Exposure to natural disasters and vaccination indicators: a systematic review and directions for future research

Global routine childhood immunization has stagnated for almost two decades, leaving children vulnerable to both immediate and long-term health risks from infectious diseases. Identifying and mitigating impediments to childhood vaccination, such as barriers resulting from exposure to natural disasters, is vital for maintaining population health. While there is general understanding that disasters have the potential to disrupt vaccination services, well designed studies on the degree to which exposure to natural disasters affects vaccination indicators are limited. Understanding the effects of natural disasters on vaccine preventable diseases is an important area for future research as some natural disasters are becoming more frequent and intense due to climate change. To understand the current state of research on exposure to natural disasters and vaccination indicators (i.e., vaccination metrics including administration, coverage, rates), we conducted a systematic literature review of all literature in Embase, Google Scholar, PubMed, and Web of Science up until September 11-12, 2025. We aimed to identify relevant peer reviewed literature focusing on natural disasters and immunization and to assess them for relevance and inclusion. Seventeen studies met the criteria for inclusion. These studies examined the relationship between exposure to cyclones/hurricanes, droughts, earthquakes, flooding, heat waves, and multiple disaster types and changes in vaccination among different age groups. Most (16/17 (94.12%)) papers identified a connection or association between exposure to natural disasters and reduced vaccination indicators. The majority (13/17 (76.47%)) of studies focused on early-childhood vaccinations. Characteristics that affect vulnerability to under-vaccination-exposure level, geographical location, socioeconomic status-were assessed in several papers. Areas for future research include quantifying the degree to which different disaster types affect multiple vaccination indicators within the same individuals and changes in communities over time.