Abstract
Phase two of the Royal Commission of Inquiry into the Covid-19 pandemic is asking New Zealanders to comment on how pandemics should be responded to in future. One approach is to think about strategic decisions and their counterfactuals. That means comparing our experience of using an elimination strategy for almost two years with what is likely to have happened if we had followed the conventional path taken by most countries. There is considerable evidence favouring elimination for pandemics that have similar or greater clinical severity to Covid-19.
We can also draw on growing evidence about interventions that worked well and those that need to be improved or delivered more effectively in the next pandemic. For example, receiving Covid-19 vaccines before being exposed to the virus greatly improved outcomes. And N95 respirator masks are highly effective at stopping airborne pathogens but were underused in Aotearoa New Zealand (NZ). There is a lot to learn and put in place given the increasing threats of pandemic diseases.