The Biden administration is facing increasing criticism from frustrated state health officials over a troubled system for distributing monkeypox vaccines that's slowing their ability to quickly reach patients.

Why it matters: Every delay intensifies concern that the government is fumbling the early response to another emerging health threat that could lead to uncontrolled disease spread in the general population.

Typically vaccines, including COVID-19 shots, are distributed through a CDC-run system that is integrated with state databases that track vaccinations and doses, the New York Times reports.

• But the monkeypox vaccine is being distributed by the National Strategic Stockpile, overseen by a different agency under HHS, which is not linked to state databases, per the Times. It's led to instances in which hundreds of doses were routed to the wrong states or lost in transit.

What they're saying: "We had no way to track vaccine shipments, when they actually shipped or when they were going to arrive," Chris Van Deusen, a spokesperson for the Texas Department of State Health Services, told the Times. "They just showed up with no notice."

• Washington state health officials told Axios they also struggled early on with the online ordering system.
• CDC and HHS officials have since resolved those technical issues, but the department is still having to do some heavy lifting when it comes to finding who has the capacity to receive and store vaccines and then redistributing the doses to those places with cold storage.
• The number of confirmed U.S. cases of monkeypox is approaching 12,000 amid troubling new signs the virus could be spread among people without outward symptoms.

Driving the news: HHS announced Monday that it's accelerating its planned delivery of additional Jynneos vaccine, making up to 442,000 doses available for states and jurisdictions to order weeks earlier than originally planned.

• That's in part a response to the nation's new strategy to stretch supplies via intradermal injection, between skin layers. This will allow providers to use one vaccine vial for five injections.
• But there's been limited CDC training to administer shots that way, which could further delay vaccinations, Jennifer Mahn, clinical and sexual health director at the National Coalition of STD Directors, told Axios.
• The manufacturer of Jynneos also warned senior Biden administration health officials about splitting the shots due to limited safety data, the Washington Post first reported.

Between the lines: The frustration is spreading to Congress, where some lawmakers are questioning why HHS isn't freeing up a smallpox drug called tecovirimat, or TPOXX, for treating monkeypox from the Strategic National Stockpile.

• Providers say the current amount of paperwork, lengthy visits and follow-up required for each patient prescribed the drug prevent some patients from getting the care they need.
• "This has made huge barriers for people without primary care providers or without routine access to care," Mary Foote, a medical director in the New York City Department of Health and member of the Infectious Diseases Society of America, told reporters last week.

What to watch: Though the government has ordered more vaccine, the immediate pressure is on local public health providers to get what's available in the arms of people most at risk.

• "We are seeing exponential growth in the numbers — that's not a good sign, however, we have heard from some jurisdictions that they feel like they're turning the corner on new infections," David Harvey, the executive director of the National Coalition of STD Directors, told Axios.
• Now, he added, the big question is how fast can front-line workers intervene in this outbreak and whether it will be fast enough to prevent monkeypox from becoming endemic.