Good morning, Hank.

It's Tuesday. So later this week I will be on Capitol Hill in Washington, DC to discuss tuberculosis with congresspeople, senators, and their aides.

In related news, there will be a major announcement on Thursday about our family's efforts to fight tuberculosis, which remains the world's deadliest infectious disease even though we know how to end it. We know how to end it on an individual level. TB is generally curable with a four to six month regimen of four different antibiotics.

But we also know how to end it on, like, a societal level. Like, when my great uncle Stokes died of tuberculosis in 1930, it was still one of the leading causes of death in the United States. In 1900 in the US, there were almost as many hospital beds for tuberculosis patients as there were hospital beds for all other health care problems combined. And now, while TB is still a problem in the United States, we've decreased the death rate by over 99%. We know how to do this. We've done it before.

And as Dr. Salmaan Keshavjee argues in this TED Talk that I will link to below, and I hope you have a chance to watch, the key boils down to an acronym - STP. First, search.

We need to find people with TB and diagnose them correctly. The WHO estimates that of the 10 million people who will get sick this year with tuberculosis, about 4 million will never be diagnosed. And when you're living with active, untreated TB, it's very easy to spread the infection.

Experts estimate that every year a person is living with active, untreated tuberculosis, the infection will spread to between five and 15 more people. And the reason these people go undiagnosed is because they simply don't have access to accurate screening and testing. In the United States, beginning in the 1950s, we built these x-ray vans and sent them out all over the country offering free chest x-rays to everyone so that we could identify cases of tuberculosis.

And it worked. Today we have even better technology. There are x-ray machines that can fit into backpacks, and we have super accurate, if still frustratingly expensive, tests like GeneXpert that can tell you within a couple of hours if someone has TB. But we need funds and systems to implement those technologies where they are most needed in order to actively screen for TB and identify those 4 million missed cases. Secondly, treat.

Every person diagnosed with tuberculosis should be able to receive curative treatment that is appropriate to their particular infection. Most people who receive treatment cease to be infectious within a week of their first antibiotics, and so getting people on treatment, in addition to saving lives, also stops chains of infection. The frustration of TB treatment is that it does require many pills given over many months.

But the promise of it is quite simple. This deadly disease can be cured. And if we make treatment available and appropriately support people through that treatment, they will almost always be cured. And the final letter of the acronym - prevent. Whenever anyone is diagnosed with TB, their close contacts should be offered what's called preventative therapy.

This takes a bunch of different forms, but the most common one is you take some pills once a week for twelve weeks, and then you never get active tuberculosis. You prevent the infection from ever taking hold. We've been doing this in the US for over 60 years, and it's a key reason why TB rates have plummeted here. And it is long past time to stop arguing that it's too expensive or complicated for impoverished countries.

That's simply not the case. The truth is, we can't afford not to implement comprehensive STP strategies in high burden TB communities, both on an individual level - there is absolutely no excuse for over a million people every year dying of a curable disease - but it's also true on like a societal level. I mean, every dollar we invest in TB care leads to $43 in economic benefit because more people are able to work and fewer people are sick or dying or tending to the sick or dying.

So, yeah, we've known how to do this since the 1950s. The challenge has always been resource allocation, because to really address TB, we need to strengthen the whole healthcare system so it can search for cases, treat the cases it finds, and prevent future cases. And I'll be the first to acknowledge that's not easy work.

We've seen how difficult that work is in our fight against maternal mortality in Sierra Leone. But in that fight, we're seeing huge results. Maternal mortality since 2019 in Sierra Leone has dropped by half. And so I believe in the possibility of change because I've seen the change. And ultimately, that's why I'm going to be in Washington, DC this week. Hank, I kind of see this as the biggest bet of my life, a bet that we simply don't have to accept a world where so many people are dying of a disease that no one should die of.

On Thursday, I hope to announce the beginning, and only the beginning, of that bet. If you're interested in the details, and more broadly interested in the details of upcoming efforts to fight tuberculosis in various ways, please check out our new TB Fighters newsletter. It was built by folks in Nerdfighteria.

It's available now at the link in the doobly do. It's got everything from, like, meditations on Emily Dickinson’s references to tuberculosis to talking about how we're going to end this stupid disease. So thanks to the TB fighters in our community who built that newsletter, it's really cool.

I hope you'll check it out. Links in the doobly doo. Hank, I'll see you on Friday.