After repeating early COVID mistakes, US now has the world's biggest monkeypox outbreak - USA TODAY

Gostin and other public health officials seem both frustrated and surprised that the outbreak has gotten as bad as it has. .

Ranney pointed to a range of factors that probably contributed to the slow early response, including competing priorities of federal agencies, along with the decentralization of America's public health system with many decisions left to the 50 states, and the sheer exhaustion many public health officials feel after more than two years of battling COVID-19.

Plus, Americans can't expect to have a first-rate public health system if we pay for only a second-rate one, said Dr.

"If you fund something at a small fraction of what it needs to get the job done and then you beat it up for not getting the job done, you're not being logical," said Frieden, now president and CEO of Resolve to Save Lives, an initiative aimed at preventing epidemics and cardiovascular disease. "We have really underfunded public health.".

Frieden said he remembers traveling to Africa's Democratic Republic of the Congo when he was CDC director in the early 2010s and hearing from officials who were worried that monkeypox and other infectious diseases eventually would spread across the globe.

COVID-19 fatigue also is playing a role in the slow response, Auclair said.

Public health officials don't want to be the bad guys again, telling people what they shouldn't do. .

If monkeypox does become endemic, meaning it never fully goes away, it probably will follow the same path as HIV/AIDS did, said Gregg Gonsalves, an HIV/AIDS activist and epidemiologist at the Yale School of Public Health.

Ranney said clinicians still have to get their state department of health to authorize every monkeypox test, which she described as an unnecessary impediment.

"When the federal government puts its mind to something, it can get it done," said Gonsalves, adding he has seen nothing with that level of government support or urgency with the monkeypox outbreak. "That's the kind of focus you need, and it doesn't exist.".

Gonsalves said with frustration that officials apparently were afraid the doses might be needed someday against smallpox instead of recognizing that they were needed immediately against monkeypox.

Public health officials shouldn't be telling men not to have sex, Frieden said, but encouraging fewer partners until more vaccine becomes available.

The tools for fighting monkeypox are there, Gonsalves said.

The administration has not made public health enough of a priority, Gonsalves said, charging that officials have alternated between saying there's no problem and blaming the CDC