Tecovirimat—also known as TPOXX—an antiviral drug approved by the Food and Drug Administration four years ago for the treatment of smallpox, has quickly become one of the most important tools in treating monkeypox infections. The disease, which causes deeply painful blisters in addition to flu-like symptoms, is the same genus as smallpox, which has prompted physicians to prescribe it as an off-label treatment for severe cases.

But TPOXX was only approved to treat smallpox infections under animal studies rather than human trials, which are impossible to conduct, given its global extinction four decades ago. Without human trials for monkeypox, TPOXX’s use must be conducted only by doctors who are part of a hospital’s internal review board, each of whom is required to fill out dozens of pages of paperwork in order to secure TPOXX for their patients. With some cities seeing scores of new cases on a daily basis, doctors are facing an increasingly unmanageable patient backlog.

“Only certain individuals are allowed to do consent… that limits it to a small number of individuals,” said Dr. Timothy Brewer, a professor of epidemiology at UCLA’s Fielding School of Public Health and of Medicine. “At UCLA, we’re trying to expand the number of people who have that authority, and I’m sure other institutions are as well, but that clearly is the limiting factor.”