John Green’s crusade to make the world “suck less”

Whether he is writing novels about young love, contemplating our species’ long-term prospects, or supporting public health projects abroad, John Green is driven by one mission: “I’m trying to make the case that humanity is worth it.”

It began with a YouTube channel, Vlogbrothers, in which he and his brother, Hank, an author and entrepreneur, exchanged messages with each other and their audience ranging from the mundane to the esoteric, and in doing so, nurtured a massive community focused on global problems.

John Green’s 2012 young adult novel, The Fault in Our Stars, became one of the best-selling books of this century and propelled him to celebrity status, giving him the metaphorical equivalent of a “giant robot suit,” as he put it in his characteristically nerdy parlance. With the newfound fame, the brothers aspired to make the world “suck less.”(Green credits their parents, both activists, for that passion.) 

In the intervening years, their YouTube following has grown to 3.8 million, and they have become genuine forces in global health philanthropy, organizing massive fundraising drives for their chosen causes and confronting global pharmaceutical giants. These interests have inspired Green’s creative pursuits, including the podcast The Anthropocene Reviewed and its follow-up book, both of which grapple with the world as humanity has made it. 

His next book, Everything Is Tuberculosis, which is set to come out in March, will center on Green’s latest obsession: TB, the infectious disease that kills more people than any other. Last year, Green launched a successful campaign to pressure pharmaceutical company Johnson & Johnson to stop reported patent abuses that were inflating the cost of a lifesaving tuberculosis drug. He has also raised more than $35 million for a Partners in Health project to reduce maternal mortality in Sierra Leone, which until recently had the highest rate of women dying in childbirth in the world. That money will help pay for a new government hospital set to open in the coming months.

Green and I spoke in October about his humanitarian work, how it has complicated his awkward relationship with celebrity, and why he retains a stubborn optimism about humankind.

You started vlogbrothers with this idea that “We want to make the world suck less.” How do you conceptualize why the world sucks?

There are ways that the world sucks that the world just sucks. This species has been around for 250,000 years; for 249,800 of those years, about half of children died before the age of 5. That just sucks. It’s completely unfair. It’s wildly unjust. But there was nothing that we could do about it. 

The ways the world sucks that most interest me are the ways the world sucks because of human-built systems, because those problems have human-buildable solutions.

Your forthcoming book is called Everything Is Tuberculosis. What does that mean exactly?

Tuberculosis is the deadliest infectious disease in the world. It kills about 1.3 million people every year. It’s gonna kill over 100,000 people this month. All of those deaths are needless because we’ve had the cure to tuberculosis since the mid-1950s. 

What does it mean to live in that world? What does it mean to live in a world where the deadliest infectious disease has been curable since my father was born? 

It means that we’re doing an extraordinarily poor job of distributing resources. Our systems of marshaling and distributing resources have obviously failed in this case. It’s clearly a human-built problem that has a human-buildable solution, which is encouraging to me. We are the cause of tuberculosis, which also means that we can be the cure of tuberculosis.

When I say in the book title that everything is tuberculosis, I really do mean it. Tuberculosis radically shaped American geography. It’s the reason that cities like Pasadena and Colorado Springs and Asheville, North Carolina, exist. It’s the reason New Mexico is a state. It’s one of the reasons World War I happened. It radically reshaped almost everything about our lives. It’s been this quiet force throughout human history that’s pushing us this way and that, that we often don’t notice, but it’s a really, really profound force in human history.

I just listened to your podcast episode about humanity’s temporal range. I’ve more than once heard you describe how your existence would be completely unrecognizable to somebody who lived a couple of centuries ago.

Why is it so challenging for us to remember that context, the long history that has created the world in which we now live?

Well, in the dreary grind of daily living, as I think Robert Penn Warren called it, it’s really hard to remember historical context because we’re busy trying to pay the mortgage and trying to make sure our kids get to school on time and trying to get them to eat some breakfast before they go. I feel that too. Believe me, I struggled to get my kids to eat breakfast this morning.

It’s so easy to feel hopeless in our current moment. I’m someone who’s unusually prone to despair. Maybe I’ve been fighting this for a long time, which is why I’m so focused on it. Part of the reason we feel despair is because we don’t see long-term change when we’re just looking at crisis after crisis after crisis after crisis. 

When I try to contextualize my life and the world and our place in that world, I feel more hopeful because I see more examples that give me cause for hope. In the last 30 years, we’ve reduced child mortality by over 50 percent, the fastest decline in human history. 

Yet, the last 30 years have sucked terribly. Both of these things are true at the same time and holding those competing ideas together is really challenging, but I also think it’s essential.

You’ve touched on something I wanted to ask you about, that I think about a lot. I have three kids under the age of 6. They are ignorant of all of the world’s problems. 

God bless you.

Something that we talk about at Future Perfect is the perception among a lot of young people that the world sucks, that it’s getting worse, and that it could end catastrophically, maybe even pretty soon, whether that’s because of climate change or some other existential risk. 

What do you hear from your audience about their outlook on humanity’s future and how do you respond to their concerns? How do you resolve that tension for yourself?

