The Phantom Plague: How Tuberculosis Shaped History

by Vidya Krishnan

Harvard Public Health Magazine,  Best Public Health Books and Journalism of 2022

The definitive social history of tuberculosis, from its origins as a haunting mystery to its modern reemergence that now threatens populations around the world.

It killed novelist George Orwell, Eleanor Roosevelt, and millions of others – rich and poor. Desmond Tutu, Amitabh Bachchan, and Nelson Mandela survived it, just.  For centuries, tuberculosis has ravaged cities and plagued the human body. 

In  Phantom Plague , Vidya Krishnan, traces the history of tuberculosis from the slums of 19th-century New York to modern Mumbai. In a narrative spanning century, Krishnan shows how superstition and folk-remedies, made way for scientific understanding of TB, such that it was controlled and cured in the West. 

The cure was never available to black and brown nations. And the tuberculosis bacillus showed a remarkable ability to adapt – so that at the very moment it could have been extinguished as a threat to humanity, it found a way back, aided by authoritarian government, toxic kindness of philanthropists, science denialism and medical apartheid.

Krishnan’s original reporting paints a granular portrait of the post-antibiotic era as a new, aggressive, drug resistant strain of TB takes over. Phantom Plague is an urgent, riveting and fascinating narrative that deftly exposes the weakest links in our battle against this ancient foe. 

Genres: Nonfiction, History, Science, Medical, Medicine, Audiobook, Health

320 pages, Hardcover

First published February 1, 2022

Reviews

[🩶 April • A.M. Flynn • 🩶 · Rating 4 out of 5]

Some scary history and information. i love medical non-fictions.

[Steve · Rating 4 out of 5]

I had mixed feelings about this book and if I could, I would rate it 3.5 stars. I feel that the content is important and that it clearly shows existing inequities in healthcare, which would gain it a 5-star rating. While the book focuses on India, its lessons are broadly applicable to the developing world. All this made the book a compelling read. On the other hand, there was not a lot of science in the book and it strayed away from tuberculosis in order for the author to make points about current economic structures. I also did not enjoy the tone of the book which came across as pontificating, so much so that even when I agreed with the content, which was quite frequent, I was still ready to put down the book several times, hence the lower star rating. There are better books on tuberculosis out there, including Catching Breath by Kathryn Lougheed (which I received as an advance reader copy from the publisher). Thank you to Netgalley and PublicAffairs/Bold Type Book for the advance reader copy.

[Edith · Rating 3 out of 5]

5 stars for importance; 2 1/2 for execution. Ms. Krishnan is not a great writer; the information she retails is jumbled and sometimes repetitive. Fact checking seems to be a little weak: Jane Seymour was not the mother of Elizabeth I, and opinion is not settled as to the cause of Jane Austen's death. It is an esthetically unpleasing book. Angry books often are. However, in my opinion, she is right to be furious, and it's a book that should be read, and widely.

This book details the catastrophe that is global TB care. Even if you did not believe the details Ms. Krishnan provides, a person with any experience in how the goods of the world get apportioned would have guessed how distribution of effective TB treatments would be made. You might not, however, have guessed how completely these drugs are restricted from the poor and resourceless who need them, and how much more freely available they are to those with resources, especially in India, and especially in Mumbai, which appears to be the world capital of TB infection (and drug resistant TB, and multi-drug resistant TB).

Ms. Krishnan's indictment of Big Pharma, and the various forms of defending their intellectual property, as these companies fight to preserve their rights in drugs that make them thousands with every course of TB medication (but might be given to patients for much less) resonates particularly well at the moment in history. Her account of their doings, as well as the actions of governments and legal entities, is well worth reading.

If not otherwise motivated to do so by common compassion, why should the US and other developed countries care about what is happening in India? Because as life has recently illustrated, bacteria and viruses do not observe international borders. Drug resistant TB will be more than a phantom plague if we do not stop it where it now lives. I hope a better book on this extremely important subject appears; perhaps Ms. Krishnan herself will write it.

[laurel [the suspected bibliophile] · Rating 4 out of 5]

Less a look at tuberculosis and its place in history and more an examination of the unequal structures of the global health economy as it impacts Black and brown communities in India, China, and other high-poverty, high-population communities.

While there are several glaring errors (Jane Seymour did not give birth to Elizabeth I) that should have been caught during content edits, this contains a wealth of information, context and recommendations on how to adjust healthcare to help the patients and not line pockets.

