What characterises emergency response to slowly developing crises and disasters?

As part of efforts to understand the political dynamics of slowly developing crises and disasters, Reidar Staupe-Delgado and Olivier Rubin at Roskilde University and Copenhagen Center for Disaster Research (COPE) have carried out the two-year research project SlowDisasters centred on the politics of global health emergencies like antimicrobial resistance. Results from the research project sheds new light on how very slow and permanent issues like antimicrobial resistance plays out politically in relation to more cyclical issues like outbreaks of Ebola virus disease.

The salience of different kinds of global health emergencies

Global health scholars are well aware that there is no clear proportionality between the global toll of a disease and its salience on the global health agenda. At the World Health Organization (WHO)-level, for instance, a global health emergency declaration is typically reserved for diseases that meet specific criteria. There is typically a sense of novelty involved, whether in terms of novel disease or a sense of unprecedented severity or risk. This poses a problem for slowly developing crises and disasters, as their arrival is unsurprising and scarcely gives rise to any sense of novelty. Antimicrobial resistance is one good example, as we have known about the risk of resistance since the invention of penicillin a century ago. Results from the SlowDisasters research project helps us understand how different temporal categories of global health issues have distinct political dynamics associated with them.

Some global health issues are of a cyclical nature. Ebola falls into this category. Recent global responses to Ebola virus disease have been characterised by delays and controversy. However, this dynamic is similar to other cyclical issues in agenda setting research. A sense of familiarity with an issue is often perceived initially for cyclical kinds of problems, and Ebola was no exception. By the time it is clear that an issue is not behaving as we expect it to, a costly shift towards a novelty-based response logic is often initiated. A similar tendency could be observed when new strains of COVID-19 emerged. This is a common but major hindrance for efforts at securing more proactive response to slowly developing crises and disasters.

Other global health issues are based on conjecture and anticipation. The prospect of an avian flu pandemic has spurred fear and controversy for decades. As a global health issue, commentators have fluxed between being puzzled at the lack of attention to it and others with the amount of attention to it. It is very rare for an issue to be treated as an actual emergency before it has occurred. However, as the avian flu question and a few other issues (e.g., genetic modifications, certain nanotechnologies) illustrate, some issues in global health can and do receive significant attention before a significant global or regional toll has been reached.

Some global health issues are of what we can call a perpetual nature. Antimicrobial resistance falls into this category. The continued advancement of the problem is rooted in the evolutionary process of biology and cannot be readily stopped. This might help explain the relative lack of interest in antimicrobial resistance at the global level. Not only does it fail to meet most novelty-based or surprise-based criteria inherent to most definitions of emergency, it also has few immediately available solutions. It is a long-term issue in need of long-term solutions.

As previously mentioned, we are typically more inclined to see novel and surprising events in emergency terms. We can say that when faced with the unfamiliar, the alarms are generally more likely to go off. To date, for example, all global health emergencies at the WHO level have been viral diseases. With the exception of polio (the longest running WHO-level global health emergency declaration, activated almost a decade ago and still in effect), all of these have displayed different novel or surprising aspects that were seen to satisfy WHO emergency criteria. Meanwhile, a range of global health issues, chief among them climate change and antimicrobial resistance, fall outside the scope when a novelty-based logic is applied.

Five lessons for overcoming obstacles to proactive response

The project offers five insights on how we can work towards overcoming obstacles to proactive response:

1. Recognise that early warning does not automatically translate into early warning. Early warning signals need to be followed by clear recommendations for courses of action to be effective.
2. Maintain awareness of that an emerging issue with familiar traits can also have significant unfamiliar aspects early on. However, once unfamiliar and novelty aspects become evident, the response should remain sensible.
3. Early action is more likely in situations where responses are sensible and where they also build on existing efforts on the ground. If emergency is seen as a threat to local interest and autonomy, the situation is more likely to be downplayed and the response is often less effective as a result.
4. As an active situation becomes increasingly protracted, it is likely to fragment along existing social lines. As an increasing number of people return to normalcy, pockets of the population is likely to remain heavily affected. The HIV/AIDS global epidemic can offer important insights on the dynamics of a protracted global health emergency.
5. The fuzziest problems often fall outside of the definition of emergency altogether, including climate change and antibiotic resistance. These are arguably the two biggest challenges to global health, and ways of productively conceptualising these issues in global health need to be found. In the absence of clear interventions that can curb their onset, global health agendas have instead focused on specific infectious diseases. However, the global health community will increasingly need to grapple also with macro-forces that change the rules of the game. New definitions and guidelines need to reflect these realities.

 

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