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Bioterrorism – the manipulation of disease crises by terrorist groups to achieve political aims – is an under-researched threat to Africa. The increasing frequency of epidemics and pandemics such as Ebola and Covid-19, concurrent with the regional increase in terrorism, increases the potential for disease crises to be exploited as political weapons by terrorist groups, either directly or indirectly. This paper produces insights about the intersection of terrorism and disease in Africa through the exploration of terrorism’s interaction with the Global Polio Eradication Initiative (GPEI), with reference to targeted violence, anti-vaccination rhetoric and anti-West suspicions in Nigeria, Pakistan and Afghanistan. Terrorism is shown to be significantly hindering polio eradication in these states, and it is argued that these actions should be incorporated into an expanded conceptualisation of bioterrorism. Lessons are drawn from the GPEI to augment current understandings of terrorism, counter-terrorism and disease in Africa, with recommendations for future action.