ORIGINAL RESEARCH article
Front. Public Health
Sec. Infectious Diseases: Epidemiology and Prevention
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1600363
Barriers to Vaccine Acceptance and Immunization Coverage in Kazakhstan: A Mixed-Methods Study Using the COM-B Framework
Provisionally accepted
Lena Kassabekova1
Manar Smagul2
Gaukhar Nukenova2Aigul Satayeva1Bibigul Aubakirova2Aizhan Yesmagambetova2
Gulnur Zhakhina3*- 1Scientific and Practical Center for Sanitary and Epidemiological Expertise, Almaty, Kazakhstan
- 2National Center for Public Health, Astana, Kazakhstan
- 3Nazarbayev University, Nur-Sultan, Kazakhstan
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Background: Vaccine hesitancy remains a significant public health challenge, affecting immunization coverage and increasing the risk of vaccine-preventable diseases. Understanding the factors influencing vaccine acceptance is crucial for developing targeted interventions. This study examines immunization coverage, vaccine hesitancy, and barriers to vaccine uptake in Kazakhstan, focusing on routine childhood immunization, COVID-19 vaccination, and HPV vaccination. Methods: A mixedmethods approach was used, combining quantitative immunization coverage data with qualitative insights from focus group discussions (FGDs). Immunization trends were presented using national data from 2020 to 2022. The study included FGDs with healthcare workers, unvaccinated older adults, mothers/caregivers of unvaccinated young children and of adolescent girls, focusing on COVID-19, routine immunization, and HPV vaccination. Thematic analysis was used for defining main themes in discussions. Results: Although routine immunization coverage improved in 2022 compared to 2020, general vaccine refusals increased by 2.62 times. The primary reasons for vaccine refusal included personal beliefs (68%), concerns about vaccine safety (54%), and distrust in healthcare institutions (39%). COVID-19 vaccine hesitancy was particularly high among elderly individuals, influenced by skepticism regarding vaccine safety, multiple vaccine options, and conspiracy theories. Healthcare professionals exhibited mixed confidence in COVID-19 vaccines expressing concerns about long-term safety. HPV vaccination hesitancy was linked to limited awareness and misconceptions about cervical cancer. Conclusion: Despite improvements in immunization coverage, vaccine hesitancy remains a critical barrier in Kazakhstan. Addressing misinformation, enhancing healthcare communication, and implementing targeted educational campaigns are essential for improving vaccine acceptance and public trust in immunization programs.
Keywords: Vaccine hesitancy, Immunization coverage, Public Health, Vaccine acceptance, COM-B framework
Received: 26 Mar 2025; Accepted: 14 May 2025.
Copyright: © 2025 Kassabekova, Smagul, Nukenova, Satayeva, Aubakirova, Yesmagambetova and Zhakhina. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Gulnur Zhakhina, Nazarbayev University, Nur-Sultan, Kazakhstan
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.