Georgia has a vaccine inequality problem

Note: This article first appeared on the Caucasus Data Blog, a joint effort of OC Media and CRRC Georgia. It was written by David Sichinava, CRRC Georgia's Research Director. The views expressed in this article are those of the author’s alone and do not in any way reflect the views of CRRC Georgia, or any related entity.

A fast and timely rollout of COVID-19 vaccines is essential for keeping the pandemic at bay. While far-reaching immunisation helps save lives, it also helps with quickly reopening the economy. Nevertheless, not everyone has access to life-saving vaccines. Rich countries have been quick to hoard doses to vaccinate their own populations, leaving poorer states lagging behind. 

But unequal access to COVID-19 vaccines within countries also threatens the effective and timely mitigation of the pandemic. Notably, even in countries boasting high rates of vaccine rollout, such as the UK and Israel, COVID-19 vaccines are less accessible to vulnerable and disadvantaged populations. As recent CRRC/NDI data shows, Georgia is no exception.

Despite initial successes in curbing the COVID-19 pandemic, Georgia has done considerably worse in managing infection rates and vaccinations than its neighbours. In the first 10 days of August 2021, the country led global league tables in infection and death rates per 100,000 residents, while simultaneously lagging far behind in immunisation.

As of 25 July 2021, when the last interviews of the CRRC/NDI study were administered, about 7% of Georgians in the survey reported receiving at least one dose of the COVID-19 vaccine. The Georgian government initially prioritised vaccinating older people, so this group is slightly more likely to be inoculated (10%) than those younger than 35 (4%) and between 35 and 54 (8%). More Tbilisi residents (16%) received at least one shot than those from other urban areas (6%) and rural areas (2%).

Notably, a respondent’s socio-economic status predicted whether they had been vaccinated. About 16% of Georgians with a higher education had received at least one dose, as opposed to a mere 4% of those with no higher education. 

About a quarter of respondents with the highest socio-economic standing in the country (as measured by an asset ownership index) had received at least one dose, compared to 6% of those with the median number of assets, and 3% of Georgians within the lowest socioeconomic bracket.

A lack of information might contribute to low immunisation rates. The research indicates that those groups who were least likely to be vaccinated also claimed that they did not have enough information on the immunisation process. For instance, only 18% in the highest socio-economic status say that they did not have enough information on the vaccination process in Georgia, compared to almost half of those within the median (48%) and lowest standing on the socio-economic bracket (46%). 

Similarly, a larger share of Georgians with no higher education (47%) stated that they did not have enough information on vaccination, than those who had attained higher education (30%).

There was also geographic variation. For example, only one-third of Tbilisians reported not having enough information about Georgia’s immunisation process, compared with 43% in other urban areas and 47% in rural areas. 

Not surprisingly, in the days of the initial phase of vaccine rollout, available vaccination time slots in the capital and larger urban areas were filled almost instantaneously. Many Tbilisians even booked available places in vaccination centres outside the capital. This may be because they had better access to information and knowledge of the online booking system: CRRC/NDI data shows that 61% of Tbilisi residents knew how to access online booking system, as opposed to 45% of Georgians from other urban areas and only 27% of rural residents.

Those who reside outside the capital are not the only group put in a disadvantaged position. Other vulnerable groups such as older people, ethnic minorities, poorer Georgians, and those with no higher education were also less likely to have knowledge of how to use the online vaccination booking system. Few among those who claimed not to have enough information on the immunisation process knew how to use the online booking system.

While in the last few weeks, Georgia has accelerated its immunisation efforts, vaccinating more than 20,000 people daily, it is likely that the factors described in this article will continue to affect the timely and equitable access to life-saving vaccines. 

Considering the lack of pro-immunisation information provided by the government and the prevalence of anti-vaccine sentiment among many Georgians, it is crucial that information be disseminated explaining the process and benefits of immunisation. As the data above shows, it’s also critical that this is done in a manner that effectively reaches all Georgians.

Note: Differences were identified using two logistic regression model predicting (a) whether the respondent had a COVID-19 vaccine, (b) whether they reported not having enough information on the immunization process in Georgia, and (c) whether the respondent knew how to use online vaccine booking system. Predictors in each of the models included the following social and demographic variables: gender, age, education, settlement type, ethnicity, partisanship, and a durable goods index. A durable goods index is a common proxy measure of a household’s economic status, which counts the number of appliances present in the household. The lowest value corresponds to the score of 0. The median value corresponds to 6, and the highest value of the index is 10. The replication code is available here.

