John Green’s journey to becoming a leading advocate for wiping out tuberculosis worldwide has its roots in another of his philanthropic interests: the health of mothers and infants in Sierra Leone.
The Indianapolis-based author didn’t have many thoughts about the infectious disease until he visited Sierra Leone in 2019 to learn more about why the African nation ranked last among 183 countries for maternal mortality rate.
Green and his brother, fellow author Hank Green, led a $25 million fundraising initiative for improved health care in Sierra Leone, where one in 20 women dies in childbirth. The initiative is one of the Greens’ many philanthropic projects, which have included Project for Awesome, a telethon-style fundraiser on YouTube that started in 2007 to raise money for multiple charities.
It was in Sierra Leone that John Green said he “met a young man who was very sick with multidrug-resistant tuberculosis.” Henry, the teenager in Sierra Leone, has the same first name as Green’s adolescent son.
“Like a lot of people I talked to, I thought tuberculosis was a problem of the past,” said Green, author of popular novels such as “The Fault in Our Stars” and “Looking for Alaska.” “In following [Henry’s] story over the last five years, I’ve become deeply invested in how to better treat this totally curable disease.”
In the United States, TB—a major cause of illness and death through the 1940s—is mostly an afterthought, thanks to medicine and public health measures. In 2021, 602 Americans died from tuberculosis, according to the World Health Organization. Worldwide, however, more than 1 million fatalities were blamed on tuberculosis in 2022. Only the coronavirus pandemic claimed more lives.
Green said it’s difficult to understand why TB, which affects the lungs, is curable but still prevalent in countries such as India, China and Nigeria. In September, the author spoke about the disease at the United Nations.
“Twenty-three years ago, Dr. Peter Mugyenyi, in a room very much like this one, said of HIV medications, ‘Where are the drugs? The drugs are where the disease is not. And where is the disease? The disease is where the drugs are not,’” Green said in his address to world leaders. “That is the situation that we are in today with tuberculosis: The cure is where the disease is not, and the disease is where the cure is not.”
The Green brothers leverage money to tackle maternal mortality in Sierra Leone. When fighting TB, they’ve found success by leveraging influence. John and Hank Green make videos for a YouTube channel titled “Vlogbrothers,” which has racked up more than 998 million views since its 2007 debut.
Last year, John Green encouraged his audience to pressure New Jersey-based Johnson & Johnson to allow generic versions of its patented TB drug, bedaquiline, in low- and middle-income countries. Using a similar tactic, he encouraged his audience to pressure San Jose, California-based diagnostics company Cepheid and its parent, Washington, D.C.-based Danaher, to reduce the cost of rapid tests for multidrug-resistant TB.
Green acknowledges that the grassroots efforts of the “Vlogbrothers” audience, collectively known as Nerdfighteria, followed established health organizations calling for change. But it’s also true that Johnson & Johnson relented on the patent issue, and Danaher reduced the price of tests 20%, after Nerdfighteria became involved.
At 46, Green has described himself as being “retired” from writing the young adult fiction of best-sellers “Turtles All the Way Down” and “Paper Towns.” His 2021 book, “The Anthropocene Reviewed,” was a compilation of nonfiction essays on topics ranging from Lascaux cave paintings to Diet Dr. Pepper.
Up next is a deep dive on tuberculosis, he said.
“It’s nonfiction,” Green said of a book likely to be released in early 2025. “It’s a history of human responses to tuberculosis intertwined with a contemporary story of one person’s experience.”
Fahmi Farah, a Dallas-based physician and co-founder of the Global Health Alliance Foundation, said U.S. residents should be aware of tuberculosis and its threat.
“Before, I think people just didn’t care that much because it was not in the Western world as much, and it was considered to be contained in a certain area,” Farah told IBJ. “But we live in a very global world. What’s happening very far from us is not really very far, because it’s going to travel to us.”
The Green brothers have helped send charitable donations around the world since they launched Project for Awesome. The annual event has raised about $12 million for various causes, and the 2024 edition is scheduled for Feb. 16-18.
In Sierra Leone, the Green brothers work with Partners in Health—a long-running beneficiary of Project for Awesome funds. It’s a group John Green notes has helped to build health care systems from Haiti to Rwanda.
But money the Green brothers raise for Partners in Health Sierra Leone doesn’t come from Project for Awesome. John and Hank Green and their families donated $6.5 million toward the $25 million initiative announced in 2019.
A new maternity center, the Maternal Center of Excellence, is expected to open this year thanks to a public-private alliance between Partners in Health and the Sierra Leone government.
John Green returned to Sierra Leone last year to see the Maternal Center of Excellence under construction.
“I don’t want to try to bring the solution,” Green said. “I’m not an expert. I’m a novelist. But I want to listen to the experts and learn from them.”
The health care system of Sierra Leone, a country about the size of Maine on the western coast of Africa, was debilitated by a civil war in the 1990s and an Ebola epidemic a decade ago.
At the time the Green brothers announced plans to raise money for the Maternal Center of Excellence, one in 17 Sierra Leonean women was dying in childbirth. Today, the statistic is slightly improved, to one in 20.
The Maternal Center of Excellence will open in Kono District in the eastern part of the country.
Mohamed Morchid, head of mission for Doctors Without Borders, told IBJ about his organization’s work in Sierra Leone’s Kenema and Tonkolili districts that border Kono to the west and south.
Morchid said the country’s rainy season from July through October affects rural roads and presents challenges in transporting expectant mothers to health care facilities.
