Australia is facing a concerning diphtheria outbreak, a disease once nearly eradicated, now making an unexpected return. However, what is particularly alarming is not just the resurgence, but the locations and circumstances of its spread.
In 2026, over 220 cases have been reported, predominantly in the Northern Territory and northern regions of Australia. The majority of those affected are Aboriginal people, especially those residing in remote or very remote communities.
While this resurgence has surprised much of mainstream Australia, those involved in Aboriginal health see it as part of a broader, ongoing issue.
When discussions arise about Closing the Gap, this is the gap we refer to.
Overcrowded housing conditions facilitate the rapid spread of infectious diseases in communities marked by poverty and food insecurity. Practical obstacles to accessing transportation and healthcare services exacerbate these issues. In remote areas, the scarcity of affordable, nutritious food and poor environmental health conditions further contribute to the problem.
These factors create an environment where diseases associated with poverty continue to thrive, even in a nation as wealthy as Australia.
Across the NT, Aboriginal community-controlled health services continue to treat disproportionately high rates of communicable diseases such as rheumatic heart disease, skin infections and scabies – all closely linked to overcrowding and poor environmental health. The climate crisis is intensifying many of these pressures in communities already facing housing stress and infrastructure shortages, as well as contributing to the spread of infectious diseases through changing temperatures and rainfall patterns.
Communicable diseases hunt down vulnerable communities. Around the world, outbreaks take hold where poverty, overcrowding and inequality increase exposure to illness. Australia is not immune.
The re-emergence of a preventable disease should force us to confront those conditions.
Aboriginal community-controlled health services have helped drive significant improvements in health including in child health, antenatal care and chronic disease treatment and prevention.
Life expectancy has increased significantly over the past 20 years, by about nine years for Aboriginal men and five years for Aboriginal women.
These gains are the result of decades of work led by Aboriginal-controlled primary healthcare services and built on trust, prevention and long-term relationships with community.
Vaccination rates among Aboriginal and Torres Strait Islander children have also improved since the Covid pandemic began. About 90% of Aboriginal and Torres Strait Islander children aged two to five are fully immunised. Aboriginal community-controlled health services have been central to achieving this.
But this outbreak also shows the enormous pressures these services are under.
A report commissioned by Aboriginal Medical Services Alliance Northern Territory in 2025 called Facing the Health Gap found that most Aboriginal health services in the NT had to reduce core services because of workforce shortages.
Half of our member services across the territory reported more than 10 unfilled positions. Recruitment and retention continue to be undermined by remoteness, workforce shortages and inadequate staff accommodation.
A well-resourced Aboriginal community-controlled health sector is not an optional extra to Australia’s healthcare system. It is a critical part of public health infrastructure.
We saw that during early Covid years. We are seeing it again now.
The commonwealth’s $7.2m emergency support package, including additional vaccines and surge workforce support, is an important and welcome response to an escalating outbreak.
Aboriginal community-controlled services have been working closely with the mainstream health system to help coordinate vaccination, outreach and public health messaging in affected communities – particularly because many of our services are continuing to deliver primary healthcare.
But emergency responses are not enough.
We cannot continue to wait until outbreaks escalate before investing in prevention, the workforce and the living conditions that keep communities safe and healthy.
This outbreak should trigger a serious process of reflection and learning for governments and health authorities. That includes examining the timeliness of the response, the coordination between agencies, the role of public health systems and, critically, how governments engage respectfully and meaningfully with Aboriginal leadership.
Because if there is one lesson from this outbreak, it is that strong primary healthcare is our best defence against public health crises. And across much of the NT, this is delivered by Aboriginal community-controlled health services.
Diphtheria should not become normal in Australia. Nor should overcrowded housing, preventable diseases and unequal access to healthcare.
