Diphtheria's Return Exposes the Real Gap: Why Remote Indigenous Communities Are Paying the Price

The diphtheria outbreak should shock Australia. Not simply because a disease once considered virtually eradicated has returned, but because of where it is spreading and why.

More than 220 cases have been recorded in 2026, primarily across the Northern Territory and northern Australia. The overwhelming majority of patients are Aboriginal people, including those living in remote and very remote communities.

For much of mainstream Australia, the return of diphtheria has come as a surprise. But for those of us working in Aboriginal health, this outbreak is not isolated.

When we talk about Closing the Gap, this is the gap.

It is overcrowded housing that allows infectious diseases to spread quickly in communities with high levels of poverty and food insecurity. It is practical barriers to transport and healthcare access. It is the lack of affordable healthy food in remote communities and poor environmental health conditions.

These are the conditions that allow diseases of poverty to persist in one of the richest countries in the world.

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 Covid. 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.