The ongoing diphtheria outbreak in the Kimberley, Pilbara, and Goldfields is a direct consequence of long-term under-investment in the environmental determinants of health, and governments must urgently invest more in Aboriginal environmental health initiatives.
The Aboriginal Health Council of Western Australia is expressing urgent concern regarding the resurgence of this potentially fatal disease—which had not been seen in regional WA for over half a century—and is disproportionately impacting Aboriginal people.
Recently declared a Communicable Disease Incident of National Significance, AHCWA warns that diphtheria is being driven by crowded conditions with limited access to facilities required to wash people, clothes and bedding.
More than 94 per cent of cases in the 2026 outbreak have occurred among Aboriginal and Torres Strait Islander people, and two-thirds of these cases present as cutaneous diphtheria, where bacteria spread through direct contact with infected wounds and sores. The
pre-existing high burden of skin infections in many Aboriginal communities is a significant driver of transmission in this outbreak, as the diphtheria bacteria frequently infects existing skin lesions.
AHCWA Chair Vicki O’Donnell OAM said that while vaccination remains a critical tool for preventing severe illness and death, vaccines alone cannot stop the spread of the bacteria.
“To reduce rates of disease we need parity in community infrastructure, essential services and living conditions—including housing, water, sewerage and waste management,” Ms O’Donnell said.
Inadequate housing and crowded living conditions often result in the breakdown of essential health hardware—such as functioning showers, laundry facilities and reliable hot water—which directly hinders the regular washing needed to prevent the spread of bacteria and undermines the effective management of skin infections.
Ms O’Donnell said existing skin infections—often caused by group A streptococcus—are already primary drivers of Acute Rheumatic Fever and Rheumatic Heart Disease. “It is unacceptable that our people continue to suffer from ARF and RHD, diseases that are entirely preventable through improved living conditions”, she said.
The solution to curbing the current spread and preventing future outbreaks lies in the Aboriginal Environmental Health Model of Care. Co-designed by AHCWA, the Aboriginal Community Controlled Sector, and the WA Department of Health, the Model shifts the focus from reacting to individual diseases towards addressing the underlying structural drivers of ill health. The Model is built on six core domains, including Healthy Homes, which ensures that essential ‘health hardware’—such as functioning showers, laundry facilities, and wastewater removal systems—are routinely assessed, maintained, and repaired.
AHCWA acknowledges the Western Australian Government’s recent commitment of $3.7 million over two years to pilot the AEH Model of Care across the Kimberley, Pilbara, and metropolitan regions. This investment follows extensive advocacy by AHCWA and the Aboriginal Community Controlled Health Services Sector.
But the current pilot funding represents only a fraction of what is required to achieve genuine health equity. AHCWA is calling on both the WA State and Commonwealth Governments to fully fund the AEH Model of Care, with an additional $30 million per year required to support full statewide implementation.
“Aboriginal Community Controlled Health Services are best placed to deliver these practical, culturally secure solutions, but they must be resourced to do so effectively across every region,” Ms O’Donnell said.
“To prevent future diphtheria outbreaks and eliminate preventable diseases like RHD, we must move beyond pilots and instead sustainably invest in addressing the underlying causes of disease”.