We can live better with COVID-19 and reduce the burden of infection, illness and death and the effect on workplaces, schools and daily life. A range of technical terms (eradication, elimination, control) with specific meanings have been misused during the pandemic, causing confusion among the community and decision-makers. “Elimination” does not mean outbreaks of COVID-19 will never occur; it means that sustained, ongoing outbreaks with high rates of illness and death can be prevented. We have achieved elimination of measles and polio through vaccination in Australia, but still have occasional outbreaks of measles. It may be possible to do the same for SARS-CoV-2 with high rates of boosters and/or vaccinations matched to variants, supported by other measures such as safe indoor air, masks and ventilation. The economy will fare better when COVID-19 is well controlled.
We believe the best possible outcome for Australia is a measles-like situation, in which occasional outbreaks occur because of imported infections, but sustained community transmission is prevented because a high enough proportion of people has vaccine-induced immunity, and our lives can continue normally. This is what “elimination” means. We believe it may be achievable with better vaccines, and that we should always aspire for the best control – but vaccines alone are not enough at this time. Better vaccines may come in the future. We can certainly control SARS-CoV-2 better until then with layered, whole of society protections addressing safe indoor air, respiratory protection and optimal vaccination – a vaccine-PLUS strategy.