As the number of confirmed COVID-19 cases in Africa surpasses 500 000, the new coronavirus is at the forefront of the public consciousness. But the continent was beset by infectious disease long before the current pandemic began. And, as long as governments and donors remain preoccupied with curbing COVID-19, killers like HIV and Aids, malaria, and tuberculosis (TB) will only grow stronger. By Abdourahmane Diallo, Lucica Ditiu & Winnie Byanyima Of the 38 million people worldwide living with HIV, the virus that causes Aids, 25,6 million reside in Sub-Saharan Africa. Africa accounted for 380 000 malaria deaths — 94% of the global total — in 2018. And, 2,6 million people in Africa develop TB every year, resulting in 630 000 deaths. Over the last two decades, considerable progress has been made in fighting these diseases. Aids-related deaths have been reduced by more than half since 2004, thanks largely to the availability of antiretroviral therapy. The TB mortality rate fell by 42% between 2000 and 2017. And malaria deaths decreased by 60% between 2000 and 2015; a child who contracts malaria today has a better chance of survival than ever before. But the COVID-19 crisis threatens to stall or even reverse this progress, not least by inundating already-fragile health systems. Italy has one doctor for every 243 residents and yet, in some regions, its health system buckled under the weight of COVID-19 cases. Imagine what a similar outbreak would do in African countries, which have an average of one doctor for every 5 000 residents. To be sure, the coronavirus has spread more slowly in Africa than in Europe and North America. But the World Health Organisation (WHO) warns that the outbreak could be stretched out over a few years. If so, the continent’s under-resourced health systems will be under severe strain for a long time to come. And what resources governments do have are likely to be channelled toward COVID-19 — even if it means redirecting them from other deadly diseases. Supply-chain disruptions caused by containment measures elsewhere compound the risks, by threatening access to the preventive-health resources, diagnostics, and treatments needed to combat HIV, TB and malaria. Already, some African countries have paused programmes providing TB and HIV treatments and diagnostics, and suspended distribution of insecticide-treated mosquito nets (ITNs) — essential to protect against malaria — right before the high-transmission rainy season. The WHO forecasts that under the worst-case scenario (suspension of all ITN campaigns and a 75% reduction in access to effective antimalarial drugs), the COVID-19 crisis could lead to a doubling of malaria deaths this year in Sub-Saharan Africa. Such high malaria mortality levels were last recorded 20 years ago. Moreover, a six-month disruption of antiretroviral therapy could lead to more than 500 000 additional deaths from Aids-related illnesses (including TB) in Sub-Saharan Africa in 2020-21. In 2019, an estimated 440 000 people died of Aids-related illnesses in the region. Like