A lot of the people I hear from feel very hopeless and very scared, and they do feel like the world sucks and is getting worse. In important ways, they’re right, and I think it’s really important to acknowledge that they’re right. I don’t know what it’s like to have my high school graduation ruined by a global pandemic. I don’t know what it’s like to see housing and education and health care all become progressively less affordable than they’ve ever been. I don’t know what it’s like to grow up in the world that they’re growing up in.

At the same time, they don’t know what it’s like to grow up in a world where 12 million kids die every year before the age of five, whereas now fewer than 6 million do. When I talk to young people about this, I try not to minimize their concerns because I think their concerns are real. Climate change is a catastrophe and it has the potential to be a catastrophe beyond our current imagining. There are profound and growing inequities in our world today. That’s all real.

But at the same time, it is also true that people have been predicting the end of the world since the moment that they realized the world might end. By the end of the world, of course, I don’t mean the end of life on Earth. Life on Earth will be just fine without us — arguably, from its perspective, better. I mean the end of humanity in the world. 

I’m very afraid of that. It’s my biggest fear because I think we are good news or have the potential to be good news. It’s my biggest fear because I think we’re the most interesting thing that ever happened to this planet. It’s my biggest fear because I love humanity and I think we’re worth fighting for.

What exactly is the human endeavor?

We started out, as I think somebody once put it, as an animal of no consequence. Now we know approximately what’s keeping the stars apart and approximately how far away our star is from our planet. We know that we’re on a planet and we know that we can read Hamlet anytime we want. We can listen to Billie Holiday records and communicate with the dead. 

That’s a pretty impressive series of accomplishments to me and I think it’s worth celebrating. That’s what I mean by the human endeavor: the overall attempt by each member of our species to take care of each other and to push us forward in our knowledge and understanding of the world.

I find our ability to make art everywhere all the time, no matter what, really fascinating and really encouraging. My son and I were just on a tour of World War I battle sites last week, and we saw all of this so-called trench art, which is art that was made in the trenches by soldiers on both sides of World War I, often taking exploded shells and carving onto them beautiful sunrises or landscapes or portraits. Some of these works of art are astonishing and nobody made those works of art hoping to get rich. Nobody made those works of art hoping to find an audience of millions of people. They made those works of art because there was value in the making and value in the sharing even if it was only sharing it with your buddies in the trenches.

Last year, you targeted Johnson & Johnson for its patent practices and artificially inflating prices for life-saving treatments. That is a different tactic than encouraging people’s curiosity, empathy, and optimism. When is confrontation the right approach?

I really dislike any form of confrontation, including confrontation with big pharmaceutical companies that have a lot of power and employ a lot of nice people. I find that very stressful. 

But when Doctors Without Borders and Partners in Health and Treatment Action Group were all reaching out saying this is a huge problem and it’s making it really difficult for us to get the medicine to the people we need to get it to, I felt like I had to listen. I’m a big believer in listening to people who know a lot more than I do. That’s kind of the foundational concept of my philanthropy. 

I’ll be honest, I tried to have some private conversations [with Johnson & Johnson], and they didn’t go anywhere. So then I felt the only conversation I can really have is a public conversation.

I was thinking about the people I’ve known who died of drug-resistant tuberculosis and feeling angry on their behalf, feeling frustrated by the systemic failures on their behalf. Maybe that gave me a little more strength of conviction than I might otherwise have had.

What is your project with Partners in Health in Sierra Leone?

Our project is centered around the maternal mortality crisis, which is also a child mortality crisis because children are much more likely to die or otherwise experience serious disability and serious illness if their mothers die in childbirth. At the time we started this in 2019, Sierra Leone had the highest maternal mortality rate in the world. About one in 17 women could expect to die in pregnancy or childbirth, which wasn’t that different from the rate we would have seen 500 or 5,000 years ago. 

One of the arguments that Partners in Health and our community wanted to make is that there are no excuses for not expanding access to maternal health care. That means not just in Sierra Leone — it means everywhere. But our hope is that this project could provide a blueprint for how to do that with more community health workers, with more nurses, and also ultimately with a world-class maternal care center at Koidu Government Hospital. That is where the lion’s share of the money that we’ve raised so far will go.

For the first time, there will be a neonatal intensive care unit (NICU). There will also be adequate operating theaters for emergency C-sections. So many people die in Sierra Leone for want of an emergency C-section, or they die because they have high blood pressure, or they die because of hemorrhaging after giving birth. All things that are very treatable in rich countries and that should be treatable no matter who you are or where you live.

Five years ago, when you were announcing your and Hank’s initial $6.5 million donation to Partners in Health for the Sierra Leone project, you said you were trying to take lessons that you had learned from earlier philanthropic ventures and apply them to this effort in Sierra Leone. Now that you’ve had five more years of experience trying to stand this up, what else have you learned?

The biggest thing I’ve learned is that when you get community buy-in, things go much better than when you don’t.

Most of the people building the Maternal Center of Excellence are women. Most of the welders, the masons, the steel workers. But they all had to be trained. I had no idea about the complexity of that. That was something that never crossed my mind, that you’re going to need to train up a workforce alongside building a hospital. Now that turns out to be an amazingly good investment because those people now have skills that they’re going to take with them the rest of their lives. 

