(1) The precautionary principle (that reasonable steps to protect people and reduce risk should not await scientific certainty) influences our advice. Much is still unknown (such as the chronic health impact and long-term health effects including on children) and the virus is clearly still evolving/worsening. Delta is very unlikely to be the last SARS-Cov-2 variant we face, nor the worst. Low case numbers should be the Australian strategy for the foreseeable future. Analogies to seasonal influenza are less helpful than measles and polio.
(2) Ethical considerations influence our advice – this includes an appreciation of impact of both disease and lockdowns, especially on high risk and disadvantaged populations, on children and on low-and-middle-income countries. In just one example, recommendations of 3rd booster shots (which we make in specific instances) need to be considered in a context of low vaccination rates in some Australian communities, and some of our neighbours having no vaccine at all and ensuring that Australia contributes to global vaccine supply.
(3) Coming to terms with the concepts of risk, uncertainty and probability is key to navigating both personal and institutional decision making during the pandemic We all do this in our daily lives, but the stakes are higher and the uncertainty is greater in these cataclysmic times. All decisions and options come with the possibility of beneficial outcomes and the risk of adverse outcomes. Good decisions are based on a thoughtful weighing of the alternatives and their likely consequences and on how we weight those consequences and risks. However, the inherent uncertainty of the present environment means that, even with careful consideration, bad things can follow from good decisions.
(4) Science works by peer review, engagement, criticism, and collaboration – mostly playing out in conferences, peer review, grant applications and scholarly editorials. As hard as this is to do this in a pandemic, this is still a crucial principle that we encourage policy makers to understand and engage in.
(5) Real-world data is important. In the early days of the pandemic knowledge about SARS-CoV02 was very limited and decisions were based on analogy with other viruses and predictions of models. As more data have been acquired in epidemiological studies, these data can inform decisions directly and also lead to be better predictive models. .
(6) Changing recommendations over time is evidence of science working We will challenge our own thinking and recommendations constantly as knowledge advances and new tools and data become available. We aim to be agile and responsive to changing situations and changing evidence.
(7) Aspire to elimination: A range of technical terms (eradication, elimination, control) with specific meanings have been widely misused during the pandemic, causing confusion among the community and decision makers. Eradication (getting rid of the virus from the world) is likely not possible for SARS-COV-2. Elimination for countries or regions is possible. This does not mean outbreaks of COVID-19 will never occur. It means sustained, ongoing outbreaks can be prevented. We have achieved elimination of measles and polio through vaccination in Australia, and it may be possible to do the same for SARS-CoV-2. We believe the best possible outcome for Australia is a measles-like situation, where occasional outbreaks occur because of infection imported through travel, but sustained community transmission is prevented because enough people have sufficient vaccine-induced immunity, and our lives can continue normally. This is what the technical term “elimination” means. This is achievable with booster vaccinations that are matched to Delta or other variants and other measures outlined in our advice.