The making of public health emergencies: West Nile virus in New York City.

In this article we use the case of the West Nile virus (WNV) to investigate the social construction of public health emergencies (PHEs) and the subsequent changes in public health governance that they instigate. Informed by medical sociological literature on the social construction of illness, science and technology studies, and risk and disaster literature, we create a conceptual framework for connecting health and crisis. Our investigation of the WNV analyses PHEs as brief, but vitally important, moments in which a 'crisis' is co-constructed between states, affected populations and disease vectors. In these moments of crisis new interventions are enacted, which have long-term effects for institutional structures and disease management. Using extensive qualitative data collection, we conceptualise two mechanisms that underlie the declaration of PHEs and the expansion of related 'emergencies' across space and time: (i) crisis interventions that have the potential to marginalise the interaction of citizens with state institutions and (ii) institutional rearrangement of state agencies stemming from the original crisis issue, resulting in altered networks and institutional practices and drawing heavily upon the crisis as a symbol of similar, future public health threats.