A spectre from the past is haunting the corridors of NHS England. Australia has confirmed its first diphtheria death in an outbreak now classified as the worst in decades. The news landed on desks in Whitehall this morning. Sources say the UK Health Security Agency has been quietly monitoring the situation for weeks. But this death changes the calculus.
Diphtheria. A disease most doctors have only read about in textbooks. A bacterial infection that clogs the throat. It suffocates its victims. In the 1940s, it killed thousands of British children every year. Then came the vaccine. It was supposed to be a solved problem. But vaccine hesitancy, war, and displacement have resurrected it. Europe has seen sporadic cases. The UK recorded a handful in recent years among asylum seekers and vulnerable populations. But Australia’s outbreak is different. It is community transmission. Sustained. Dangerous.
The deceased was a child. Unvaccinated. Details are sparse but the implications are clear. If it can happen in Sydney, it can happen in Sunderland. The NHS is already creaking under record waiting lists and winter pressures. A diphtheria outbreak would be a political and operational catastrophe.
Here is what I am hearing. The UKHSA has reviewed its stocks of diphtheria antitoxin. They are adequate for now. But procurement is being quietly ramped up. Vaccination records for newly arrived migrants are being scrutinised. The Joint Committee on Vaccination and Immunisation has been asked to model scenarios. No one is panicking. But there is a grim sense of readiness.
The politics are tricky. Anti-vaccine rhetoric has not gone away. It has evolved. The government cannot be seen to scaremonger. But neither can it be caught flat-footed. The health secretary has been briefed. He is expected to make a statement in the coming days. Expect language about “vigilance” and “protecting the most vulnerable.” Expect opposition MPs to ask why the UK is not doing more.
Backbenchers are already rattled. One told me the NHS is “not ready for a 19th century disease.” That is harsh. But it captures the mood. The last major UK outbreak was in the 1970s. Most doctors have never seen a case. Diagnostic delays could be fatal. Public awareness is zero. This is a classic sleeper crisis.
The key number to watch is R0. Diphtheria’s basic reproduction number is around 6. That is higher than Covid. But the vaccine is effective. The problem is coverage. UK childhood vaccination rates have slipped below 90% for some jabs. The MMR scandal did long-term damage. Trust is still being rebuilt. For diphtheria, coverage is better but uneven. Some urban areas have worrying gaps.
World Health Organisation data shows a global resurgence. Yemen, Bangladesh, Nigeria. War zones. But Australia proves it can happen anywhere. The UK is not an island. Travel, migration, family visits. The disease does not respect borders.
So what happens next? A single case in the UK will trigger a full public health response. Tracing, isolation, prophylactic antibiotics. The media will go into overdrive. Schools will close. The government will need to show control. If it happens in a community with low vaccine uptake, it could spread fast. The autumn and winter are prime time for respiratory infections. Diphtheria is no exception.
The Lobby is watching. The usual suspects are asking questions. Is the NHS ready? Are vaccine mandates coming back? Not yet. But the conversation has started. In private.
For now, the message from the UKHSA is calm. Plans are in place. But plans only survive first contact with reality. This is a test. The system has passed earlier ones. Ebola, monkeypox, polio in London sewage. But diphtheria is different. It is airborne. It is fast. And it once killed more than any other infectious disease in children.
The ghosts of Victorian England are stirring. Whitehall is holding its breath.