AUTHOR=Kassabekova Lena , Smagul Manar , Nukenova Gaukhar , Satayeva Aigul , Aubakirova Bibigul , Zhakhina Gulnur , Yesmagambetova Aizhan 

TITLE=Barriers to vaccine acceptance and immunization coverage in Kazakhstan: a mixed-methods study using the COM-B framework

JOURNAL=Frontiers in Public Health

VOLUME=Volume 13 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1600363

DOI=10.3389/fpubh.2025.1600363

ISSN=2296-2565

ABSTRACT=BackgroundVaccine 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.MethodsA mixed-methods 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.ResultsAlthough 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 older adult 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.ConclusionDespite 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.