is hard to kill. — 00:00:29 · tuberculosis
  • ★★ John says a strep infection might be cured with about seven days of antibiotics, but TB needs several months, and in the past people often took antibiotics for years. — 00:00:29 · tuberculosis
  • ★ John says one of his friends survived TB after taking between 20,000 and 30,000 pills. — 00:00:58 · tuberculosis
  • ★★★ John says that with the current standard of care, drug-sensitive TB can be cured with four to six months of daily therapy, while drug-resistant TB takes at least six months and often much longer. — 00:00:58 · tuberculosis
  • ★★★ John says interrupting TB care in the middle of months of treatment is potentially catastrophic, both for individuals and for society. (hedged) — 00:01:27 · tuberculosis
  • ★★★ John says people on appropriate treatment almost never spread TB, but untreated TB is extremely infectious: the average untreated case infects 10 to 15 more people per year. — 00:01:27 · tuberculosis
  • ★★★ John says that if we suddenly stop treating TB, as has happened in many communities, disease prevalence will suddenly rise. — 00:01:56 · tuberculosis
  • ★★★ John says even a brief pause in treatment gives TB a good chance to develop drug resistance, so the drugs that worked before no longer work when treatment resumes weeks or months later. — 00:01:56 · tuberculosis
  • ★★★ John says this makes TB harder or impossible to cure for individuals and spreads drug-resistant TB worldwide, which could lead to untreatable strains, a terrifying prospect. — 00:01:56
  • ★★ John says that by one estimate TB has killed about one in every seven humans who have ever lived. — 00:02:26 · tuberculosis
  • ★★ John says densely populated communities fared worse: in early industrial England about one in three people were dying of tuberculosis. — 00:02:26 · tuberculosis, England

00:02:55 — The US freeze on TB funding, patients without medication, why only governments can respond at scale

  • ★★★ John says a resurgence of TB, especially drug-resistant TB, would mean not thousands but millions or tens of millions more premature deaths. — 00:02:55 · tuberculosis
  • ★★ John says the United States is currently the main funder of the TB response in impoverished communities. — 00:02:55 · United States, tuberculosis
  • ★★ John says US dominance of TB funding is not ideal: he wants more wealthy countries to take a bigger part in fighting diseases of injustice. — 00:02:55
  • ★★★ John says it is devastating to watch the US haphazardly and chaotically freeze, in effect, all TB funding. — 00:02:55 · tuberculosis, United States
  • ★★★ John says that although the US government can claim medicines are still flowing, he hears again and again from people on the ground, from Tanzania to Sierra Leone, who cannot get their TB medication. — 00:03:24 · Sierra Leone, United States
  • ★★ John says friends ask him how to get their meds, and he doesn't know what to tell them because the supply chains are frozen. — 00:03:24
  • ★★★ John says individuals and philanthropy cannot step in at this scale: responding to a crisis this size needs at-scale logistics that only governments can provide. — 00:03:53
  • ★★★ John feels utterly powerless watching decades of progress against TB and other diseases of injustice put at risk, not for lack of tools but for lack of political will. — 00:03:53 · tuberculosis
  • ★★ John says TB fighters in the community have been organizing call-a-thons and other responses. — 00:03:53

00:04:22 — Calling his representatives, P4A money to Save the Children and Partners In Health, perks

  • ★★ John says phoning his senators and congresspeople or their offices has made him feel quite empowered: someone has to make the case, and he is grateful we still have some say in our governance. — 00:04:22 · United States Congress
  • ★★★ John says philanthropy cannot replace USAID's at-scale responses, but supporting global health charities is more important than ever. — 00:04:22 · global health, United States
  • ★★★ John says he is proud that half the money raised during the Project for Awesome will go to Save the Children and Partners In Health. — 00:04:22 · Project for Awesome, Save the Children, Partners In Health
  • ★★ John says he needs the Project for Awesome every year but really needs it this year (2025): it is silly and fun but also a serious fundraiser. — 00:04:22 · Project for Awesome
  • ★★ John says the Project for Awesome has raised over $22 million for charity in the last 19 years. — 00:04:52 · Project for Awesome
  • ★★★ John says the fundraiser is live, with perks including the first chapters of his next book and a signed postcard of a frog version of himself, all at projectforawesome.com/donate. — 00:04:52 · Project for Awesome, John Green

00:05:21 — Despair is not the right response: TB deaths halved in 25 years; sign-off

  • ★★★ Facing big global problems that risk reversing progress, John says he feels close to despair but believes despair is not the right response now. — 00:05:21
  • ★★★ John says TB deaths have fallen by more than half in the last 25 years: that progress is under threat but still real, and it shows progress is possible. — 00:05:21 · tuberculosis, progress

Threads in this video

Where the stories that moved here went next

Mentioned

Central: Project for Awesome · tuberculosis

Also: Projects: TBFighters

Works: Everything Is Tuberculosis

Organizations: Federal government of the United States · Partners In Health · Save the Children · United States Agency for International Development · United States Congress · United States Senate

Concepts: Antibiotic · antimicrobial resistance · cell wall · despair · global health · multidrug-resistant tuberculosis · progress

Places: England · Sierra Leone · Tanzania · United States

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