Understanding the Rising Trend of Medical Exemptions in Childhood Vaccination: A Qualitative Study of Healthcare Providers’ Perspectives in Kazakhstan

<b>Background:</b> 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.<br /> <b>Methods:</b> 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.<br /> <b>Results:</b> 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.<br /> <b>Conclusion:</b> 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.<br />