Recent decades have seen accelerated progress in the evidence and tools to tackle the scourge of diseases caused by group A streptococcus (Strep A). We have new evidence in the areas of primary, secondary and tertiary prevention, and examples of how each can be implemented in practice. We also now have new tools on the horizon, including better long-acting penicillins, new approaches to echocardiographic screening for rheumatic heart disease (RHD), the possibility of a diagnostic test for acute rheumatic fever, systems level approaches to controlling skin infections and implementing RHD control, and Strep A vaccines entering clinical trials, among many other advances. And we have more accurate estimates than ever of the burden of disease. In the eyes of many who have devoted their professional lives to battling Strep A, this combination of information and tools should rightly see a reduction in disease burden. But this is not the reality. Clearly there is a disconnect between evidence and implementation, that allows the 5th (or 6th) most lethal pathogen on the planet to continue to cause disease and death unabated. This presentation will explore what is needed to finally change that.