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

In this article, we consider the role that onset patterns play in shaping how acute global events are taken to be, drawing on illustrative cases from the field of global health emergencies. We identify four temporal manifestation patterns that we argue display distinct political dynamics. First, an emergent onset pattern (e.g. the H1N1 health emergency), with political dynamics dominated by novelty-induced uncertainty and lack of information as well as familiar analogies. Second, an anticipatory onset pattern (e.g. the risk of a global avian flu health emergency), with a political dynamic characterised by dread of an as-of-yet unrealised high-consequence risk. Third, a cyclical onset pattern (e.g. Ebola), with a political dynamic characterised by a sense of familiarity and expectedness, unless eventual ‘unexpected’ or ‘unprecedented’ aspects manifest themselves. Lastly, a perpetual onset pattern (e.g. antimicrobial resistance), with political dynamics characterised by incrementalism and low political salience. We argue that acuteness is often associated with a departure from expected manifestation patterns, such as an escalation or other traits that make events appear unfamiliar. Whilst drawing on global health emergences in this paper, the four categories theorised here may also be used on a range of other adversities at the global or local level.