COVID-19 has posed unprecedented challenges to health systems worldwide, overwhelming health facilities and placing enormous pressure on the health workforce. In the third round of the World Health Organization’s ‘global pulse’ survey on continuity of essential health services during the pandemic, 92% of 129 participating countries reported critical bottlenecks to scaling up access to COVID-19 diagnostics, therapeutics, vaccines and equipment. In addition, widespread disruptions to emergency services and primary care have been documented in many areas, including maternal and child health, care for the elderly and global health issues such as HIV and tuberculosis. These disruptions could reverse years of progress in fragile and low-income contexts as scarce staff are diverted from routine services and funds are re-allocated to support COVID-19 activities.