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Real Reasons for Hope

2025-10-01 · letter vlog · John · 5:36 · watch on YouTube

Topic: Global development (also: Nerdfighteria) · mode: News analysis · tags: timely hook, calendar ritual, self promotion, heavy topic

John offers two under-reported reasons for hope: the cost of curing multidrug-resistant TB has fallen from about $30,000 to under $300 through decades of advocacy, and maternal mortality in Sierra Leone has dropped by over 60% in ten years; he argues that such progress is slow, unglamorous and real, and that today is the middle of the story, not the end.

What is said

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

00:00:00 — Pizzamas shirts, reply to Hank's Wikipedia talk-page story, and the question of whether hope is justified

  • ★★ John praises the Pizzamas shirts, available only for the next 10 days at pizzamas.com. — 00:00:00 · Pizzamas
  • ★ John thanks Hank for recalling that the talk page of his proposed Wikipedia page said having a notable brother does not convey notoriety; Hank may be the more notable brother today, but John will always be the first notable brother in the eyes of Wikipedia editors. (playful) — 00:00:00 · Wikipedia, Hank Green

00:00:29 — The cost of curing multidrug-resistant TB, from supportive care and $30,000 to under $300

  • ★★ John has been thinking about whether hope is justified, and specifically about two very hopeful stories that have not been in the news, and why. — 00:00:29 · hope
  • ★★★ In the 1990s the WHO-recommended therapy for MDR-TB was supportive care, meaning waiting for patients to die; curing it in poor communities was seen as impossible and too costly at about $30,000. — 00:00:29
  • ★★★ Partners In Health treated MDR-TB in Peru, proving it curable in a famous Lancet study; costs then fell to about $3,000, since none of the drugs were under patent, and the WHO began recommending treatment. — 00:00:58 · Partners In Health
  • ★★ John says this was good news for everyone, since stopping chains of infection meant people, potentially including the viewer, never got MDR-TB. — 00:01:27
  • ★★★ John says advocates, including many viewers, kept pressuring governments and drug companies to lower the price, famously pressing Johnson & Johnson to abandon evergreening its bedaquiline patent. — 00:01:27 · Nerdfighteria
  • ★★ John says that since bedaquiline went off patent its price has dropped by about 60% in just two years. — 00:01:56
  • ★★★ A couple of weeks ago the Stop TB Partnership announced that curing MDR-TB now costs less than $300, a price drop of over 99% since PIH began proving it curable in poor communities. — 00:01:56 · Partners In Health

00:02:26 — The 2025 Pizzamas pin subscription, starting with Frankenstein

  • ★★★ John calls it a concrete example of life getting better for the most vulnerable through broad, decades-long collaboration: too slow and still insufficient, but real. — 00:02:26 · collective action, progress
  • ★★★ John says for some reason this is not news: he has not seen it reported anywhere, though he pays attention to tuberculosis news. — 00:02:26 · tuberculosis
  • ★★ John plugs the 2025 Pizzamas pin subscription: monthly bookplates featuring John and his mustache as a different literary character each month, beginning with Frankenstein. — 00:02:26 · Pizzamas
  • ★ John remarks that Frankenstein is a very tubercular novel, but that is another story. — 00:02:26 · tuberculosis

00:02:55 — Maternal mortality falling globally and much faster in Sierra Leone; Koidu Government Hospital and the role of viewers

  • ★★ John says the subscription is the only way to get Pizzamas all year round. — 00:02:55 · Pizzamas
  • ★★★ John's second under-covered story is the massive reduction in maternal mortality in what used to be the epicenter of that crisis. — 00:02:55 · maternal death
  • ★★★ Globally maternal mortality has fallen only slowly since 2015, even worsening the year after COVID emerged as health systems were strained: about 23% in the last 10 years. — 00:02:55 · maternal death, COVID-19 pandemic
  • ★★ John calls that progress kind of uninspiring, not least because progress in the decade before was faster. — 00:03:24 · maternal death
  • ★★★ John says that in Sierra Leone over the same period maternal mortality has dropped by over 60%. — 00:03:24 · Sierra Leone, maternal death
  • ★★ A decade ago Koidu Government Hospital in Kono had no 24-hour electricity, running water, blood bank or working x-ray machine, few medicines, little or no paid staff, and so very few patients. — 00:03:24 · Koidu Government Hospital, Sierra Leone
  • ★★★ John says the hospital now has all of that and much more, and as a result maternal mortality there has declined precipitously. — 00:03:53 · Koidu Government Hospital, maternal death
  • ★★★ John says maternal mortality at the hospital will decline further with the opening next month (November 2025) of the Maternal Center of Excellence there. — 00:03:53 · Maternal Center of Excellence, Koidu Government Hospital, maternal death
  • ★★★ John says this is primarily the result of the Sierra Leonean government investing in health and health workers, but private philanthropy, including all viewers, played an important role. — 00:03:53 · Sierra Leone, Nerdfighteria
  • ★★★ John tells viewers who bought a Pizzamas shirt, donated monthly to Partners In Health or encouraged others to care about maternal mortality that they played a role in this story. — 00:03:53 · Pizzamas, Partners In Health, maternal death

00:04:23 — Hope without denying outrage: the world can get better, today is the middle of the story, activism works slowly

  • ★★ John is sorry it is not front-page news and believes it should be, but says it is real cause for hope. — 00:04:23 · hope
  • ★★★ John says neither cause for hope should negate the many reasons for outrage: in many ways the world is getting worse, especially for the most vulnerable. — 00:04:23
  • ★★★ John is not saying progress is inevitable or that the world will get better, only that these two examples show the world can get better. — 00:04:23 · progress

  • ★★★ John's last reason for hope: our lives feel like a story from birth that ends today, but today is not the end of the story, it is the middle. — 00:04:52 · hope

    “Today is the middle of the story.”

  • ★★★ In Sierra Leone's strengthening health system and falling MDR-TB costs John sees how activism works: over many years, difficult, often unappreciated and unreported, but it works. — 00:04:52 · Sierra Leone

  • ★★ John says we can and will change the story, because the human story is always changing. — 00:05:21

Threads in this video

Where the stories that moved here went next

Mentioned

Central: hope · maternal death · multidrug-resistant tuberculosis · Sierra Leone

Also: Projects: Pizzamas

Works: Frankenstein · Pizzamas pin subscription

Organizations: Johnson & Johnson · Koidu Government Hospital · Maternal Center of Excellence · Partners In Health · Stop TB Partnership · The Lancet · Wikipedia · World Health Organization

Concepts: collective action · evergreening · generic drug · moustache · patent · progress · tuberculosis

Places: Kono District · Peru

Events: COVID-19 pandemic

Products: Bedaquiline

fact: global maternal mortality

Also centred on multidrug-resistant tuberculosis: Barely Contained Rage: An Open Letter to Johnson & Johnson · Talking Tuberculosis, GeneXpert, J&J, and more with MY HEROES · MASSIVE Tuberculosis News · End of a Rough Year · ITS ALL HAPPENING

Replies to

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