SARS-CoV-2 has infected more than 278 million people globally, with at least 5.4 million deaths recorded by the World Health Organisation as of 26 December 2021. The omicron (B.1.1.529) variant of concern is spreading rapidly.1 Some countries view infection as a net harm and pursue strategies ranging from suppression to elimination.2 They seek to sustain low infection rates through a combination of vaccination, public health measures, and financial support measures (vaccines-plus). Other countries implemented mitigation strategies that aim to prevent health systems from being overwhelmed by building population immunity through a combination of infection and vaccination. These countries rely on a vaccines-only approach and seem willing to tolerate high levels of infection provided their healthcare systems can cope. The high transmissibility and degree of immune escape by the delta and omicron variants means sustained protective population immunity is unlikely to be achieved with the current vaccines based on the original strain.3 Compared to delta, omicron is much more likely to infect those who were vaccinated or exposed to previous SARS-CoV-2 variants, suggesting significant immune escape.4 Widespread transmission brings a degree of unpredictability to the pandemic response. High transmission risks more rapid adaptation of SARS-CoV-2, with outcomes that include increased transmissibility (seen with α, delta, and omicron), increased antibody immune escape (β and omicron) or greater pathogenicity (delta and α).5 There are other drawbacks to a vaccines-only strategy. Countries which tolerated high transmission have seen rises in both covid-specific and all-cause mortality, healthcare worker shortages, and repeated lockdowns to control surges in case numbers.26789 Countries which suppressed transmission early saw reduced mortality and less economic damage.271011 While vaccination greatly reduces risks of serious illness and death, long covid remains a concern.1213 Disruption to education as …