Australia's rheumatic heart disease plan lacks full funding

Declaration adopted in Perth at global congress

Global health leaders launched the Perth Declaration at the closing ceremony of the Second World Congress on Rheumatic Heart Disease on 14 November 2026, setting a collective target to eliminate rheumatic fever and rheumatic heart disease as public-health problems by 2040.^[1] The congress brought together researchers, clinicians, advocates and people with lived experience of the disease.

Professor Jagat Narula, President of the World Heart Federation, said the Perth Declaration marked "the most significant global effort to date to eliminate rheumatic heart disease and save hundreds of thousands of lives each year."^[1] Professor Derek Chew, Chief Scientific and Medical Officer of the National Heart Foundation of Australia, said: "This is a disease that shouldn't exist: we know the causes, we know the solutions, we just need commitment and action from world leaders to make it happen."^[1]

The declaration sets an interim goal of halving rheumatic fever and RHD deaths among people younger than 25 by 2035 in countries with established surveillance, and calls for a regulatory pathway for a Strep A vaccine by 2028 and financing for phase-three vaccine trials to begin by 2031.^[1]

A disease that starts with a sore throat

Rheumatic heart disease begins with a Strep A throat or skin infection. In some people the immune response develops into acute rheumatic fever, which can permanently scar the heart valves and require lifelong care or surgery.^[2]

Prevention is well understood: prompt treatment of Strep A infections, followed by regular benzathine penicillin G injections for anyone who has experienced acute rheumatic fever or RHD.^[2] The Australian Government says the disease mostly affects Aboriginal and Torres Strait Islander children, particularly those in rural and remote areas.

At 31 December 2024, 11,794 people were recorded with RHD or a history of acute rheumatic fever in participating Australian jurisdictional registers, with Aboriginal and Torres Strait Islander people accounting for 9,496 of those, 81 per cent of the total.^[3] In 2024 alone, 506 acute rheumatic fever diagnoses were recorded across five jurisdictions, with First Nations people making up 93 per cent of cases and the highest diagnosis rate falling among First Nations children aged 5 to 14.

In the four main jurisdictions, Queensland, Western Australia, South Australia and the Northern Territory, only 32.4 per cent of First Nations people on regular penicillin prophylaxis received at least 80 per cent of their scheduled doses in 2024.^[3] The Australian Institute of Health and Welfare says the gap between prescription and delivery reflects the structural barriers facing remote communities.

Roadmap without a price tag

Australia's RHD Roadmap was commissioned in 2018, written through END RHD and NACCHO, and presented to the COAG Health Council in March 2019 as a plan to eliminate the disease by 2031.^[4] The END RHD Endgame report recorded that, at the time it was written, the most recent national policy commitments had no funding attached.

Commonwealth funding has since flowed through separate streams rather than a unified program. The 2025-26 federal budget papers recorded $15.4 million over three years from 2025-26 to detect, treat and prevent RHD in high-risk communities, alongside $9.2 million over 2025-26 to 2027-28 for the Rheumatic Fever Strategy's register and control programs.^[5] An earlier commitment of $35 million for Strep A vaccine development was made across 2019-20 and 2020-21.

The 2025-26 budget allocations of $15.4 million and $9.2 million across the two RHD streams are discrete program and research commitments, not a published, fully costed appropriation for the 2031 Roadmap.^[5] The Department of Health, Disability and Ageing says the Australian Government is committed to ending RHD as a public-health issue by 2030, one year earlier than the Roadmap's benchmark, through the Rheumatic Fever Strategy and vaccine development.^[2]

Federal Health Minister Mark Butler said in June 2024 that rheumatic heart disease was "a preventable disease" and "a shared challenge in Australia and Pacific island countries".^[6] The Perth Declaration's 2040 global target sits a decade beyond the domestic deadline the government has set itself.