People from rich countries or especially rich individuals kind of come into a community thinking that they have the solutions, which generally means that they don’t really understand the complexity of the problems. 

How do you know when your work is effective?

We’re obsessed with quantifying the good that we’re doing, with testing it, with making sure that we can evaluate kids and making sure that we know that they’re learning what we think they’re learning. 

The risk is that it’s easy to conflate what is important with what is easily measurable. We need to be very careful not to apply what’s easily measurable and assume that it is therefore what’s most important. 

The obvious way that we measure the success of this project is by how many kids are surviving childbirth and how many mothers are surviving childbirth. But I also think you need to look at what, if anything, is the overall effect on reducing poverty. Is it improving educational access? Because we know that kids are more likely to be in school if their moms survive childbirth, but we haven’t yet proven that lower maternal mortality will lead to higher educational attainment.

I want to look at that through a 20- or 30-year lens, not through a three- to five-year lens. I’m pretty tired of health care interventions that attempt to prove something in 18 months or with a three-year grant.

What do you think is the biggest blind spot people today have that future generations will look back on and think, “What were they doing?”

I think there are a lot of ways that people in the future will look back on us and think, “How did they do that?” The way that we think, “How did they let everybody smoke on airplanes?” The way that we treat non-human animals, especially the animals that we consume as meat, will be one. 

The ways we distribute resources and build systems will be another. I hope people of the future will be absolutely astonished that within a single country, depending on your zip code, your life expectancy could vary by 25 or 30 years. I think people will be astonished that there were places where health care systems were so robust that someone like my brother could get diagnosed with cancer and be in remission within six months and other places where somebody diagnosed with that same cancer would be dead within six months.

What advice do you have for ethically minded people who are trying to figure out how to contribute to this project of improving humanity?

First, it’s so easy to get overwhelmed and have decision paralysis. There are so many problems and there are so many people trying to address them and it can be so hard to know who’s addressing them most effectively or what the problems beneath all the other problems are. And that’s okay. I think it’s okay to pick a problem and trust that other people are going to be addressing other problems with the same passion and interest that you’re addressing yours. 

I don’t labor under the delusion that tuberculosis is the biggest problem in the world or that it’s the only problem that we should be paying attention to. I just think it’s one that we should be paying attention to and it’s the one that I happen to pay attention to. 

My second piece of advice would be don’t listen to the doomsayers. Don’t buy into the people who are telling you that none of this matters because it’s all worthless anyway. 

That’s a really compelling ethical argument in some ways because it’s so simple, it’s so straightforward. “This is all dumb.” “None of it matters.” “We should give up” is chef’s kiss from the perspective of wanting to have an explanation that has extraordinary explanatory power. 

The problem with despair, of course, is that it’s untrue, like any super-simplistic worldview. Fight against despair and believe that together we can make the world better for each other.

Please do not judge me: I love U2, and therefore I love Bono. I think he’s a notable example of how perilous this transition can be from pop-culture curio to being an actual expert who can influence even more influential people.

Yeah, I think about Bono a lot.

Okay, there you go. How have you managed that transition?

I want to approach it with real humility because you can do so much unintended damage when you have a lot of power and when you have a really loud voice. It’s so easy. 

My brother described it to me once as having a giant robot suit. I have this giant robot suit and it makes me super powerful. But when I walk around, it’s really easy for me to step on houses.

I’ve been given a lot of power, and I don’t think that I should have it, to be honest with you. I think that our social order gives way too much power to celebrities, even like seventh-tier celebrities like myself. It freaks me out and I think we should be freaked out by it. I just try to remember that I’m very, very rarely the smartest person in the room.

Do you see a unifying thread across your work, from The Fault in Our Stars to The Anthropocene Reviewed and Vlogbrothers to the maternal health project in Sierra Leone?

I’m trying to make the case that humanity is worth it. That humanity is worth the trial and travail and suffering and injustice and oppression, the catastrophe and horrors that we visit upon ourselves and each other. That, despite all of that, it’s a blessing to be here and humanity can be good news. I really believe that. I don’t know that we are good news, but I think we can be.

I don’t want to sound too pretentious about it, but I need to make that case for myself as much as I need to make it for anybody else.

What do you mean by that?

I’m very prone to desperate hopelessness, and I need every morning to be able to make the case to myself that it’s a good idea to get out of bed and go on.

You talk about resiliency being one of humanity’s defining traits.

I love how resilient we are. We’re so underrated as a species, Dylan. It drives me crazy. Does anybody think raccoons would be better at having this kind of power? Does anybody think dolphins would be better at having this kind of power? Have you read about dolphins? 

Which is not to say in any way that we aren’t terrible. I want to be clear that I’m very pissed off. I’m infuriated by humanity’s many failures. What kind of insanity is it to have the deadliest infectious disease in the world be something that we’ve known how to cure for 75 years? That’s monstrous.

It’s just that we rate ourselves so lowly. There’s a lot to recommend about us.