Georgian views on increased diversity in parliament

Note: This article first appeared on the Caucasus Data Blog, a joint production of OC Media and CRRC Georgia. It was written by Dustin Gilbreath, Deputy Research Director at CRRC Georgia. The views presented in the article do not represent the views of CRRC Georgia, the Carnegie Foundation, the Levan Mikeladze Foundation, the Government of Sweden, or any related entity.

Georgia is a diverse country, with numerous languages, religions, and ethnic groups. Yet, parliament underrepresents both women and ethnic minorities relative to their total shares in the population. Moreover, there are no known LGBTQ+ parliamentarians in Georgia’s history. Data from the September 2020 Future of Georgia survey suggests that people are most positive about more women in parliament, followed by ethnic minorities and LGBT people. 

The data suggests that people are roughly three times as likely to think that there are too few female members of parliament compared with too few minority members of parliament. Very few people (6%) think there are too many female members of parliament, while roughly three times as many (15%) think that there are too many minority members of parliament. 

Similarly, substantially more people think that having more women would have a positive impact than think having more ethnic minorities would. Perhaps unsurprisingly given the homophobic riot on 5 July a large majority of Georgians (69%) think that having more LGBTQ+ people in parliament would have a negative impact, and only 4% think it would have a positive impact.

Age, sex, and education predict people’s views on whether the number of female members of parliament are adequate. Younger people (18-34) are 11-12 percentage points more likely to think that there are too few women in parliament compared to older people. People with vocational education are 8 points less likely than those with tertiary education and 12 points less likely than those with only a secondary education to report there are too few women in parliament. Women are 13 percentage points more likely to report there are too few women in parliament.

When it comes to whether having more women in parliament would be positive or negative, the data suggests that attitudes vary by age, sex, settlement type, and education type. Women are 15 percentage points more likely to think it would have a positive impact. Young people are 10 percentage points more likely to think there would be a positive impact. People in rural areas are 10 percentage points more likely to report there would be a positive impact than people in Tbilisi. People with vocational education are 7 percentage points less likely to think having more women in parliament would have a positive impact.

When it comes to the number of ethnic minorities in parliament, ethnicity and education predict people’s attitudes. While ethnic minorities have a 55% chance of thinking that there were too few ethnic minorities in parliament, ethnic Georgians only had a 13% chance. People with vocational education are slightly more likely to think that there are too many ethnic minorities in parliament, controlling for other factors.

With regard to the impact of having more ethnic minorities in parliament, the data suggests that people with vocational education are more likely to think it would have a negative impact. Ethnic minorities are significantly more likely to think it would have a positive impact.

Although relatively few people had positive views of more LGBTQ+ people being in parliament, there is some variance in attitudes. Notably, ethnic minorities are by far the least negative, controlling for other factors. People with lower levels of education also had relatively less negative attitudes as did people in Tbilisi, people under the age of 55, and non-IDPs.

The above data shows a few patterns. Women are the group that people have the most positive attitudes about in terms of representation in parliament, followed by ethnic minorities and LGBTQ+ people. Women and ethnic minorities are significantly more positive about members of their own group being represented in parliament. Ethnic minorities are also the least negative group about increased LGBTQ+ representation in parliament.

Note: The data analysis in the above is based on ordered logistic regression models controlling for respondent age group (18-34, 35-54, 55+), education level (secondary or less, vocational education, or tertiary education), sex (female or male), settlement type (capital, other urban, or rural), wealth (a simple additive index of ownership of 10 durable goods), and IDP status (IDP or not). The data used in this article are available here.

A different kind of social distance

Note: This article first appeared on the Caucasus Data Blog, a joint effort of CRRC Georgia and OC Media. It was written by Nino Zubashvili, a researcher at CRRC Georgia. The views expressed in the article are the author’s alone and do not reflect the views of CRRC Georgia, or any related entity. 

While the pandemic made ‘social distance’ about physically staying apart from one another, long before that, social distance in the social sciences measured inter-group acceptance, tolerance, and/or prejudice. The same approach is used in post-conflict settings to measure the extent of alienation between conflict divided societies, with studies suggesting that social boundaries grow between people across conflict lines when there is a lack of interaction. 

