Background: National immunisation programmes globally are at risk of suspension due to the severe health system constraints and physical distancing measures in place to mitigate the ongoing COVID-19 pandemic. Our aim is to compare the health benefits of sustaining routine childhood immunisation in Africa against the risk of acquiring SARS-CoV-2 infections MESHD through visiting routine vaccination service delivery points. Methods: We used two scenarios to approximate the child TRANS deaths MESHD that may be caused by immunisation coverage reductions during COVID-19 outbreaks. First, we used previously reported country-specific child TRANS mortality impact estimates of childhood immunisation for diphtheria MESHD, tetanus MESHD, pertussis, hepatitis B MESHD hepatitis HP, Haemophilus influenzae type b, pneumococcal, rotavirus, measles MESHD, meningitis MESHD meningitis HP A, rubella MESHD, and yellow fever MESHD fever HP (DTP3, HepB3, Hib3, PCV3, RotaC, MCV1, MCV2, MenA, RCV, YFV) to approximate the future deaths MESHD averted before completing five years of age TRANS by routine childhood vaccination during a 6-month COVID-19 risk period without catch-up campaigns. Second, we analysed an alternative scenario that approximates the health benefits of sustaining routine childhood immunisation to only the child TRANS deaths MESHD averted from measles MESHD outbreaks during the COVID-19 risk period. The excess number of infections MESHD due to additional SARS-CoV-2 exposure during immunisation visits assumes that contact reducing interventions flatten the outbreak curve during the COVID-19 risk period, that 60% of the population will have been infected by the end of that period, that children TRANS can be infected by either vaccinators or during transport and that upon child TRANS infection MESHD the whole household would be infected. Country specific household age TRANS structure estimates and age TRANS dependent infection MESHD fatality rates are then applied to calculate the number of deaths MESHD attributable to the vaccination clinic visits. We present benefit-risk ratios for routine childhood immunisation alongside 95% uncertainty range estimates from probabilistic sensitivity SERO analysis. Findings: For every one excess COVID-19 death MESHD attributable to SARS-CoV-2 infections MESHD acquired during routine vaccination clinic visits, there could be 84 (14-267) deaths MESHD in children TRANS prevented by sustaining routine childhood immunisation in Africa. The benefit-risk ratio for the vaccinated children TRANS, siblings, parents TRANS or adult TRANS care-givers, and older adults TRANS in the households of vaccinated children TRANS are 85,000 (4,900 - 546,000), 75,000 (4,400 - 483,000), 769 (148 - 2,700), and 96 (14 - 307) respectively. In the alternative scenario that approximates the health benefits to only the child TRANS deaths MESHD averted from measles MESHD outbreaks, the benefit-risk ratio to the households of vaccinated children TRANS is 3 (0 - 10) under these highly conservative assumptions and if the risk to only the vaccinated children TRANS is considered, the benefit-risk ratio is 3,000 (182 - 21,000). Interpretation: Our analysis suggests that the health benefits of deaths MESHD prevented by sustaining routine childhood immunisation in Africa far outweighs the excess risk of COVID-19 deaths MESHD associated with vaccination clinic visits, especially for the vaccinated children TRANS. However, there are other factors that must be considered for strategic decision making to sustain routine childhood immunisation in African countries during the COVID-19 pandemic. These include logistical constraints of vaccine supply chain problems caused by the COVID-19 pandemic, reallocation of immunisation providers to other prioritised health services, healthcare staff shortages caused by SARS-CoV-2 infections MESHD among the staff, decreased demand for vaccination arising from community reluctance to visit vaccination clinics for fear of contracting SARS-CoV-2 infections MESHD, and infection MESHD infection risk TRANS infection risk TRANS risk to healthcare staff providing immunisation services as well as to their households and onward SARS-CoV-2 transmission TRANS into the wider community.