Hydroxychloroquine and COVID-19: critiquing the impact of disease public profile on policy and clinical decision-making

The controversy surrounding the use of

hydroxychloroquine (HCQ), an antimalarial drug, for

COVID-19 has raised numerous ethical and policy

problems. Since the suggestion that HCQ has potential

for COVID-19, there have been varying responses from

clinicians and healthcare institutions, ranging from

adoption of protocols using HCQ for routine care to the

conduct of randomised controlled trials to an effective

system-wide prohibition on its use for COVID-19.

In this article, we argue that the concept of ’disease

public profile’ has become a prominent, if not the sole,

determinant in decision-making across various healthcare

responses to the pandemic. In the case of COVID-19,

the disease’s public profile is based on clinical and

non-clinical factors that include contagiousness, clinical

presentation and media coverage. In particular, we briefly

examine the dangers of a heightened public profile in

magnifying the inequality of diseases and undermining

three key ethical concepts, namely (1) evidence-based

practice, (2) sustainable allocation and (3) meaningful

consent.