^{Florent Jouinot from Swiss AIDS Federation reports on AFRAVIH 2026 in Lausanne.} 

When Steve Ahuka Mundeke traces the history of mpox, he begins in 1970 in the Democratic Republic of the Congo. At that time, the world’s attention was focused on the eradication of smallpox. Mpox, on the other hand, remained in the shadows, as it was regarded as a rare tropical disease that was scarcely transmissible from person to person and remained confined to rural areas. 

For decades, this perception justified inaction. As late as 1986, the disease was still classified as of little significance to public health. A misjudgement with serious consequences. 

For on the ground, the situation was changing. The discontinuation of smallpox vaccination, armed conflicts and population movements contributed to the first major epidemic in 1996. Then, in 2003, the virus crossed the borders of the Global South for the first time and triggered an epidemic in the United States. However, it was not until 2022 that Mpox became a global priority, when the epidemic hit countries in the Global North on a massive scale and prompted the WHO to declare a public health emergency of international concern. 

The response was swift: increased surveillance, access to vaccines, accelerated research. As a result, the epidemic was quickly brought under control in Europe and North America. Yet this success masks another reality.  

A ‘statistical victory’ in Central Africa 

In the Democratic Republic of the Congo, where almost 90% of global cases are still concentrated today, the situation remains worrying. The emergence of a new variant, clade 1b, marks a turning point: human-to-human transmission is increasing, including through sexual contact. 

“We are witnessing a rupture that is both biological and geopolitical,” emphasises Steve Ahuka Mundeke. Mpox is no longer merely a rural zoonosis; it is becoming an infection embedded in complex urban and social dynamics, exacerbated by poverty, promiscuity and conflict-induced population movements. 

Nevertheless, the end of the international public health emergency in 2025 led to a rapid retreat: a decline in surveillance, the cessation of large-scale vaccination campaigns, and unequal access to preventive measures. In March 2026, the Congolese government declared the end of the epidemic – a ‘statistical victory’ with fewer than 200 cases per week, yet one that remains fragile. 

For the conditions for a renewed outbreak remain in place: low vaccination coverage, particularly in rural areas, which are, however, closest to the animal reservoir.  

Switzerland faced with a persistent threat 

For Switzerland, which recorded a sharp rise in cases in 2022 before they could be brought under control, the temptation is great to regard Mpox as a closed chapter. However, developments observed in Central Africa suggest a very real risk of a new global pandemic, as highlighted by a series of Clade 1b diagnoses recently in Zurich or the recent tuberculosis diagnosis in a primary school teacher from Valais. 

For Aids-Hilfe Schweiz, two things are at stake: 

• Maintaining vigilance in the most at-risk communities and within the healthcare system;
• Integrating Mpox sustainably into a holistic approach to sexually transmitted infections and ensuring genuine access to vaccination, testing and treatment services 

Furthermore, there is a question of solidarity: supporting the fight against Mpox in the DR Congo is not only an ethical obligation but also a global prevention strategy.  

Tuberculosis: Proof that medicine alone is not enough 

The observation made by Ablo Prudence Wachinou regarding tuberculosis is equally revealing. As an old disease long associated with poverty, it experienced a spectacular decline with the advent of antibiotics in the mid-20th century, before re-emerging. 

Why? Because tuberculosis is as much a social disease as it is a medical one. 

“Tuberculosis cannot be cured by medication alone,” the speaker reminds us. Living conditions, nutrition, access to healthcare: these factors determine the course of the epidemic just as much as scientific innovations. 

A recent study, the RATION programme, provides striking evidence of this. By providing food aid to people with tuberculosis and their families, the researchers achieved the best results in reducing transmission and mortality, thereby outperforming certain medical interventions. 

A lesson that also applies in Switzerland 

Although tuberculosis is rare in Switzerland today, it has not disappeared. It primarily affects vulnerable population groups, particularly migrants or people in precarious living situations – contexts in which social determinants also play a central role. 

For Aids-Hilfe Schweiz, this reality reflects challenges already familiar in the fight against HIV: the importance of social support, access to rights and the reduction of inequalities. 

The frequent overlap between HIV and tuberculosis in many contexts underscores the need for integrated approaches.  

A shared conclusion: do not look away too soon 

Mpox or tuberculosis, the same struggle: these infections serve as a reminder that international attention is often cyclical – intense during crises, but then quickly waning. The risk is always the same: confusing control with elimination. At AFRAVIH 2026, the message is clear: as long as inequalities in access to healthcare, vaccines and living conditions persist, infectious diseases will continue to circulate and, sooner or later, re-emerge where they are no longer expected.