Under anthropogenic climate change, emerging diseases and pathogens are increasingly prevalent in high latitude and altitude regions that were previously protected by cold winter temperatures. Ongoing island‐wide dieback of a foundation species, the cushion plant Azorella macquariensis, on World Heritage listed Macquarie Island provides the first sub‐Antarctic example. To better understand the island‐wide progression of cushion dieback and its drivers, we established and quantified plant condition classes and measured microclimate across 62 sites. We then tested whether the drivers of cushion dieback were associated with (i) water stress: represented by vapour pressure deficit, wind exposure and gravel content, (ii) pathogen virulence: using freezing days and extreme humidity as empirically supported surrogates, or (iii) both. There was a strong north‐south progression in cushion condition, with dieback most active in the centre of the island and advanced in the north. Dieback was most extensive at sites with fewer freezing days and high humidity. Natural southern refugia were explained by the significantly colder temperatures, associated with a north‐south temperature gradient. It is expected that under current climate change trajectories, where Macquarie is likely to continue to become warmer and wetter, cushion dieback will remain pervasive, expanding most slowly in the south and potentially outpacing recovery. We emphasise the need for increased awareness to prevent the establishment of pathogens into and across the landscapes of newly susceptible high latitude and altitude regions. Areas of high conservation significance need to be prioritised for management, to prevent further landscape‐scale change under current climate trajectories.