Steve Beerman "Keynote Immunization for Drowning" NDPA Symposium 2012

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Immunization for Drowning Prevention -The public health approach to save lives in the Asia and the USA

Dr Stephen Beerman BSc, BSR, MD, CCFP, FCFPPresident, International Life Saving Federation

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� Objectives

� Highlights - World Conference on Drowning Prevention

� Global Drowning Picture

� Child Drowning in the USA

� The Drowning Prevention Immunization

� Taking drowning prevention to the next level

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ILS is your link to the UN, WHO, IOC, UNICEF & UNOSDP

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ILS Members from the USA

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Goal #4 �To reduce by two-thirds the mortality

rate for children under 5 years old.

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DROWNING IN ASIA

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World Conference on Drowning Prevention

May 2011, Vietnam

� Dr David Meddings – WHO , May 2011

� Drowning is a major public health challenge

� In areas where progress on infectious disease reduction is large – drowning is unmasked

� Continued progress on the Child Survival Agenda will require LMIC nations to reduce drowning.

http://www.worldconferenceondrowningprevention2011.org

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World Conference on Drowning Prevention

May 2011, Vietnam

� Dr. Michael Linnan, UNICEF/TASC /International Drowning

Research Centre – Dhaka, Bangladesh

� The scale of the child drowning epidemic in Asia has been greatly underestimated by the global public health community.� Due to methods of estimating drowning deaths

� Need for population based data (Household Surveys)

� Health system data sources are inaccurate

� 2 large drowning cohorts in LMIC nations of Asia� Under 5 (1-5) due to lack of adult supervision

� Over 5 due to lack of survival swimming ability

� Effective and cost efficient interventions are known

http://www.worldconferenceondrowningprevention2011.org

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Drowning is instantly fatal –most often

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What we know today – Drowning in Asia

� Injury was overshadowed by other mortality causes

� Drowning is under reported

� Drowning accounts for ½ of all child injury deaths *

� Toddlers 1-4 drowning >90% of injury deaths

� Injury deaths as a proportion of all mortality will rise

� >75% of the world’s children live in high risk nations

� Academic debate of mortality burden -it is large!

� Most drowning mortality is preventable!

� Prevention interventions are effective

* Child Mortality and Injury Asia: UNICEF Innocenti Research Centre

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Survival Swimming in High Resource Populations

� Conclusions:

� Participation in formal swimming lessons was associated with an 88% reduction in the risk of drowning in the 1- to 4-year-old children

� Informal swimming lessons also reduced

� Age 5-19 also showed benefit

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� The need for a global alliance is high

� Collaborative skill/resource mix is essential

� ILS, WHO, UNICEF, TASC, and ILS Members, etc

� Academic Public Health

� Governments

� Funding Partners/Investors

� Effective Governance and Management Capacity

� Accountability and scholarly approach needed

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Public Health Approach

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The Public Health Approach� Targeted Interventions� Regulation

� Fencing, water hazard reduction, safety equipment, facility regulation, lifeguarding

Primary� Adult supervision� Survival Swimming Skills� Water safety education

Secondary� Lifesaving rescue � CPR

Tertiary� ICU/Specialized care

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Immunizations

Disease prevention

lifelong immunity preferred

Herd immunity

Mortality reduction

Cost effective

Safety

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World Conference on Drowning Prevention May 2011, Vietnam

� Precise Child drowning Intervention Trial (Bangladesh)

� Under 5 – Adult Supervision via Creche/Daycare

� Over 5 - Survival Swimming instruction in ponds

� Very significant mortality reductions

� Cheaper than all the usual immunizations

� Life long immunity from drowning and other injury

� Herd Immunity

� Safely delivered in the project

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Survival Swimming Skills that save lives

� There are minor variations of this around the world� Self - rescue

� Fall into water

� Stay on the surface for 30 seconds

� Move forward for 20 meters in any manner

� Water safety awareness

� Rescue of others� Reaching and throwing

� CPR

� Can be achieved in few classes with trained instructor

� Safety issues are critical to the success of this approach

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Immunization in the USAThe Role of Cost-Effectiveness in U.S. Vaccination Policy

Jane J. Kim, Ph.D.

N Engl J Med 2011; 365:1760-1761November 10, 2011

� The public-sector cost of fully vaccinating one person as recommended through adulthood (not including annual influenza vaccines) is roughly $1,450 for males and $1,800 for females.

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Epidemiology Transformation = positive sustainable outcomes

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Drowning in Spain� WHO data for Spain 2056 drown in 2008

� Population of 44.6 million

� Population under 15 yrs is 15%� Drowning Rate is 4.6 per 100,000 in 2008

� WHO data for Spain Road Traffic Accident � 2003 5478 deaths

� 2008 2560 deaths

� When a public health approach becomes a priority for attention, funding and policy – deaths are preventable

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Take drowning prevention to the next level

� We need all players on the team

� Survival Swimming Skills are an immunization against drowning� for life

� cost effective

� herd effect

� It will reduce disaster mortality� Skills must be imbedded in your community before the disaster

� All citizens must be empowered

� Barriers exclude the highest risk populations � Work very hard for barrier free delivery

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Compare with Malaria� Global Burden of Malaria

� Annual worldwide deaths due to malaria: 1.1 million

� April 25 2008 UN Secretary General announced ‘ROLL BACK MALARIA PARTNERSHIP’

� BUDGET $3.6 BILLION ($1.7 BILLION FROM GATES FOUNDATION = START-UP)

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Drowning Prevention – A Public Health Issue

Take it to the next level 1. Reduce drowning in your community via targeted and barrier free

programs

a) Statutory regulations and enforcement

b) Adult supervision and water safety

c) Survival swimming skills for every child

d) CPR training

2. Learn to apply a public health approach to aquatics to improve positioning, resources and outcomes

3. Coordination, facilitation and learning with ILS, ILS Members and collaborative partners

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Thank you