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Correspondence to Dr Kristin N Saarlas; ksaarlas@ taskforce. org © Author(s) (or their employer(s)) 2021. Reuse permitted under CC BY. Published by BMJ. THE EFFECT OF COVID-19 ON CRITICAL HEALTH PROGRAMMES By September 2021, the COVID19 pandemic has resulted in more than 4.7 million reported deaths globally and caused sweeping disruptions to all aspects of health systems. In addition to direct effects on morbidity and mortality, the pandemic has hindered the ability to access and provide routine healthcare services in all countries and worsened the plight of conflictaffected communities and hardtoaccess populations. The pandemic has also disrupted delivery of and access to critical public health campaigns that provide essential childhood vaccines; deliver nutritional supplements; and control, eliminate, or eradicate a variety of debilitating neglected tropical diseases (NTDs). Although campaigns for delivering insecticidetreated bednets (ITNs) for malaria prevention and vaccines for polio and some other diseases successfully adapted approaches to safely continue or resume services, data from the COVID19 Impact Tracker indicate that, as of 31 December 2020, more than half of the 530 campaigns planned to occur in 2020 were suspended, postponed or cancelled with similar delays already in 2021. 4 Countries’ health systems have also been affected by the devastating economic impact of the pandemic. The disruption of immunisation campaigns alone has left at least 228 million children across more than 50 countries at risk of diseases such as measles, yellow fever and polio. Many NTDs treated with mass drug administration campaigns and activities have also been disrupted at a time when NTD programmes were progressing toward ambitious goals for 2030. Outbreaks of vaccinederived poliovirus expanded in several countries. Countries could experience especially fast resurgence of these diseases if they are unable to safely resume activities in the near future. The daunting challenge now facing the countries and the broader global health community is how to safely and expeditiously implement essential health campaigns, strengthen primary healthcare (PHC) systems and simultaneously introduce COVID19 vaccines worldwide. This challenge will be acutely felt by community health workers (CHWs) and local health systems that are understaffed and have limited resources to Summary box