Remember this? Vaccines in short supply. Long lines at clinics. Case numbers going up every day. A spreading public dread, fear and suspicion. The Government announcing everything is under control — but it isn’t. The Covid pandemic and the monkeypox outbreak are quite different, but the early responses have exposed similar — and disturbing — shortcomings. Once again, the United States and the world are racing to catch up to a virus that is moving faster.

Monkeypox, an infectious disease that can bring excruciating pain but usually not death, is caused by a virus related to smallpox. In May, it appeared for the first time outside of locations in Africa where it is endemic, and has spread rapidly in social networks of men who have sex with men. The time to contain monkeypox was at the outset. The United States now has 7,102 cases of the global total of more than 25,000 cases in countries that have not historically reported it. Monkeypox spreads by very close and prolonged contacts, such as sexual encounters, and can persist on surfaces in heavily contaminated areas, where lots of viruses have been shedding for a long time. This is not a contagion like Covid, but there is a real danger it could become uncontainable and spread to other populations.

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 owing 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 Centres for Disease Control and Prevention, last 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 Organisation 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 may cost $7 billion, but so far Congress has not 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.