Crisis Negotiation as a Vocation

How a Pediatrician in South Kazakhstan Has Been Convincing Parents to Accept Vaccinations for a Quarter of a Century

“There are many rejections this year, there has never been anything like this,” says Dr. Kanymkul Amangeldievna Alzhanova, Deputy Chief Doctor for Maternal and Child Health at Shymkent Polyclinic No. 11. The doctor, who has been responsible for immuno-prevention for the past 25 years, watched disconsolately what was unfolding at the beginning of the school year. Parents, fearing that first-graders would be vaccinated against COVID-19 without their consent, turned down routine revaccinations against tuberculosis.

Kazakhstan is an epidemiologically unfavorable country for tuberculosis. Almost two-thirds of patients are carriers of the drug-resistant form of the disease. Due to refusals, a Bacillus Calmette–Guérin (BCG) revaccination campaign in Shymkent lasted for two months instead of the usual month-long timeframe. In support of this campaign, Dr. Alzhanova and her colleagues tried numerous methods to convince parents to have their children vaccinated, including: parents’ meetings with medical workers, individual talks in polyclinics, and invitations to observe the vaccination process directly.

“I tried to meet with all the parents as much as possible,” says Dr. Alzhanova. She is a well-known doctor in the city. Twenty-five years ago, when she started as a young pediatrician in a polyclinic, she was assigned to a sparsely populated area. While the authorities were building the clinic’s capacity, Dr. Alzhanova worked with children in almost all districts of Shymkent. Due to the relationships she has nurtured over the past 25 years, Dr. Alzhanova believes she can calm anxious parents. “The magic” works even during Zoom meetings. The results are striking: on average, she convinces half of all patients who initially refuse vaccinations.

Rather than engaging in scientific arguments with patients, Dr. Alzhanova prefers to reassure anxious visitors. “Across the board, I often have aggressive parents. We have the most hectic job with pregnant women. I try to appeal to them compassionately,” she says. As the number of rejections increased over the years, communication skills have become as essential in her work as immuno-prevention itself.

In November 2021, Dr. Alzhanova accepted the opportunity to participate in a five-day workshop on vaccinology, hosted by UNICEF and the Alliance of Family Physicians of Kazakhstan. The workshop was part of a USAID-funded program to strengthen Kazakhstan’s immunization system. The participants identified false medical exemptions as one of the major reasons for the decrease in vaccination rates and developed their interpersonal communication skills. The 25-year veteran was interested in the interpersonal communication sessions. Participants simulated the most ambiguous real life situations - for example, a patient’s refusal to vaccinate due to misconceptions. Through this training, Dr. Alzhanova realized the importance of the role psychologists and social workers play in healthcare facilities and the importance of educating them on the basics of immunization.

Dr. Alzhanova returned from the training eager to share her new knowledge with her colleagues: general practitioners, pediatricians, and highly specialized doctors. She shared the most interesting information via voice messages in chat rooms, and after the completion of the training, she organized her own mini-seminar on vaccinology. During this seminar, her colleagues working at Shymkent Outpatient Clinic themselves learned about certain disorders that are not contraindications to vaccinations.

True and false medical exemptions in children were one of the most important topics at this seminar. Domestic neurologists often identify various abnormalities in children, and pediatricians and therapists can provide a medical exemption from preventive vaccinations on this basis. Dr. Alzhanova admits that as she grew older, she began to follow the advice of her colleagues and not insist on vaccinations.

Earlier, while working as a district doctor, she often made decisions in favor of vaccination after collecting the medical history. The training reminded her of these moments, and she once again assured herself of her knowledge and competence. 

Dr. Alzhanova also draws on her experience dealing with a measles outbreak in 2018-2019. A 23-year-old male, who came to Shymkent for military service, had measles and inadvertently spread the virus beyond the garrison. Dr. Alzhanova and her team quickly organized and led a campaign to immunize more than 1,000 people against measles. 

“We were afraid, of course, but it was our duty. We were especially concerned about young children, so we brought in all the doctors and nurses at that time. Everyone was sent out on door-to-door rounds to identify children with fever in the early stages and isolate them on the same day,” she explains.

While the measles outbreak was contained, the vaccine reluctance is increasing. Every year in Kazakhstan, 5,000 to 8,000 parents refuse to vaccinate their children, threatening a new measles surge within five years.

Dr. Alzhanova is certain that negative publications and posts about vaccination in social media and mass media strongly fuel parental skepticism. “We persuade, speak on television, translate into Kazakh, and explain in our own words,” she notes with satisfaction the efforts of her team, adding that she herself is engaged in education literally “at every step.” Now her team is focused on the vaccination of teenagers against COVID-19 and she has already had several school children immunized under her watch.

When asked if she likes her job, she answers, without hesitation, “I like it. But I get very tired..emotionally tired. When I go to work, I have energy, I surprise myself!” Dr. Alzhanova always welcomes colleagues who come for consultations “with a baby, with pregnant women, and with nursing mothers. I never turn down a consultation. It’s my profession. That’s how I can help,” she says.

Through USAID support, more than 1,600 healthcare professionals from 24 urban and rural healthcare organizations from 7 regions of Kazakhstan (Aktobe, Atyrau, Kyzylorda, Turkestan, Almaty, East-Kazakhstan and Karaganda) were trained through online and offline seminars in vaccinology, false medical contraindications from vaccinations, and interpersonal communication skills in immunization to increase demand for routine and COVID-19 vaccination.