Unlike the early days of the coronavirus pandemic, effective vaccines exist against monkeypox, but the one that is most suitable, the two-dose Jynneos, has been in short supply, largely due to a manufacturing bottleneck, and will probably remain so for months. In a recent preprint, Yale School of Public Health scientists estimate that there are 498,000 high-risk gay men in the United States. In ideal circumstances, they project that rapid distribution of vaccines to one third of them, along with increased testing and contact tracing, could support containment. But that would require at least 329,000 doses, which is almost all of the 336,710 the government had shipped as of July 29. The total highest-risk, vulnerable population may be even higher, estimated at up to 1.7 million by Rochelle Walensky, director of the Centers for Disease Control and Prevention, on Thursday. More doses are on the way, and government experts are looking at a dosing method using a shallow injection into the skin to stretch existing supplies. But the virus is also spreading fast and it may well be too late to contain it. The recent declarations of emergency by the Biden administration, New York, California and the World Health Organization underscore that the crisis is nowhere near resolution.

In the United States, much of the burden of public health falls on the states, and they are overwhelmed and chronically underfunded, many still reeling from the pandemic. The Biden administration has informed Congress that a monkeypox response might cost $7 billion, but so far Congress hasn’t even voted a cent of the last covid response request, much less addressed the crying need for a system of more effective and robust pandemic preparedness. We seem stuck in a pattern of panic and neglect, too often declaring an emergency about a virus after it has run out of control, rather than getting ahead of it.