Does Childhood Immunization Rebound after Extreme Shocks? Evidence from Floods and Strikes in Pakistan

In 2022, childhood immunization in the Sindh province of Pakistan was disrupted by the worst floods in Pakistan's history and by vaccinator strikes. We use weekly data on all vaccinations from 12 of the lowest immunization districts in Sindh, strike timing, and satellite flood data to examine 2.5-month impacts. Despite intensive catchup efforts by the government and the international community, immunizations declined 19 percent more in flooded towns than nonflooded towns postfloods, and 11,500 children missed vaccinations as result of the floods. Immunizations in strike towns were 48 percent lower than in nonstrike towns, with 15,300 lost immunizations over the entire postperiod.