Suction entrapment fatalities appear to be happening with disturbing frequency overseas, calling into question the need for international standards to help prevent such incidents. In April, two fatal entrapments occurred within days of each other — one in China, the other in India.

The first happened in Macao, China, on April 4. According to reports, 37-year-old Wu Jisheng was relaxing in an inground spa with his wife and child at a Four Seasons Hotel when the pump malfunctioned. This created a vacuum around the man’s buttocks, preventing him from raising his head above water in the approximately 3-foot-deep spa, according to the website Shanghaiist. Pictures show that the spa had only one suction outlet.

A pool at an apartment complex in Bengaluru, India, was the site of the second tragedy. It also occurred in early April and claimed the life of an 11-year-old boy.

According to the Deccan Herald, Siddharth Nambiar was swimming with others in the pool when he put his hands in the pipe and inlet, which, according to the story, lacked a covering that it referred to as a “mesh.”

In both countries, there’s a dearth of regulation and monitoring of pool and spa circulation systems to avoid suction entrapment, observers said.

According to Dr. T.N.V.V. Rao, who served as head of water solutions for Underwriters Laboratories in India, health officials are supposed to conduct safety inspections, “but this is not followed,” he stated in an email.

China has now seen two reported entrapment fatalities in less than a year. In July 2014, a 12-year-old boy was sucked into a 13-inch circulation pipe at a waterpark in Xi’an, Shaanxi province. After that incident, industry professionals in China remarked that the accident may have occurred because there was little government oversight.

It’s not likely that either nation will do anything immediately to raise safety standards in response, industry observers report. However, there is a silver lining.

“Now that all drain covers made in the U.S. have anti-entrapment certifications and requirements, my understanding is, those manufacturers are selling these products around the world,” said Tom Lachocki, CEO of the National Swimming Pool Foundation in Colorado Springs, Colo. “The likelihood is, in time, more and more covers will be replaced with anti-entrapment covers.”

Beyond exports of safer equipment, these nations are benefiting from U.S. expertise in the form of education and training. NSPF instructors in China have trained approximately 150 pool professionals, and 11 courses are scheduled this year. About 20 people are Certified Pool Operators in India, as well.

But there’s more work to be done. “We are communicating with a couple of leaders in the area to start implementing more training in those countries,” Lachocki said.

While NSPF reaches out to the nations’ leaders, another man is trying to raise the issue with hotel operators, who might be able to institute change. What’s particularly problematic about the Macao incident is that it occurred at a Canadian-based hotel chain with a large presence in the U.S.

“The thing that amazes me is that so many of these large hotel chains conform very rigorously to American standards … but the moment they go overseas, the adherence isn’t very strict, if it exists at all,” said Dr. John Fletemeyer, executive director of the Aquatic Law & Safety Institute in Seattle.

Fletemeyer conducted a three-year investigation evaluating the safety of 86 pools in seven countries. Those operated by hotels were some of the biggest offenders.

“I haven’t found any of the big chain hotels where they have adapted uniform safety procedures across the boad,” Fletemeyer said. “There doesn’t seem to be a level of cognizance of swimming pool safety within upper management overseas.”

He’s been writing to risk managers associated with major hotel operators, but “I think so far it’s falling on deaf ears.”