“Cars or buses or public transportation is not available,” he said. “Most of the time, the only way is motorbikes.”
At the health care facilities, there’s a shortage of doctors, nurses and lab technicians, Morchid said.
“The gap is one of availability of human resources in number and also professional experience,” he said. “There’s also a gap in medical supplies, especially for the free health care initiatives the government is committed to.”
The Green brothers are working on a way to help support the Maternal Center of Excellence once it opens. By selling subscriptions to clubs for coffee, socks and bars of soap at a website billed as the Good Store, John and Hank Green have donated more than $4 million to the cause.
“It’s not like the building opens, all these nurses and doctors and community health workers are hired, and the need for funding goes away overnight,” John Green said before a Jan. 18 State of Tourism event presented by Visit Indy at the Indiana Convention Center, where he received the Bill McGowan Leadership Award for his efforts to promote Indianapolis. “We hope that, over time, the government will become stronger and the health care system in the country will become stronger. But it’s going to take a tremendous amount of support.”
Green credited his brother, a Montana resident who received treatment last year after being diagnosed with Hodgkin’s lymphoma, for suggesting the subscription clubs.
“Hank had this idea to do subscriptions, because the money comes in every month,” Green said. “We call it the Newman’s Own model. Newman’s Own [founded by actor Paul Newman in 1982] is a great company that donates all their money to charity.”
As an author with more than 50 million books in print worldwide, Green knows tuberculosis isn’t a trendy topic.
“I’ve definitely cornered a lot of people at cocktail parties to talk to them about tuberculosis and had them say, ‘Huh. OK,’” Green said. “It may seem like a weird thing for a [young adult] novelist to do, but it doesn’t feel weird to me. It feels like an extension of the work I’ve been trying to do for the last 15 years.”
Farah, the doctor based in Texas, said Green’s voice is welcomed in the discussion of health concerns.
“A person of influence can get messages across to the mass public,” she said. “Where we lack, in my opinion, in the United States when it comes to the field of medicine—not just tuberculosis—is public education. We really fall short on that, so a celebrity talking about key things that aren’t so prevalent can make a big difference.”
India accounted for 27% of tuberculosis cases in the world in 2022, according to the World Health Organization. There’s no lack of awareness in that country, Farah said.
“They have hospitals dedicated to tuberculosis,” she said. “Those are completely segregated because of how infectious this is and how it spreads very quickly. It’s airborne, so you don’t even have to be in close proximity as long as the patient is in the same building. The entire building can get contaminated unless the patient is in a restricted, airtight room.”
German microbiologist Robert Koch discovered M. tuberculosis, the bacterium that causes TB, in 1882. When speaking at the United Nations, Green referenced the nearly 150 years that have passed since Koch’s discovery.
“Maybe it was possible to say in the 19th century that death from tuberculosis was caused by a bacterium called M. tuberculosis, but we can really no longer say that,” Green said in New York. “Today we have to accept the reality that, since we know how to kill that bacteria, we know how to cure this disease. Today, we have to accept the reality that death from tuberculosis is caused by human-built systems, by human choice.”
Before the Green brothers raised money for improved health care in Sierra Leone, John Green traveled to Ethiopia in 2014 as a guest of Bill Gates to learn more about that country’s needs for access to clean water.
Green challenged his audience to raise $100,000 for Ethiopian assistance, and Gates pledged a matching donation if the goal was reached. The members of Nerdfighteria contributed $220,000.
“He helped me think about the importance of health care systems and finding ways to be supportive,” Green said of the influence of Gates, co-founder of Microsoft.
Chicago-based author Keir Graff met Green when they worked as editorial assistants at Booklist magazine before the publication of Green’s debut novel, “Looking for Alaska,” in 2005.
“I remember a news item about him being in Africa with Bill Gates,” Graff said. “I kind of shook my head and thought, ‘Of course, if that’s going to be anybody I know, it’s going to be John.’”
Graff, who writes books for adults and young readers, including 2023 collaboration “Minerva Keen’s Detective Club” with James Patterson, said he admires Green’s approach to dealing with his celebrity.
“It’s extreme success, the kind of success that most authors dream of,” Graff said. “And many authors don’t handle it well. The thing that really impresses me about John is the way he’s navigated that level of success and celebrity and attention. I think he’s done it about as well as anybody could. Rather than being more self-absorbed, he’s really turned the opposite way. It seems to me that he’s really trying to use his success to help other people and to bring attention to worthy causes.”
Mainstream buzz related to Green has dissipated since the 2014 blockbuster film adaptation of “The Fault in Our Stars,” a project that landed the author onstage at the MTV Movie Awards.
Another round of intense attention could accompany the release of a movie adaptation of Green’s 2017 novel “Turtles All the Way Down.” On Thursday, he announced a Feb. 8 appearance at a television festival in Georgia, where Green and director Hannah Marks will share a sneak peek of “Turtles” before it debuts on the Max streaming platform. A release date has yet to be announced.
Fame and fortune aren’t the goal, he said.
“There’s not a ton of fulfillment for me in just having more,” Green said. “It just doesn’t get me excited. What gets me excited is the thought of having more impact, getting to work with interesting people and getting to learn.”
Tuberculosis, cited by Harvard Library as the cause of about 40% of working-class deaths in American cities in the late 1800s, has proven to be a vast study topic.
“It’s been hugely fun to learn about this extremely strange disease that occupies such a central part of our history,” he said. “I find that really fulfilling. For me, life is about wanting to do cool stuff with interesting people. That’s just what I’m trying to do.”•