Patent law, ethics, medical experiments, government responses to pandemics, and other diseases are addressed at length, showing the long-ranging impacts of colonialism, capitalism and white supremacy upon the rest of the world.

At its core, it is a chilling look at the resurgence of a once "vanquished" foe.

[Armita · Rating 4 out of 5]

Forget about reading horror fiction- this one is probably scarier than anything Stephen King has ever written.

[Tony Cundell · Rating 3 out of 5]

When I read the statement in the book that Jane Seymour was the mother of Elizabeth Tudor, I questioned the accuracy of the book. When I checked the references and found the vast majority were for websites not books, publications, scientific articles, etc it confirmed that the book had a low level of accuracy so was more an opinion piece that a well researched book.

Also there was no mention of Waksman discovery of streptomycin. A huge omission.

[Jennifer Mangler · Rating 2 out of 5]

This book was not what I was expecting. I was expecting a thorough history of tuberculosis. This was not that. The main focus of the book was on the TB epidemic in India. While I found that information fascinating (and now want to learn more about this), I couldn't help but be disappointed as I was expecting a more historical look at the disease. I rated it 2 stars because the title and description do not necessarily match the content.

[Ali · Rating 4 out of 5]

"Poverty is the disease. TB is the symptom. The global fight against TB will be won, or more likely, lost in India. "

Honestly the cover for this book is not doing it any favours - underneath the staid exterior is a lively, high level, engaging social history of TB, not a medical or academic history. Krishnan had a journalists style, with a lot of context - digressions include the history of germ theory and the basics on the Tuskegee Syphilis Trials. It is in the second half of the book, however, where she sharpens her focus to the constellation of factors which has led to a massive expansion in drug-resistant TB in Mumbai. She weaves history, policy analysis together with the stories of TB survivors and activists. This specificity is, I think, the most successful part of the book as it is in these very specific stories that the scale of the catastrophe - not just with TB but will all infectious diseases - really becomes apparent. While overcrowding, growing wealth inequality and the rise of religious fundamentalism all factor into this story, her deepest condemnation is for the patent system which prevents global access to medication, and inevitably ensures the survival of adaptable viruses and bacteria. I did not realise that India's patent laws had traditionally defied the US-led market approach (although as with many things I learn, other things make more sense now!) and this was strangely cheering to know, even as it is under sustained attack. Finally, Krishnan leans in to the heroes here, making this a hopeful book, even amid the subject matter

[Jeff Kirchner · Rating 2 out of 5]

Not the book I was expecting to read

As a physician who spent my entire career caring for patients with HIV disease and a strong interest in Infectious diseases including TB this book was literally all over the place, clinically inaccurate at times and was too much of a political diatribe. I am all for global health equity. Will we ever see it - even in the United States. Sadly No. Find a new title for this book.

[Manish · Rating 3 out of 5]

Phantom Plague is an important book. . The introductory chapters on Koch, Pasteur and Semmelweis were interesting but suddenly tapered off. I was looking forward to reading about the evolution of the front line antibiotics that became the mainstay of the treatment but Vidya Krishnan never ventures into it. TB being the indirect inspiration for Stoker to create the character of Dracula was something I never knew about.

While the book aims to cover the crisis of Tuberculosis, the bulk of it is centered on the harrowing experiences of patients diagnosed with DR and XDR TB in India (specifically Mumbai - the TB capital of the world). And the book is also a Marxist analysis of the global patent system, a critique of TRIPS and WTO and a scathing indictment of Johnson and Johnson's tactics to safeguard its flagship TB drug bedaquiline.The plan of the present Modi government to eliminate TB in India by 2025 is also portrayed to be a sham and detached from any coherent policy shifts in the bureaucracy.

[Tini · Rating 1 out of 5]

Very important topic, but badly executed. Incoherent and apparently not a lot of fact checking as already the first page states a steroid, two anti malaria drug and antiviral drug as antibiotics.

[Christal Toussaint · Rating 4 out of 5]

Jam packed with information. A must read for anyone who has read or plans to read Everything is Tuberculosis by John Green. Krishnan offers an invaluable insight on the role of the west on ongoing global healthcare inequalities. Specifically eye opening with her descriptions of the politics of global pharmaceuticals.

