In early 2021, the predominant reason for refusing vaccines was that the respondent did not trust vaccine producers. Although this remained a significant concern in all three countries, much more striking is the rising prevalence of the response that “counterindication” was the reason a respondent did not plan to be vaccinated. By August 2021 this accounted for the plurality of vaccine hesitant people in all three countries. The rise of counterindication is not solely an effect of composition, it also continuously rose in absolute terms in Uzbekistan and Kazakhstan. See annex 2 for more details on counterindication patterns in Central Asia.

Among those saying they will not vaccinate in Kazakhstan and Tajikistan, those who cited counterindication were the “stickiest” in their responses, in the sense that they were consistently the least likely to change their response. In Uzbekistan only the “other” category is stickier, and in Uzbekistan, many people providing “other” responses describe ineligibility due to various health criteria that are not formally counterindication restrictions on vaccination. For instance, a common response in the other category was the (mistaken) impression that vaccines were unsafe for people over age 60 or 65.

The prevalence of counterindication as a reason for vaccine hesitancy in Central Asia is likely linked to official guidance (please see annex 2 for more details). In Kazakhstan, Uzbekistan, and to a limited extent Tajikistan, vaccination programs explicitly excluded some at-risk groups, with public communications campaigns often listing these conditions explicitly. Eligibility restrictions were primarily based on perceived risk arising due to pre-existing health conditions. However, the guidance in some cases strongly contrasted with conventional practice elsewhere in the world where members of these same at-risk groups are often targeted for early vaccination with the same vaccines.<sup>8</sup>

# Methods

Our survey experiment was embedded in the Listening to Central Asia series of surveys in Tajikistan, Uzbekistan, and Kazakhstan, surveys that are designed to continuously monitor wellbeing and views on topical policy issues.<sup>9</sup> The surveys are nationally representative and based on fieldwork conducted in two phases. In the first phase, a national in-person household survey was conducted in each country using regionally stratified two-stage cluster sampling procedures. In the second stage, a randomly selected subsample from the first stage in each country was recruited in a monthly panel survey using a phone-based method conducted by private survey companies under the direction of World Bank staff. The sub-samples were each nationally representative and for the present study include a total of 6,783 individual responses (2,714 in Uzbekistan, 2,267 in Tajikistan, and 1,802 in Kazakhstan). Data collection for the survey experiment was conducted May-June 2021. Descriptive statistics on vaccination and concerns related to COVID-19 were collected continuously in all three countries from early 2021 to August 2022.

For the core experiment, we randomly assigned respondents to one of five groups within each country survey. Each respondent was asked if they would agree to be vaccinated, and a subset of respondents

> 8 - A list of prioritized groups by country is provided at the following website: https://graphics.reuters.com/world <u>coronavirus-tracker-and-maps/vaccination-rollout-and-access/</u>

> 9 See https://www.worldbank.org/en/country/uzbekistan/brief/l2cu; and <u>https://www.worldbank.org/en/country/tajikistan/brief/listening2tajikistan</u>

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