Vietnam, where more than nine out of 10 registered vehicles are motorcycles and each household typically owns two, is grappling with how to boost road safety. Each year close to 15,000 people (out of a population of 86 million) die in traffic-related accidents, mostly motorbikes.
Since December 2007 adults have been legally required to wear helmets when riding motorbikes, or otherwise face fines of up to US$10; in April 2010 the government extended the requirement to children aged six and above.
Adult helmet-wearing has increased from some 40 percent of motorbike riders in 2007 to more than 90 percent in February 2011. Full-face, half-face and open-face helmets are seen alongside “tropical” helmeted riders who choose the lighter-weight headgear with more ventilation.
According to the national traffic police, in the first nine months of 2012, there were nearly 6,600 road traffic deaths - mostly involving motorcycles - and some 25,000 people injured, an almost 18 percent and 28.5 percent drop from the same period in 2011, respectively.
“This is thanks to helmets,” the division’s deputy director Tran Son told IRIN, crediting helmet-wearing legislation for the drop.
A 2008 review of 61 international studies concluded that helmets reduced the risk of head injury by around 69 percent and death by almost 42 percent.
Yet, excuses abound for why riders forego them. “I don’t want to mess up my hair;” “My mother doesn’t wear one;” “I am going such a short distance;” “Fate determines when we die, not a helmet;” and “Why buy my child a quality motorcycle helmet when she will outgrow it soon?”
Baseball cap “helmets”
Even with a helmet law in place, the percentage of head, face and neck injuries among patients (not only caused by traffic accidents) has increased at Vietnam’s largest surgical centre, the Health Ministry’s Viet Duc University Hospital in the capital, Hanoi. In 2008, the first year after the new helmet law was enacted, 34 percent of injury patients had head, face and neck injuries, which increased to 36 percent the following year, 42 percent the year after and 43.5 percent in 2011.
The hospital’s deputy chief of planning, Nguyen Duc Chinh, blamed substandard helmets for the rising injury rate.
Little of what is worn as protective headgear - most notably the baseball cap “helmet” - offers real protection, according to a recent World Health Organization (WHO) and Hanoi School of Public Health study in three northern provinces. Less than 20 percent of 581 helmets surveyed withstood laboratory impact tests.
Youths preferred baseball caps-cum-helmets with a chin strap, while some women opted for helmets with openings in the back to keep their ponytails in place.
Even as reported road traffic accidents have fallen in recent years, the “seriousness” of the complications, fatalities and injuries they cause - has increased, according to the Ministry of Transportation.
The ministry’s Department of Traffic Safety deputy director-general Le Minh Chau told IRIN head-on collisions between large vehicles coupled with lack of awareness among motorbike drivers about expressway safety are two reasons: two serious accidents happened recently on the elevated ring road in Hanoi when motorcyclists disobeyed a ban to enter and immediately died.
A 2009 WHO preliminary study of the impact of the 2007 helmet law on head injuries calculated a 16 percent drop in risk of road traffic head injuries (and an 18 percent drop in risk of death) from three months before the passage of the 2007 helmet law to three months afterwards.
One of the study’s co-authors, Jonathon Passmore, technical officer for road safety and injury prevention at WHO in Vietnam, told IRIN that five years after the law’s passage, “limited information” shows the law continues to reduce head injuries, but that the percentage of riders wearing helmets is down, while use of low-quality helmets is increasing.
WHO is finalizing a hospital survey of road injury patients dating back to 2006 to determine the impact the helmet law has had on road deaths and injuries.
For the government’s National Traffic Safety Committee vice-chairman Nguyen Hoang Hiep the large number of low-quality helmets is attributable to “lack of the state clamping down, and [the] psychology of riders.”
As of May 2011, Vietnam’s Ministry of Industry and Trade has certified 444 helmets from some 80 manufacturers. But this has not stopped vendors from selling “helmet-like” gear, said Hiep. “A vendor simply says that an [uncertified] helmet is not intended for motorbike use, but rather is just a hat for going out. The state cannot fine the seller in this case because it is not like the vendor has hung out a sign saying `motorcycle helmets for sale here’. [The vendor] can argue that it is not his responsibility how people use their purchases. The state’s hands are then tied.”
According to recent WHO market research, of 80 helmets purchased new in Hanoi that were marked with the state certification label, 54 percent did not pass safety tests.
For Greig Craft, president of the Asia Injury Prevention Foundation (AIP), a US-based NGO in Hanoi, counterfeit helmets have become a “hot” commodity and need to be outlawed just as fake medicines have been. “Like anything in the developing world, the counterfeiters have got into the business. The regulatory system is not working. But you would need an army to gather up unsafe helmets,” he said.
“The problem [uncertified helmets] is so widespread and there are just not enough police to enforce it. For a short period, we could do it, but not over the longer-term,” said Hiep. Traffic police are posted mostly in cities and along national highways, leaving rural areas bereft of official reminders of an oft-unheeded helmet law.
Nevertheless, the state must find a way to strengthen helmet safety regulations, Hiep acknowledged. “We must act on principle alone. Once we have uncovered a loophole, we must close it.”
Four government ministries are expected soon to issue a circular laying out tougher regulations in the production, distribution, circulation and use of helmets. “The state will more closely oversee [the above],” said Hiep, without explaining the how.
Motorbike riders choose cheap, vanity helmets as a fashion statement while trying to cut costs, Hiep said. A state-certified helmet costs on average $10, while counterfeits and helmet-like headgear cost only a fraction of that, according to the WHO’s three-province helmet analysis, which noted that the cheaper the helmets, the more likely they were to fail safety tests.
Costly medical treatment
But these savings pale in comparison to hospitalization, said Viet Duc Hospital planning official Chinh, who estimated door-to-door costs for head trauma treatment total about $1,000, roughly a year’s salary.
“I was only going a short distance,” said Dang Van Tuy, 28, repeating a rural motorbike mantra to explain why he was not wearing a helmet when he fell off his motorbike in Hai Duong Province, 45km from Hanoi. IRIN met him and other road injury patients at Viet Duc hospital.
Next to him was Nguyen Van Tham, 23, from Bac Giang Province, also some 40km from the capital. A family member spoke for Tham, who was in discomfort and unable to speak. “We found him mangled and purple. We do not know what happened or if he wore a helmet.”
Health workers and activists have for years called for helmet wearing legislation to apply to children under six, who are currently exempt.
For children six and older, enforcement is patchy. A February 2011 Vietnam National University study estimated some 30 percent of children wear helmets based on observations at schools and traffic intersections.
According to AIP, at least 500 children a month or 6,000 children a year under the age of 10 are killed in road accidents, mostly involving motorcycles.
Vietnam is one of 10 countries worldwide where the US-based Bloomberg Family Foundation has invested, in total, $125 million to boost road safety from 2010-2014. These countries - Brazil, Cambodia, China, Egypt, India, Kenya, Mexico, Russian Federation, Turkey and Vietnam - account for half the world’s annual estimated 1.3 million road traffic fatalities, according to WHO’s first global report on road safety published in 2009. The next update is expected in early 2013. In addition to Vietnam, support to Kenya, India and Cambodia is focused on boosting helmet-wearing and safety.
“Putting helmets on kids - `how quaint’, people say when they learn what I do,” said Craft. “What they do not know is that it is a road war out here.”