[Andrea]

Going to stop reading this one. The premise is incredibly interesting, but I’m only 51 pages in and I’ve run across three content errors (miscategorization of medications as antibiotics [p. 1]; incorrectly identifying Princess Elizabeth’s mother [p. 25]; stating that Semmelweis’s best friend Markusovszky conspired to have him institutionalized, when it was actually a different colleague, Ferdinand Ritter von Hebra [p. 49]). I didn’t even realize the third example WAS a content error until, moved by the author’s gripping retelling of Semmelweis’s involuntary commitment, I took to Wikipedia/Google and discovered the mix-up.

While these errors might be incidental to the main thrust of the book, the fact that there were this many errors made me leery of continuing. I don’t want to read while constantly wondering if what I’m learning is true, especially since I am a nurse and reading this book would have informed my understanding of a disease that I could come into contact with and/or be expected to educate patients about.

[Leah · Rating 4 out of 5]

found out about this book from tiktokker john green. so much interesting information, my only problem was I didn't understand why it was structured the way it was. starts with a brief history of tb, then jumps to current day tb epidemic in india, then history of tb in india, and then info about other diseases like hiv. while I learned a lot about tb and the tb crisis in india, I actually think this book is less about the disease and more of an argument against patronizing humanitarian global public health interventions. the WHO basically caused widespread drug resistant tb through terrible, unscientific policies that severely limit which countries can get medications. a big chunk of the book is actually about patents and how developed nations support strict global patent regulations so that big pharma can continue to set prices for meds. fuck the WHO! fuck bill gates! paul farmer continues to look good, as usual.

[Shain Verow · Rating 5 out of 5]

It’s a great and concise history of the impact of TB on virtually every aspect of human history and culture, which is a subject near and dear to my heart. However, the real fire comes later in the book, where the author starts to get into why we have failed to defeat TB, why it is getting worse, and how legal structures, wealthy individuals, and corporations fight very hard to keep it that way.

That part is absolutely brutal, and having worked in biotech as long as I could morally stand it, I know it is extremely true from the other side of the table. It could easily be written off as a conspiracy, except it is well cited, well argued, logical, and tracks with other historical examples. So, yeah, we’re literally killing millions of people every few years to keep the powerful in power and the wealthy rich. I hope that you can read this and understand what is happening. This would have been my life’s work, except the problem is not intended to be solved, and solving it is quite risky.

[Amber · Rating 4 out of 5]

4.5⭐️ actual

*deep breath*

FUCK capitalism, FUCK international patent law, and FUCK! BIG! PHARMA!!!

[Toni · Rating 3 out of 5]

Started out strong enough to hold my interest. Got very dry toward the middle, downright preaching toward the end.

[Preetam Chatterjee · Rating 5 out of 5]

From the very outset, Krishnan pulls to bits the comforting illusion that tuberculosis is a relic of the past. Instead, she presents it as a living, mutating, and deeply entrenched global crisis—what she calls a “phantom plague", one that is simultaneously everywhere and nowhere, seen and unseen.

The metaphor is apt: tuberculosis lingers in bodies silently, often undetected, with nearly a quarter of the world’s population carrying latent infection. This ghostliness becomes the central emotional and intellectual axis of the book.

What makes the narrative predominantly compelling is its refusal to follow a linear, triumphalist history of medicine. Unlike classical narratives that move from ignorance to enlightenment—from superstition to germ theory—this book is structured around a more unsettling premise: that even after scientific breakthroughs, the disease persists because of human choices. As one reviewer appropriately notes, the book eventually shows how “history shaped tuberculosis” rather than the other way around . This inversion is vital. It shifts the burden of explanation from microbes to mankind.

In this sense, this book invites comparison with works like ‘The Ghost Map’ or ‘Spillove’r. Like Johnson, Krishnan explores the intersection of disease and urban life—crowded slums, poor sanitation, and fragile public health systems. Like Quammen, she situates disease within a broader ecological and global framework.

Yet where these works often retain a sense of scientific wonder, Krishnan’s tone is more harsh, even prosecutorial. Her subject is not merely the spread of disease, but the persistence of injustice.

One of the book’s most powerful narrative strategies is its use of individual stories. Patients are not statistics but central characters—fragile, suffering, often betrayed.

The story of drug-resistant tuberculosis patients, forced to endure what one reviewer calls a “thousand-pill odyssey” of treatment, lingers long after the page is turned.

