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President Donald Trump, North Korean Leader Kim Jong Un, and Mycobacterium tuberculosis — the airborne bacterium responsible for causing tuberculosis, the deadliest infectious disease on the planet — are embroiled in a potentially awkward three-way love triangle.

I wish this was the setup to a late-night talk show host’s punchline, but it isn’t.

In an effort to smooth over U.S. relations with the diplomatically isolated, deeply impoverished, and potentially nuclear-capable North Korea, Trump fawned over Kim, who is known for violating human rights. “We went back and forth, then we fell in love” said the president. “He wrote me beautiful letters. And they are great letters. We fell in love.” Romance is in the air, and maybe — just maybe — this is the beginning of a wannabe strong man bromance that successfully sidesteps the ongoing potential of shared nuclear annihilation.


The problem, of course, is that three’s a crowd and the unacknowledged, completely uncontrolled, and now diplomatically amplified tuberculosis epidemic in North Korea is threatening to spoil the love between the two leaders.

North Korea has perhaps the most serious tuberculosis epidemic in the world, with an incidence rate of 513 per 100,000 people. Tuberculosis generally doesn’t create problems for otherwise healthy adults with strong immune systems. But in North Korea, the combination of ongoing famine, densely packed cities, deeply impoverished rural regions, and a poorly functioning health system is driving an uncontrolled TB epidemic that is making worse an already dire humanitarian crisis.


Which is why a puzzling decision by Peter Sands, executive director of the Global Fund to Fight AIDS, TB, and Malaria, has the potential to spoil the mutual affection between Trump and Kim. In February, the Global Fund announced it was pulling its meager funding — it had spent $69 million in North Korea between 2010 and 2017 — to stanch the spread of tuberculosis in the country. That’s less than $75 per patient per year: not enough to solve the crisis, but important nonetheless.

This is devastatingly bad geopolitics, moronic public health policy, and could make for a tragic ending to the Trump-Kim love story. There are three reasons for this.

First, untreated or poorly treated tuberculosis drives bacterial antibiotic resistance, making the disease much more expensive and often extremely difficult to effectively treat. As a result, North Korea’s uncontrolled epidemic is shaping up to be a “superbug explosion” and a public health catastrophe. This decision is amplifying the existing humanitarian disaster.

Second, Seoul, the capital of South Korea (population: 9.8 million), and Pyongyang, the capital of North Korea (population: 2.6 million), are only 120 miles apart; Seoul is 35 miles from the border with North Korea. While there is much military pomp and pageantry around the demilitarized zone between the two countries, the border between them — and North Korea’s northern borders with China and Russia — are more permeable than we might imagine.

While Kim and Trump both fetishize the fiction of hermetically sealed national borders — whether to keep in a miserable population or keep out refugees seeking asylum — airborne infections care nothing about such imagined lines, walled or otherwise. Air is shared, people move, and the transmission of tuberculosis will continue unabated. The odds that a regionally and uncontrolled drug-resistant TB epidemic will emerge grows by the day.

Third, this is a geopolitical nightmare. The Global Fund is a multilateral global health funding agency (meaning that many countries contribute to the fund and manage its disbursements) that has been the paragon of a human rights approach to global health financing. It is also supposed to be apolitical. Which raises the question: Why did it make this decision to stop funding the fight against tuberculosis in North Korea?

Originally, Sands and the Global Fund’s communications department claimed that money mismanagement led to the pullout decision. But new evidence points to behind-the-scenes pressure from the U.S. State Department on the Global Fund and other humanitarian relief agencies, urging them to cease their work with the people of North Korea.

Not only does this episode sully the Global Fund’s well-regarded reputation as an impartial, apolitical, human-rights-focused global health financing agency, but it also has the terrifying potential to destabilize the geopolitics of a region that is already hanging by a thread. It could also poison the waters between Trump and Kim, two bellicose leaders who are unlikely to respond well to the political pressure created by region-wide mass migrations and the specter of an uncontrolled, transnational epidemic of airborne, drug-resistant tuberculosis.

As a token of his love, Trump should direct his administration to call for the immediate reinstatement (and expansion) of the Global Fund’s efforts to care for people with tuberculosis in North Korea.

The end to this story is yet to be written: It could turn out to be a comedy, a tragedy, or a romance that averts disaster.

Jonathan Shaffer is a Ph.D. student in sociology at Boston University studying the politics of global health.

Editor’s note: This article was updated to correct the surname of the North Korean leader.