Keyword: Kazakhstan

ABSTRACT: For centuries, health was viewed from the lens of biomedicine as the core. This view considered medical professionals and hospitals as the sole agents and venues where health could be obtained, with only passive mentions of the impact of social determinants of health. In a paradigm shift from this view in 1978, at the Alma-Ata Declaration in Kazakhstan, 134 member countries of the WHO formalized the recognition of the social determinants of health into a global policy. Factors such as accessibility, affordability, availability, social and economic status, and education about health services are crucial for population health. The Alma-Ata Declaration required the governments of member countries to include deliberate policies that strengthen and promote population health, by ensuring that social measures are included in their national development plans while recognizing the rights of collective and individual participation of their populations. The phrase “Primary Health Care” (PHC) was then adopted. It was defined as “essential health care based on practical, scientifically sound and socially acceptable methods which are of relevant technology, made accessible and affordable to families and communities through their participation”. Health became a human right underpinned by equity and population participation principles. The aftermath of the Declaration was an immediate implementation challenge. It was soon to be realized that PHC interventions are not linear and generalizable like biomedical interventions which have specific measures and predictable outcomes. To date, there is no blueprint for universal intervention measures because economic disparities, social and situational contexts differ and determine the success of any intervention measure. Our review explores the challenges and successes of the implementation of PHC in Kazakhstan, the birthplace of the global health policy on PHC.

ABSTRACT: Background: Vaccination is one of the most effective public health interventions yet increasing numbers of unjustified medical exemptions in Kazakhstan threaten both herd immunity and public trust. In 2020 alone, over 208,000 temporary and 2,600 permanent exemptions were issued—often based on questionable clinical criteria. This study aims to explore the drivers behind the rising number of medical exemptions in Kazakhstan, with a particular focus on the perspectives and attitudes of healthcare professionals.
Methods: A qualitative approach was employed, combining a desk review of national immunization policies and statistical reports with 27 in-depth interviews conducted in 2021–2022. Participants included healthcare providers and public health experts across urban and rural regions of Kazakhstan. Thematic analysis was used to identify key patterns in the data. Relevant national regulations were also reviewed and compared with international standards.
Results: Thematic analysis revealed four major areas of concern: (1) inconsistencies in pre-vaccination monitoring practices, (2) variability in post-vaccination follow-up procedures, (3) divergent roles and responsibilities among stakeholders in granting medical exemptions, and (4) limitations in surveillance and data systems for tracking and verifying exemptions. Findings suggest that physician over-cautiousness, legal insecurity, parental pressure, and inconsistent training are key drivers of unnecessary exemptions. The overdiagnosis of precautionary conditions—particularly by specialists such as neurologists—further contributes to false contraindications. These practices erode vaccine confidence and create barriers to timely immunization.
Conclusion: Addressing the growing problem of unwarranted medical exemptions requires policy reform, clearer clinical guidelines, enhanced physician training, and improved digital monitoring systems. Strengthening these areas is essential for restoring public trust, reducing unjustified exemptions, and ensuring high vaccination coverage in Kazakhstan.