Diphtheria is a preventable bacterial disease that causes a thick membrane to form in the back of the throat, making swallowing and breathing difficult. It can cause airway obstruction and suffocation. It spreads through respiratory droplets or contact with contaminated surfaces. Diphtheria antitoxin and antibiotics save lives when given early, but without them, the disease can progress rapidly and cause suffocation, especially in children with small windpipes.
Vaccination pushed diphtheria to the brink of elimination in wealthy countries by the 1970s, reducing American cases to less than one per year on average. At the start of this century, even low-income nations were seeing steep declines.
But the disease has surged back. Climate-driven displacement, war, weak health systems, pandemic disruptions and rising vaccine hesitancy have fueled large outbreaks in Somalia, Sudan, Yemen and Chad. Diphtheria has even reappeared in Europe, usually among children who fled war zones and missed vaccinations. In the United States, protection is also slipping; diphtheria vaccination rates among kindergarteners have fallen from 95 percent in 2020 to 92 percent in 2025.
A Strain on an Already Fractured System
Somalia illustrates how quickly a preventable disease can reclaim its deadliness. The country’s current outbreak began in 2023 and has escalated sharply. National surveillance is weak, but more than 2,000 cases and at least 87 child deaths have been reported this year (2025). At Demartino Public Hospital in Mogadishu, nearly 1,000 patients were admitted to the diphtheria ward this year — compared with just 49 in 2024. About 80 percent of cases involve children.
The surge in Somalia is amplified by years of civil war and the loss of substantial US health assistance. Severe malnutrition caused by a dramatic drop in food aid makes children even more vulnerable to infection.
Vaccines Save Lives — When Children Receive Them
Most Somali children receive at least some vaccinations, but displacement, poverty, illiteracy and logistical chaos undermine complete vaccination coverage. Diphtheria immunization requires three doses in infancy, often followed by boosters in early childhood and adolescence — a schedule nearly impossible for families on the move to track.
According to Katy Clark, a diphtheria expert with the global vaccine alliance Gavi, in countries with weak diagnostic and treatment capacity, as many as one in four children with diphtheria may die of the infection. High-resource health systems tend to fare better, with a fatality rate closer to one in 20.
Somalia was the first country to request Gavi funding for diphtheria boosters to curb the outbreak. “We didn’t even have a diphtheria support modality, because we didn’t need one,” Clark said. She noted that the organization is now building a process to help countries respond to the increased disease rates.
Families Caught Between Fear and Hope
Some parents fear vaccines because of past complications. One mother of six in Somalia, Amina Hassan, said her husband refused immunizations for their children because one child developed an infection after receiving a tuberculosis vaccine. While three of the children were receiving treatment for diphtheria, Hassan told a reporter, “After this, I am going to try to convince him to get them vaccinations, and I think he will agree.”
A Path Back to Prevention
Diphtheria may be roaring back, but the tools to stop it have existed for nearly a century. With renewed vaccination programs, stronger surveillance and sustained support for fragile health systems, outbreaks like Somalia’s can be brought under control. Even in the hardest-hit communities, parents are beginning to see that vaccines offer a measure of safety in an unpredictable world.
And as more families seek protection for their children, the tide can turn — one lifesaving dose at a time.
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