Well, it's already possible to do audio-to-MIDI in Sonic Visualiser: just use a Vamp plugin.
There are currently two plugins that can be used for this -- the Aubio Notes plugin, and the Transcription plugin in the QM plugin set. They're very dependent on the source material, but they can work well for some types of music (this is one reason I wouldn't really want to try to build this sort of function in to the host). Run one of these plugins in Sonic Visualiser and you should get a new Note layer as output, which you can then export as MIDI.
This would also be a very obvious way to do audio-to-MIDI in Audacity; you can already run these plugins there, it's just that the program lacks (so far) the ability to present the result data as a note track. Any developer seriously considering writing new audio-to-MIDI code would be very well advised to at least consider doing so as a Vamp plugin.
Chris