If it wasn’t clear enough during the Covid-19 pandemic, it has become obvious during the monkeypox outbreak: The United States, among the richest, most advanced nations in the world, remains wholly unprepared to combat new pathogens.

The coronavirus was a sly, unexpected adversary. Monkeypox was a familiar foe, and tests, vaccines and treatments were already at hand. But the response to both threats sputtered and stumbled at every step.

“It’s kind of like we’re seeing the tape replayed, except some of the excuses that we were relying on to rationalize what happened back in 2020 don’t apply here,” said Sam Scarpino, who leads pathogen surveillance at the Rockefeller Foundation’s Pandemic Prevention Institute.