CRRC’s Caucasus Barometer survey has examined two dimensions of social distance over the years: 

• Approval of women of one’s ethnicity marrying into another ethnicity, measuring willingness to have an immediate and close relationship with a person;
• Approval of people of one’s ethnicity doing business with another ethnicity, measuring willingness to have a less immediate and intimate, but still close relationship with another ethnicity. 

Data from the Caucasus Barometer survey has regularly shown that Georgians are more accepting of doing business with other ethnicities, rather than of marrying them. The data from 2019 suggests a similar trend. 

The data also indicates that Georgians feel similarly distant to those living on the other side of the conflict line (i.e. to Abkhazians and Ossetians) as to ethnic minorities living in Georgia (Armenians and Azerbaijanis). 

Time series data shows that Georgian disapproval of doing business with or women marrying Abkhazians or Ossetians has not changed much over the last decade. Disapproval of such social interactions even decreased slightly. As in 2019, the differences in approval of doing business with or women marrying Abkhazians or Ossetians have been more or less in line with the approval of such interactions with Armenians and Azerbaijanis living in Georgia over the years. 

Further analysis suggests that different factors are associated with the acceptance of business and familial relations with different ethnicities. 

Trust in others is associated with the acceptance of inter-ethnic business relations. People who are generally trusting are more likely to be accepting of business relations with all groups noted here compared to those who believe that one cannot be too careful in dealing with people. 

Age is associated with acceptance of business relations with some ethnicities, with younger age groups being slightly more accepting compared to older age groups. 

Gender and ethnicity are associated with acceptance of business relations with some ethnicities. Women and ethnic Georgians appear to be less accepting in this regard. 

Interestingly, while several factors are related to acceptance of business relations with Abkhazians, Ossetians, and Azerbaijanis living in Georgia, only generalized trust is associated with acceptance of doing business with Armenians living in Georgia. 

Religious affiliation, household income, and employment situation are associated only with acceptance of doing business with Azerbaijanis (not presented on the chart below).

Other demographic variables, such as settlement type, educational attainment, several economic well-being measures, the importance of religion in daily life, and interest in permanent emigration did not show any association with approval of doing business with any of the ethnicities noted here. 

The factors associated with approval of inter-ethnic marriage differ from those associated with approval of doing business with other ethnic groups. 

The importance of religion in daily life is associated with acceptance of women marrying all of the ethnic groups considered here. Those that do not find religion important in daily life are notably more accepting of inter-ethnic marriage. 

Higher education is also associated with higher levels of acceptance in all cases.

Generalised trust is associated with acceptance of marrying Abkhazians and Ossetians only, with trusting people again being more accepting compared to those who generally have low trust in people. 

Age is associated with acceptance of marriage of some ethnicities, with younger age groups again being slightly more accepting compared to older groups. 

Willingness to emigrate permanently is associated with acceptance of women marrying Armenians living in Georgia. Ethnicity, religious affiliation, and frequency of attendance at religious services are associated only with acceptance of women marrying Azerbaijanis living in Georgia (not presented on the chart).

Settlement type, employment status, and other economic well-being measures are not associated with approval of marrying any of the above mentioned ethnicities, controlling for other factors. 

The social distance between the population of Georgia proper and Abkhazians and Ossetians, has changed little over the last decade, at least on the Georgian side of the line. Yet, the data from the last decade shows that the population felt as distant from Abkhazians and Ossetians as they do with Armenians and Azerbaijanis living in Georgia. This demonstrates a challenge for reconciliation with societies on the other side of conflict lines as well as the integration of ethnic minorities into society. While general trust is consistently associated with the approval of inter-ethnic business relations among these groups, the importance of religion in daily life and educational attainment seem to be more important factors in the acceptance of inter-ethnic marriage.  

Note: The data used in the article can be found on CRRC’s online data analysis tool. The analysis of whether people approve or disapprove of doing business or marrying people of another ethnicity was carried out using logistic regression. In all cases, regression models included the following demographic variables: sex (male, female), age group (18–35, 35–55, 55+), ethnic group (ethnic Georgian, another ethnicity), settlement type (capital, other urban, rural), educational attainment (secondary or lower education, higher than secondary education), employment situation (working, not working); economic well-being measures: household total income (medium or high, low or none), how often family does not have money enough for food (often, less often, never); religion related measures: religious affiliation (Orthodox Church, other), frequency of attendance of religious services (frequently, sometimes, rarely, never), the importance of religion in daily life (important, not important); as well as interest in permanent emigration (interested, not interested), generalized trust (you cannot be too careful, neutral, most people can be trusted). These variables were tested independently in separate regression analyses that controlled for the demographic variables.

