When the world’s first official MSIC opened in Bern, Switzerland, in 1986, Australia was a world leader in pragmatic public health interventions. Faced with the serious threat of an HIV epidemic beginning among people who inject drugs then spreading to the general population, policymakers took action and introduced programs such as the needle and syringe exchange. But in the decades since, as almost 100 MSICs have been opened around the world, Australia has dragged its feet.