To Jab or Not to Jab? Central Asia's Attitudes toward COVID-19 Vaccination

The success of vaccination programs will determine the pace and direction of efforts to return to normal. Photo credit: ADB.

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To overcome vaccine hesitancy, survey shows campaigns should target women and rural and high-risk populations and focus on family immunization.


Vaccinations are part of measures to prevent the occurrence and spread of many infectious diseases. Each country has its own vaccination program and its own set of diseases that the population is vaccinated against.

With the world fighting the coronavirus disease (COVID-19), the CAREC Institute and the Public Opinion Research Institute (Kazakhstan), with the support of the Asian Development Bank, conducted a study in seven of the 11 member countries of the Central Asia Regional Economic Cooperation (CAREC) program—Georgia, Kazakhstan, Kyrgyz Republic, Mongolia, Pakistan, Tajikistan, and Uzbekistan—about public attitudes toward COVID-19 vaccination.

The poll as detailed in the report, Analysis of Public Attitudes towards COVID-19 Vaccination in Selected CAREC Countries, shows that while majority of respondents in these countries are willing to get vaccinated, there is still a sizeable part of the population that remains skeptical.

The objective of the project is to help governments provide better roll-out mechanisms of their vaccination programs to achieve the maximum coverage needed for herd immunity. Time is critical to avoid further burdens on economies, human health, social interaction, and education.


Returning to a healthy, safe life without stifling restrictions has become a top priority for societies. Yearlong quarantine measures have affected the global economy, severely disrupted the social and economic well-being of people around the world, and caused multiple social and psychological problems.

One of the critical instruments on the road to normalcy is universal COVID-19 vaccination aimed at building herd immunity.

Of the 1,000 respondents from each country, majority expressed a positive opinion about the effectiveness of vaccinations: the highest rate of positive responses came from Mongolia (71.9%) while the lowest (29.2%) came from Kazakhstan.

Barriers to vaccination

The survey showed that the main barriers to vaccination include (i) lack of confidence in vaccine efficacy, (ii) lack of sufficient and proper information, and (iii) fear of side effects.

The poll also indicates a big disconnect between people’s receptiveness to information related to COVID-19 and the availability of such information through trusted sources.

While a significant percentage of the population trusts information received through medical professionals, they are not getting information often enough. One reason can be that medical professionals are overwhelmed at the frontlines of the health crisis. However, their participation in forming public opinion is of high importance.

Bridging the gap

Mass media campaigns together with information sharing from the ground, including from medical professionals, could bridge this gap. Some high-level international virologists or epidemiologist could also be engaged.

Information platforms and channels should be selected among the most popular information sources in each country. It is necessary to diversify channels used for reliable information dissemination through stands, leaflets, handouts in state and non-state medical institutions, shopping centers, markets, and so on. It is also necessary to involve the civil sector, civil society organizations, nongovernment organizations, and volunteers.

As much as 20% of the respondents in the seven countries polled believe that the pandemic is fake or made up by interest groups or governments. More than 49% of those who think the pandemic is made up would “Definitely” or “Rather not” get vaccinated compared with only 31% of those who are convinced that the pandemic is real.

Specific features of each target group—such as age, gender, place of residence, and educational background—impact their attitudes and choices. These need to be taken into account during advocacy activities. Special attention should be paid to rural residents as they indicated low awareness. Rural populations make up about half of the population (47.9%) in the seven countries.

Campaigns should reach out to people with education levels below secondary education. The survey showed that respondents from groups with the highest risk of infection are often the least inclined to go for vaccination.

Interestingly, people age 18–29 are almost as likely to go for vaccination as those in the 61+ age group. Middle age people (30–60 years old) are least likely to get vaccinated, and need to be specifically targeted. About 66% of 18–29-year-olds are ready to be vaccinated along with 62% of 30–45-year-olds, 65% of 46–60-year-olds, and 67% of those age 61 and older.

Forming positive attitudes

It is essential to form positive attitudes among women toward vaccination, since they often make the decisions about their children and family’s immunization. The study indicates that the main reason for participation in vaccination is family protection. This argument should be made an integral idea in any vaccination advocacy campaign.

Possible side effects are the main and prevalent reason for rejecting vaccination in all surveyed countries. Therefore, it is essential that vaccine recipients share information about their physical state and experience in social networks and other channels of information. It would be useful to ask vaccine recipients about their willingness to share this information for use in media campaigns. Experiences of recipients in countries where vaccination is already more advanced could also be used in campaigns.

Experiences of COVID-19 patients should also be shared to fight misperceptions or denial. A substantial number of people would not care to get vaccinated simply because they believe the pandemic is not very serious or fake altogether.

Encourage people, especially from the younger age group, who fell seriously sick with COVID-19, to share their experiences with the public. This will counteract the belief that only seniors are seriously affected by the virus.

In some countries it is also important to work with the clergy and religious leaders. Five of the seven countries participating in the project are countries with a predominantly Muslim population. Recommendations and instructions of religious leaders are important for significant segments of the population. The survey revealed that some respondents refused to be vaccinated for religious reasons. It is necessary to inform the clergy of the need for COVID-19 vaccination and to develop strategies jointly with religious leaders, associations, and organizations.

Mitigating the Economic Cost

The COVID-19 pandemic has been extraordinarily costly not only from the point of view of lost lives, health, and social interaction but also from an economic standpoint. For the year 2020 alone, costs in terms of lower output amounted to about 7% of GDP on average for CAREC countries according to the CAREC Institute’s Quarterly Economic Monitor in April.

There is also the looming danger of a K-shaped recovery, with the better-offs likely to recover relatively quickly while those who have less may suffer for a long time.

The correlation between retail sales and mobility data also shows that overcoming the pandemic will be key for revitalizing the domestic economy, even if the global economy recovers and external demand for CAREC products rises.

Successful vaccination campaigns are key to avoid repeatedly falling back into lockdowns which results in setbacks in the whole range of Sustainable Development Goals (no poverty, zero hunger, decent work and economic growth, quality education, gender equality and good health and well-being). Fast and successful vaccination campaigns are also preconditions for prevailing in the race against the COVID-19’s ability to mutate.


CAREC Institute. 2021. Analysis of Public Attitudes towards COVID-19 Vaccination in Selected CAREC Countries. Xinjiang.   

H. Holzhacker, K. Karymshakov, and S. Lu. 2021. The Economic Cost of COVID-19 is Huge: An Average 7% of GDP in CAREC in 2020 Alone. CAREC Quarterly Economic Monitor. April.

Hans Holzhacker
Chief Economist, CAREC Institute

Hans Holzhacker is Chief Economist at the CAREC Institute in Urumqi, People’s Republic of China. Before joining the CAREC Institute, he was the lead economist for Central Asia at the European Bank for Reconstruction and Development based in Almaty, Kazakhstan. He has 30 years of experience as an economist focusing on transition economies and holds a PhD from the University of Vienna in Austria.

Central Asia Regional Economic Cooperation Institute (CAREC)

The Central Asia Regional Economic Cooperation Institute (CAREC) is an intergovernmental organization promoting economic cooperation in Central Asia and along the ancient Silk Road through knowledge generation and sharing. CAREC is jointly shared, owned, and governed by 11 member countries: Afghanistan, Azerbaijan, People’s Republic of China, Georgia, Kazakhstan, Kyrgyz Republic, Mongolia, Pakistan, Tajikistan, Turkmenistan, and Uzbekistan.

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