These narratives anchor the book emotionally, preventing it from becoming a nonconcrete policy critique. Instead, they render the crisis intimate and immediate.

At the same time, Krishnan is intensely attentive to history. She traces tuberculosis across centuries—from its presence in ancient civilizations to its romanticisation in the nineteenth century, when it was associated with artistic sensitivity and melancholic beauty.

Figures like Franz Kafka and George Orwell appear not merely as literary references but as reminders that disease does not respect class or genius. Yet even here, Krishnan confuses the narrative: while tuberculosis afflicted both rich and poor, its outcomes were starkly unsatisfactory. The wealthy could afford rest cures and sanatoriums; the poor were left to die in overcrowded tenements.

This historical layering is one of the book’s great strengths. It reveals patterns that repeat with eerie consistency: the blaming of victims, the marginalisation of the sick, the slow and often inadequate response of governments. In this regard, the book resonates strongly with recent experiences of the COVID-19 pandemic. Many of the failures we saw during COVID—denialism, disparity, policy paralysis—were already present in the long history of tuberculosis. Krishnan’s work thus reads not only as history but as prophecy.

Perhaps the most haunting aspect of the book is its critique of global health systems. Krishnan does not shy away from naming institutions and structures that perpetuate inequality: pharmaceutical companies, international organisations, governments, and even philanthropic foundations. She argues that patent laws and profit-driven models restrict access to life-saving drugs, chiefly in the Global South. The result is what she provocatively terms “medical apartheid”—a system in which the availability of treatment is determined not by need but by geography and wealth.

This argument places this book in conversation with broader critiques of global capitalism and healthcare, such as ‘The Divide’ or ‘Medical Apartheid’. Like these works, Krishnan exposes the structural violence embedded in ostensibly neutral systems. Yet her focus on tuberculosis gives her critique a shrill, tangible urgency. This is not an abstract argument about inequality; it is a matter of life and death.

However, this same strength can also be seen as a limitation. At times, the book’s tone becomes so forceful that it risks overshadowing nuance. Critics have pointed out that certain scientific details are oversimplified or occasionally inaccurate, and that the narrative sometimes prioritises argument over balance. For readers with a strong context in medicine or epidemiology, these moments may be jarring. Yet for a general audience, they are unlikely to detract significantly from the book’s overall impact.

Krishnan writes with clarity and urgencyAnd yet, there are moments of quiet lyricism—particularly in her descriptions of suffering and resilience—that elevate the narrative. The book’s emotional cadence alternates between anger and empathy, between indictment and mourning. It is this equilibrium that gives the work its distinctive voice.

One cannot read this book without being struck by its relevance to India. While the book spans continents and centuries, its emotional centre lies in the Indian experience of tuberculosis, particularly in cities like Mumbai. Here, the disease is not an abstraction but a daily reality, shaped by overcrowding, inadequate healthcare, and social stigma.

Krishnan’s depiction of this landscape is both intimate and unsparing. She writes not as an outsider but as someone deeply embedded in the context she describes.

In comparing this work to other histories of disease, one is reminded of ‘The Great Influenza’. Barry’s account of the 1918 flu pandemic is similarly expansive, blending science, history, and narrative. Yet where Barry’s work ultimately celebrates scientific progress, Krishnan’s remains sceptical. For her, science alone is not enough. Without political will and social justice, even the most advanced medical knowledge can fail.

This scepticism is perhaps the book’s most important contribution. It challenges readers to rethink their assumptions about disease and progress. We are accustomed to viewing medical history as a series of victories—vaccines discovered, diseases eradicated, lives saved. ‘The Phantom Plague’ disrupts this narrative. It shows that progress is uneven, fragile, and often reversible. Tuberculosis, notwithstanding being curable, continues to kill millions each year—a fact that is as much a moral failure as it is a medical one.

In the end, what lingers is not just the story of a disease, but a profound unease about the world we inhabit. Krishnan forces us to confront uncomfortable questions:

1. Why do preventable diseases persist?
2. Who gets to live?
3. Who is allowed to die?
4. What does it mean to speak of “global health” in a world so deeply divided?

This is not an easy book to read, nor is it meant to be. It demands attention, engagement, and, above all, reflection. It is a work that unsettles rather than reassures, that provokes rather than comforts.

