Good morning Hank, it's Tuesday.

Project for Awesome is this weekend, and the fundraiser is live now, but listen -

I know almost nothing about almost everything. I don't know how helicopters work or how to measure the distance between the stars, etc. etc., ad literally infinitum. But I do know a lot about tuberculosis, and how TB medication works, because I spent the last four years writing a book about tuberculosis. So I can't tell you about stars or helicopters, but I can tell you what's likely to happen when TB medication and diagnostics that have already been paid for rot in warehouses due to stop-work orders issued by the US government.

So a bit of background: Tuberculosis is a curable disease, but it's not easy to cure. The TB bacteria has a thick, fatty cell wall that's difficult to penetrate, making the bacteria hard to kill, so while a strep infection might be cured with like 7 days of antibiotics, TB requires several months of antibiotics.

In the past, it was common to take antibiotics even for years to cure the disease - like I have one friend who survived TB after taking between 20 and 30 thousand pills. But with the current standard of care, so-called "drug-sensitive tuberculosis" - that is, TB that responds to our first-line antibiotics - can be cured with between four and six months of daily therapy. TB that doesn't respond to one or more of those drugs, known as "drug-resistant TB", takes at least six months to cure and often much more than that.

Okay, here's the critical thing to understand about our fraught moment. If we interrupt TB care in the middle of that four or six or more months, it is potentially catastrophic, both on an individual level and on a societal level. First off, people who are on appropriate treatment almost never spread the disease, because the bacteria is too well-controlled to be infectious. But when people are not on appropriate treatment, TB is extremely infectious, like the average untreated case of TB will infect 10-15 more people per year. So if we suddenly stop treating TB - and in many communities, we have - we will see a sudden increase in disease prevalence. Worse still, even a brief pause in treatment gives the bacteria a really good chance of developing drug resistance, so if you go back a couple weeks or a month or three months later, and treat the disease with the same drugs that were working before, those drugs will no longer work.

This makes TB harder or impossible to cure on an individual level, but on a societal level, it's also catastrophic because it means more drug-resistant TB spreading throughout the world, and having more opportunities to develop further drug resistance, potentially leading to a situation where we have strains of TB that we just can't treat effectively, which is a truly terrifying prospect.

By one estimate, Hank, TB has killed about one out of every seven humans who have ever lived, but in densely populated communities, the statistics are even more sobering. Like in early industrial England, about one out of every *three* people were dying of tuberculosis.

And so, a resistance of tuberculosis, especially drug-resistant TB, is not a matter of like thousands of premature deaths, but millions, or tens of millions.

Right now the United States is the primary funder of tuberculosis response in impoverished communities, and I want to be clear, *that's not ideal.* I would like to see more wealthy countries participating more meaningfully in the fight against diseases of injustice. But it is absolutely devastating to watch as the US haphazardly and chaotically freezes all tuberculosis funding, which is functionally what's happened. And the US government can say that medicines are still flowing, but from Tanzania to Sierra Leone, I'm hearing over and over again from people on the ground who aren't able to access their TB medication - and again, that is a catastrophe, both for those individuals and for our shared human story.

I have friends asking me "How do I get my meds?" And I don't know what to tell them, because the supply chains are just frozen.

I want to be clear, there's no way individuals or philanthropy can step in and work at this scale, because in order to respond to the scale of the crisis, we need a size of at-scale logistics that only governments can provide.

So I feel utterly powerless as we watch us risk decades of progress against TB and other diseases of injustice, not for a lack of tools, but for a lack of political will.

In response to this, TB fighters in our community have been organizing call-a-thons and other responses, and I know that seems totally inconsequential but I've actually felt quite empowered talking to my senators and congresspeople, or their offices, on the phone. Someone has to make the case, and I'm grateful that we still have some say in our governance.

And while philanthropy can't replace the at-scale responses of USAID, supporting global health charities is more important now than ever, which is why I'm so proud that half the money raised during the Project for Awesome will go to Save the Children and Partners In Health.

Hank, I need the Project for Awesome every year, but I really, really need it this year. It's silly, it's fun, but it's also a serious fundraiser that's raised over 22 million dollars for charity in the last 19 years. Again, the fundraiser is live as of this moment, you can get lots of great perks including the first couple chapters of my next book. You can also get a signed frog postcard of a frog version of horizontal video sensation John Green. I mean, the perks are endless. You can find it all at projectforawesome.com/donate.

Hank, in the face of big global problems, especially when we risk reversing progress, it is easy for me to feel despair. I feel quite close to it at the moment, to be honest with you. But I really believe that despair is not the correct response right now.

In the last 25 years, we've reduced tuberculosis deaths by more than half. That progress is very much under threat at this moment, but that progress is still real and it's a reminder that progress is possible.

So Hank, here's to better days ahead and I will see you on Friday for the Project for Awesome.