New research points to the difficulties of monitoring outbreaks of avian flu in strategic regions

In a paper recently published in the Lancet, Dr Rifat Atun, Director of the Centre for Health Management at Imperial College London's Tanaka Business School, and Professor Martin McKee of London School of Hygiene highlight the weak links in public health responses to containing avian influenza.

The research analyses a number of countries, which, for geopolitical reasons, civil conflict or because they serve as military bases, are beyond the reach of the international system of public health. The authors cite, amongst others, regions in Europe and the Caucasus (Northern Cyprus, Kosovo, Transdneistria, Ngorno-Karabakh, Abkhazia and South Ossetia), Africa (Cote d'Ivoire, Western Sahara and Sudan), the Middle East (Palestinian territories), Asia and Asia Pacific (Diego Garcia and Taiwan) and the Americas (Guantanamo bay in Cuba).

Many of these regions lie on the migratory paths of birds and are areas where Avian influenza cases have been detected. Despite the necessity of including them in the WHO's monitoring structures, areas such as Taiwan, are hampered in their efforts to establish official communication with the WHO, as in some cases such communication might imply "independent status for the state."

Dr Atun comments that "the research highlights the necessity of extending the international system of public health surveillance to these specific countries and regions as the system is as strong as the weakest link in the chain and we cannot afford to have any weakness if we are to mount a rapid and robust response to outbreaks of avian influenza."

Notes to editors
About Imperial College and Tanaka Business School
Consistently rated in the top three UK university institutions, Imperial College London is a world leading science-based university whose reputation for excellence in teaching and research attracts students (11,000) and staff (6,000) of the highest international quality. Innovative research at the College explores the interface between science, medicine, engineering and management and delivers practical solutions that enhance the quality of life and the environment - underpinned by a dynamic enterprise culture. Website: www.imperial.ac.uk

Imperial College's Tanaka Business School is a world-class provider of business education and research, focusing primarily on Imperial strengths in innovation and entrepreneurship, finance and healthcare management. The School offers full-time and executive MBAs, Master's programmes in Finance, Risk Management, Actuarial Finance, International Health Management and Management; and a PhD programme.

Dr Rifat A. Atun, Director of the Centre for Health Management, Tanaka Busines School, Imperial College London
Dr. Rifat Atun is the Director of the Centre for Health Management and Reader in International Health Management at Tanaka Business School, Imperial College London, where he leads a multidisciplinary group of researchers.

His research interests include analysis of how contextual and health systems factors influence implementation of complex health innovations and programmes, in particular new health technologies and health programmes (such as HIV/AIDS, TB and primary care). His research also explores health sector reform and new service delivery models. He has authored two books and has published widely in peer reviewed journals, such as the Lancet, BMJ, Bulletin of the WHO and Health Policy.

He works closely with the World Bank, the World Health Organisation and UK Department for International Development and has extensive experience of designing, implementing and evaluating health systems development programmes.

Rifat is a member, by distinction, of the Faculty of Public Health of the Royal College of Physicians and was recently elected as a Fellow of the Royal College of General Practitioners.

Centre for Health Management
Tanaka Business School's Centre for Health Management brings together some of the best and brightest researchers in the health management field. The Centre works with scholars around the world on projects funded by international and national agencies, to address key research questions of national and global significance. Its collaborative work with industry and governments inform policy and strategy both nationally and internationally. The Centre's staff work on consultancy projects and teach on Tanaka Business School and Imperial College programmes, as well as running training courses tailored to the needs of international health professionals.

The Centre's mission is to be the leading research centre generating knowledge in the area of health management, to contribute to scholarly debate and to inform policy and decision-making in an international context for both private and public organizations. The Centre is currently working on a major research project sponsored by Pfizer, which looks at issues of innovation and change within the life sciences industry. It is also collaborating with ministries of health from various countries to identify factors which enable or constrain health system development, and with research groups such as the European Observatory on Health Systems, Imperial College (Faculty of Medicine), Institute of Psychiatry London, London School of Economics, London School of Hygiene and Tropical Medicine, King's College London, Heidelberg University and the World Health Organization.

The Centre is funded by leading national and international organizations such as the UK Department for International Development, the EU, the World Bank, the World Health Organization, UNDP, the Open Society Institute (Soros Foundation), the UK Department of Health as well as private sector institutions such as Pfizer Inc. and Merck and Co. and Vodafone Plc.