 For ease of reading, OC Media's style does not to use qualifiers such as ‘de facto’, ‘unrecognised’, or ‘partially recognised’ when discussing institutions or political positions within Abkhazia, Nagorno-Karabakh, and South Ossetia. This does not imply a position on their status.

Data suggests Georgia has handled the pandemic poorly

Note: This post first appeared on the Caucasus Data Blog, a joint production of CRRC Georgia and OC Media. It was written by Givi Silagadze, a researcher at CRRC Georgia. The views expressed in this article are those of the author’s alone and do not in any way reflect the views of the CRRC Georgia, or any related entity.

Despite initial praise as a model case of handling the pandemic, Georgia is now seeing record numbers of COVID-19 cases and related deaths. Both health and economic data now suggests that the country has not fared well compared to its neighbours.

In early August 2021, Georgia was among the worst countries in the world in terms of COVID-19 case counts and deaths. Indeed, over the last week, over 1% of the adult population had COVID-19 at the same time.

At the start of the pandemic, headlines in international media praised Georgia as a, ‘Coronavirus success story’, and officials declared that they had ‘managed to stand ready to cope with the virus’. However, circumstances took a turn for the worse in the late autumn and the situation has not been assuring since. 

Despite the quickly deteriorating situation, government officials have been resistant to introducing measures aimed at preventing the spread of the virus. In July, public health officials said that their decisions and methods of tackling the pandemic had been successful. Moreover, polling from June 2021 suggests that 60% of the population is very satisfied (13%) or somewhat satisfied (47%) with the government’s response to COVID-19. 

But official health and economic data suggest Georgia has fared poorly compared to its neighbours, with the potential exception of performance on testing.

Health data

In the spring and summer of 2020, Georgia registered the lowest number of new, daily cases in its neighbourhood. However, by late autumn 2020, Georgia led the neighbourhood (and at times, the world) in new cases per capita. Throughout the summer of 2021, Georgia has performed worse than neighbouring countries.  

COVID-related deaths probably are the single most important indicator of how the country has handled the crisis. Georgia’s cumulative COVID-19 deaths per capita are the second-worst in the region, following Armenia.

Since late autumn 2020, Georgia has consistently fared the worst among its neighbours in COVID-19 deaths per capita. The exceptions in this regard are in the late spring of 2021 and a couple of weeks in July.

Georgia also lags behind its neighbours when it comes to vaccination, with only Armenia further behind. 

As of 10 August, at least 1 in 4 people were vaccinated with at least one dose in Azerbaijan and Russia, and 1 in 2 people in Turkey. Slightly more than 1 in 10 people received at least one dose in Georgia and fewer than 5% in Armenia.

While Georgia tends to lag behind its neighbours on many pandemic related indicators, Georgia is outperforming them on testing and tracking the virus in general. As of 9 August, 1,955 tests per thousand people have been conducted in Georgia since the beginning of the pandemic. 

The figure is significantly lower in neighbouring countries, especially in Armenia and Azerbaijan. However, this data might be misleading because Georgian officials decided to add antigen tests to the test count in December 2020, while Azerbaijan, Russia, and Turkey report only PCR tests (see here).

Moreover, Georgia registered the lowest number of excess deaths throughout 2020. 

In total, there were 333 excess deaths per 100,000 people throughout 2020 in Armenia, 190 excess deaths in Azerbaijan, 245 excess deaths in Russia, and 130 in Georgia (data was not available for Turkey). 

However, data is not available for 2021 and hence, cannot portray the full picture. 

Considering that in August 2021 Georgia tops the neighbourhood in terms of new cases as well as new deaths, it is likely that excess mortality figures have substantially deteriorated as of summer 2021. 

The fact that Armenia and Azerbaijan engaged in military conflict in autumn 2020 further complicates the task of drawing unequivocal conclusions regarding the countries’ efforts to track the virus.

