Battling an ancient scourge

PHANTOM PLAGUE: How Tuberculosis Shaped History

Author: Vidya Krishnan

Publisher: Public Affairs

Price: $27 

Pages: 320

If only we had been willing to pay attention, nearly everything we needed to know to get through the Covid pandemic was right there before us.

A pathogen that lodges in people’s airways and damages their lungs beyond repair naturally thrives in cramped and ill-ventilated quarters where the poorest might live. Tools to fight it — vaccines, drugs — will be easily available in some parts of the globe, but out of reach of millions who need them elsewhere. The governments of most nations will bungle the most straightforward of public health messages and bury their heads in the sand as thousands die every day.

These are the lessons learned from millions of deaths and centuries of failures in tuberculosis, among the oldest of scourges to affect humans. The bacterium that causes tuberculosis was identified about 150 years ago, and drugs to treat it have been available for decades. And yet TB kills more than a million people each year. It was the biggest infectious disease killer before the coronavirus came along.

In 2020, deaths from TB increased for the first time in more than a decade to 1.5 million. And because of the coronavirus, fewer cases were diagnosed and treated in 2020 than in previous years, which will lead to even more deaths down the line. The coronavirus has not supplanted TB, but turned it into an even bigger threat.

In Phantom Plague, Vidya Krishnan lays out the long, maddening history of tuberculosis, from the days when it was called consumption to the urgent danger it presents today, when some TB bacteria are resistant to all available drugs.

We meet giants in the history of germs, like Ignaz Semmelweis, the cantankerous doctor who introduced the notion of hand washing for physicians, and more familiar names like Louis Pasteur, Joseph Lister and Robert Koch, who all advanced the understanding of infectious diseases.

Some of the tangents along the way are amusing. We learn, for example, that the terror of unidentifiable contagious diseases inspired tales of vampirism, including Bram Stoker’s Dracula, and that women’s hemlines rose by several inches in the early 1900s because doctors claimed that their trailing skirts swept up and pread bacteria.

But the book is, above all, a polemic against those in power who continue to neglect this well-known killer.

Ms Krishnan wrote the book over seven years, and aside from the updated introduction, describes the world before the coronavirus appeared. She could not have known then how painfully familiar some of the lessons from failed TB control would be in countries divided by public health measures like mask mandates and vaccines.

She writes, for example, that early-20th-century anti-spitting ordinances, which were passed to curtail the spread of TB bacteria, provoked a campaign of resistance. Far from persuading people to consider the welfare of others, “the constant barrage of behavior-change messages had begun to anger some men.” Even as one in seven Americans continued to die of TB, some men openly defied the rules, spitting on the very posters describing the bans.

Ms Krishnan spends a considerable amount of time describing what she refers to as “medical apartheid.” Richer countries have mostly wiped out the TB bacteria with powerful drugs, while in places like India, scores of patients die while waiting for a diagnosis and medication.

The same narrative is playing out now with vaccines and drugs for the coronavirus, so those chapters are even more relevant. But I could have done without the long forays into the intricacies of patent law.

Ms Krishnan’s writing is most powerful toward the end, when she introduces us to patients in Mumbai whose struggles illustrate the failures of the Indian government. India had 34 per cent of the world’s TB deaths in 2020, and the city of Mumbai is the epicentre of the disease there, so her choice makes sense.

I wished for a global picture of the disease early on — one that included places like Eastern Europe, where drug-resistant TB is rampant, for example. 

A more comprehensive picture of TB might have better justified its chronological history for the first third of the book. At its best, Ms Krishnan’s writing is clear and compelling, and the book is a worthy read for anyone interested in public health and infectious diseases.

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