What makes an acute emergency? Temporal manifestation patterns and global health emergencies

Figures & data

Table 1. Kinds of health emergency manifestation patterns and their political dynamics.

	Emergent	Anticipatory	Cyclical	Perpetual
Illustrative case	H1N1	Avian flu	Ebola	AMR
Manifestation pattern (onset)	‘Emergent’ issues are perceived as novel or demonstrate novel aspects. Specifically, for infectious diseases, this category implies demonstrating new strains of concern or new contagions.	‘Anticipatory’ issues are characterised by their anticipatory–conjectural status as issues that have not yet manifested according to feared scenarios, but in which the mere possibility of their occurrence is perceived as an emergency.	‘Cyclical’ issues reoccur periodically and are characterised by traits that render them persistent issues or issues difficult to eradicate. The majority of adversities can be described as cyclical, including seasonal flu, hydro-met hazards and many other risks.	‘Perpetual’ issues have no clear endpoint or beginning. They are multi-generational or timeless adversities. Their impacts may also continue to worsen indefinitely with no clear endpoint in sight. Antimicrobial resistance is one case in point.
Political dynamic	The political dynamic is dominated by novelty-induced uncertainty and a lack of information and familiar template-based responses. This dynamic often changes as the issue matures.	The political dynamic is dominated by dread of an as-yet-unrealised high-consequence risk. It is relatively rare for such issues to attract sustained political attention prior to their manifestation, but the prospect of an avian flu pandemic is one example.	The political dynamic is dominated by a sense of familiarity and expectedness. Ebola outbreaks are a case in point. Only when manifesting as unusually severe (a novelty aspect) did the political dynamic shift towards a global emergency modus operandi.	The political dynamic is dominated by incrementalism and low political salience. Linear onset is often assumed, suggesting predictability. Attention is mainly secured when the onset departs from expectations.