The Centers for Disease Control and Prevention has identified more than 1,000 cases of monkeypox in the United States, but even though the federal government has ample treatments and vaccinations on hand, physicians say bureaucratic red tape is hindering their ability to respond to and contain the outbreak.

It is “nearly impossible” for physicians and clinics to get patients the monkeypox antiviral TPOXX, even though New York City has enough supply on hand, said Mary Foote, the medical director for emergency preparedness and response in the New York City Department of Health and Mental Hygiene…

The monkeypox treatment, TPOXX, is only available to patients and doctors under a special CDC status because it is usually used to treat smallpox, not monkeypox.

The expanded access status requires physicians to go through more than 100 pages of paperwork each time they prescribe it, and between the forms and administrative requirements, a patient visit to initiate this medication can take between one and three hours.