Economic data

The economy of Georgia has also suffered. According to data from the World Bank and International Monetary Fund, Georgia had the second-highest inflation rate, the second-worst recession, and Georgia’s debt to GDP ratio is the second-largest in the neighbourhood.

Official data suggests Georgia has not done well in comparison to its neighbours in terms of managing the epidemic, with the exception of testing and tracking the virus, at least in 2020. 

Despite the initial success in containing the virus, since autumn 2020 Georgia has been the worst-hit country in the neighbourhood. 

That Georgia lags behind in terms of vaccination is perhaps the most concerning part of this. Vaccination is considered to be the only way to substantively reduce hospitalisation and fatality rates.

Had the economic figures looked encouraging, one could have argued that the country prioritised minimising economic hardship. Yet, if that was the case, the country failed, with the second-highest inflation rate and the second-worst economic recession in the region. What is more, among its neighbours, only Armenia has a larger debt ratio to its economy than Georgia.

How Megi Bakradze’s death affected vaccine hesitancy in Georgia

[Note: This post first appeared on the Caucasus Data Blog, a joint production of CRRC Georgia and OC Media. It was written by Dustin Gilbreath, Deputy Research Director at CRRC Georgia. The views expressed in this article are those of the author’s alone and do not in any way reflect the views of the World Bank, CRRC Georgia, or any related entity.]

When Georgian nurse Megi Bakradze died following an allergic reaction to the AstraZeneca coronavirus vaccine in March, there were fears that vaccine hesitancy could grow. But how did her death really affect how people feel about vaccination?

According to previous data analysis, Georgia has among the largest vaccine hesitancy problems in the world. One incident which is widely seen to have exacerbated the issue was the death on 18 March of Megi Bakradze. Bakradze was a nurse who experienced an allergic reaction to the AstraZeneca vaccine and passed away just after having gone on television to support the vaccine rollout. Her death was later ruled to be due to negligence. The tragedy nonetheless sparked fears in Georgia around vaccination.

Newly released data from just a week after the tragedy suggests that while vaccine hesitancy shot up following her death, it recovered in the two weeks following. Forthcoming data suggests vaccine hesitancy has recovered to levels comparable to prior to the tragedy.

A February NDI and CRRC Georgia poll suggested that 35% of the public wanted to be vaccinated against COVID-19, 53% did not, and the remainder were uncertain or refused to answer. 

A World Bank survey which CRRC Georgia fielded from 24–30 March — after Bakradze’s death — suggested that only 24% of the public wanted a vaccine, 62% did not, and 14% were uncertain. 

While the questions on the surveys were slightly different, these differences were minimal suggesting that this large of a difference would not be explained by the question wording alone.

While vaccine hesitancy likely increased as a result of Bakradze’s death, the data suggests that as more time passed from the incident, vaccine hesitancy declined.

While on 24 March, only 16% of surveyed respondents wanted to be vaccinated, by 29 March, 28% did. At the start of the fieldwork, 69% answered that they did not want to be vaccinated, but by the end this number had declined to 57%.

The share responding ‘don’t know’ fluctuated by several points with no clear trend over the course of the fieldwork. 

This analysis is supported by a regression analysis, which suggests that controlling for the characteristics of respondents, there was a 1.5 percentage point increase per day in interest in getting vaccinated.

Note: Data for 30 March is not shown on the chart above as only six respondents were interviewed on this date. On prior days of fieldwork, between 256–403 respondents were interviewed.

More recent data from a forthcoming survey suggests that vaccine hesitancy has now returned to the level identified in the February CRRC and NDI survey.

While vaccine hesitancy appears to have declined to levels similar to before the Megi Bakradze tragedy, the data shows that it still has far to go until a large enough share of Georgia’s population is interested in a vaccine to protect the public.

Note: The analysis above is based on a logistic regression. The outcome variable is whether or not someone wants a COVID 19 vaccine. The regression controls for age (continuous), education level (Bachelor’s degree or higher versus no tertiary education), gender composition of the household (mixed, women only, men only), number of household members, date of interview, settlement type (Tbilisi, other urban, town, rural), and sex. 

The data used in this article is from the World Bank’s Poverty and Equity Global Practice COVID-19 High-Frequency Survey 2020-2021 Wave 1-3 (Ref. GEO_2020_HFS_v02_M) and is available here.