And yet, there is a strange, quiet hope embedded within its pages. By telling these stories—by making the invisible visible—Krishnan performs an act of resistance. She reminds us that the “phantom plague” is not inevitable. It persists because of choices, and it can be defeated by different ones.

In that sense, this book is not just a history of tuberculosis. It is a mirror held up to humanity—one that reflects not only our vulnerabilities, but also our responsibilities.

To conclude, thus, a reading of this book is less like encountering a conventional work of medical history and more like walking through a dim, echoing corridor of human sorrow—where every door opens not onto bacteria, but onto systems: poverty, power, prejudice, and policy. It is a book that insists, almost relentlessly, that disease is never merely biological. It is social, political, and profoundly moral.

A difficult but enlightening read.

[Sarah - All The Book Blog Names Are Taken · Rating 1 out of 5]

Nope. You don’t get to make glaring historical mistakes and expect me to continue reading your nonsense. On page 25 the author referenced Jane Seymour dying after giving birth to Princess Elizabeth.

About that…She died after giving birth to Prince Edward. And the website the author used, biography.com, clearly stated that multiple times in Jane’s entry. How did that make it past an editor? If a massively obvious error like that can get by editors, I can’t trust anything else in this book.

And considering the fact that historians believe Edward VI himself died of tuberculosis…come on.

[Bridget · Rating 4 out of 5]

In my John Green era. The history of TB was fascinating especially with how it influenced so many different policies and unconnected public health issues. I preferred the history component of the book more than the economic/intellectual property part. It did contain a rebuke of Bill Gates which I think is sometimes needed. Overall I learned a good global health perspective through tuberculosis.

[Adeline · Rating 4 out of 5]

the book certainly adds to one's understanding of the (counterproductive and profit-driven) interplay between healthcare, capitalism, and colonialism in context of tuberculosis

[Bearded Reader - Adam · Rating 4 out of 5]

The Phantom Plague: How Tuberculosis Shaped History by Vidya Krishnan is a fascinating exploration of how tuberculosis has shaped economics, global health, and social justice. While it touches on the science of TB, the book is more focused on the unequal global structures that impact Black and brown communities, particularly in India and China. Krishnan dives into how patent laws, colonialism, and capitalism have contributed to the resurgence of drug-resistant TB, making the book feel more like a critique of global public health policies than a medical history. Through compelling stories of survivors, activists, and policy failures, Krishnan highlights the ongoing crisis and offers hope for change. The book is engaging and accessible, never diving too deep into medical jargon but offering insightful context on a global scale. I give it 4 out of 5 stars for its depth, relevance, and thought-provoking analysis.

[Livia Frost · Rating 3 out of 5]

I loved the details about how tuberculosis shaped society, such as beards falling out of fashion due to hygiene concerns and skirts becoming slightly shorter to avoid dragging on the ground once germ theory was understood. The book also explored a lot of patent history, which was fascinating but not as directly focused on TB and its history.

[Jordan · Rating 5 out of 5]

This is an in-depth historical and modern day context and draws connections from dracula to patent laws to HIV/AIDS and back to tuberculosis (because it is in everything). So well-researched, so infuriating, so eye-opening. “In a global pandemic, deaths don’t just happen. They are inflicted on people, sometimes legally.”

[Audrey · Rating 5 out of 5]

This was an excellent read, taught me a lot, and changed how I think. Very recommendable book that looks at where medicine should be and what the current issues are in getting there.

[liv · Rating 4 out of 5]

“minority communities rarely get to be patients, they are only research subjects”

that pretty much sums it up! fuck big pharma and fuuuck ip laws

[Katelyn · Rating 5 out of 5]

This was so good. A really incredible overview of not just tuberculosis but also the tragic patterns we see in the intersections of public health, racism, classism, corporate greed, and research.

[Bharathi Arunan · Rating 4 out of 5]

“The idea of a better ordered world is one in which medical discovery will be free of all patents and there will be no profiteering from life and death.”

An important account of the status in the country today.

[Cristina · Rating 4 out of 5]

I found this book very interesting and educational. It’s not only about tuberculosis but also about other infectious diseases and the history of hygiene. It shows how mankind can be really greedy and ignorant. And sadly now I learned also about the Tuskegee experiments, another horrible thing humans did which I was not yet aware of.

[Katie · Rating 3 out of 5]

I think a better title for this would be "How History Shaped Tuberculosis" - it was interesting, but talked WAY more about other topics than it did about actual tuberculosis.