It’s a long wait for a monkeypox vaccine in San Francisco.
"I arrived here at 7:30 in the morning, so it's been three and a half hours right now," said Parind Shah, a San Francisco resident.
The wait for the antiviral drug to treat monkeypox is drawn out, too.
"We don't have an equitable system to really distribute them because they require so much paperwork," said Dr. Peter Chin-Hong, an infectious disease specialist at UCSF.
The medication is called tecovirimat, with the brand name TPOXX.
Dr. Chin-Hong cares for severe monkeypox patients.
"It works by the envelope of the virus," Dr. Chin-Hong said. "It disrupts the envelope. Monkeypox virus is a very straightforward virus. It's not complicated with spikes like COVID."
There’s not a shortage of TPOXX, but it’s only FDA-approved for smallpox. For monkeypox, it’s still considered an investigational drug.
The CDC has lifted some requirements, so doctors can prescribe it under something called expanded access. But that involves hours of forms and extra appointments.
Dr. Chin-Hong has seen it deter patients.
"He said, 'Oh, you know, it's okay. I don't want to come in, go through all this paperwork again. I think I'm just going to deal with pain. And you know what? You are asking me too many questions. I'll let you know if i need it,'" Dr. Chin-Hong said.
The latest CDC data from late July show doctors wrote about 230 TPOXX prescriptions for monkeypox. Since then, cases have more than doubled.
The CDC says monkeypox spreads when a person touches the skin of someone who is infected and is showing symptoms, like sores or scabs. It can also spread through respiratory droplets or oral fluids in close, intimate contact.
You can also get monkeypox from touching recently contaminated clothing or bedding used by an infected person who has symptoms.
"We are seeing lesions erupt that are very small," said Dr. Jason Farley, infectious disease nurse epidemiologist at The Johns Hopkins School of Medicine. "They're deeply seated, possibly under the skin, maybe look like a pimple that is forming."
If you fit any of those descriptions, health experts say call your doctor for a test as soon as you can, because antivirals like TPOXX work best when taken early into illness.
That's where public health emergencies come in. Declaring one frees up money in reserves that can’t be touched, and HHS rules won’t let providers dip from their COVID emergency funds for monkeypox.
Dr. Chin-Hong says for TPOXX, that means more help on that extra paperwork so he can care for more sick patients.