Group A streptococcus constantly throws new questions at us. The main global burden of disease resides in low and middle-income countries from autoimmune rheumatic heart disease. Importantly, invasive infections in both high and low income regions continue to cause high mortality, as illustrated by the many global upsurges seen after the COVID-19 pandemic ended. If circulation of pathogenic streptococci goes unchecked, new lineages may emerge that pose a threat to humans. Bottlenecks in bacterial population growth, coupled with altered host population immunity can lead to explosive outbreaks, sometimes with devastating consequences that appear unstoppable. What can we learn from these events when they occur; and is prevention the only real answer?