As of the end of March 2020, the COVID-19 pandemic has resulted in over 850 000 confirmed cases and an estimated 42 000 deaths worldwide. 1 All agree that safe and effective therapies for treatment and prevention are urgently needed. In the midst of this rapidly progressing crisis, evidence has emerged suggesting that antimalarial medications, such as hydroxychloroquine (HCQ), may be efficacious for COVID-19 treatment. After amplification from politicians, news outlets and social media, a rush to acquire supplies of HCQ resulted in worldwide shortages. Recent government policies may have exacerbated these issues, where wider use in both COVID-19 treatment and prevention were authorised or recommended by India, the US Food and Drug Administration and other countries. 2–4 In response to dwindling supplies, several US states have issued restrictions on HCQ use including limiting dispensation quantities and verifying indications. 5–8 Rheumatologists, researchers and patient partners must advocate for the appropriate distribution and use of HCQ, as millions of people with rheumatic diseases worldwide depend on HCQ to control disease activity and maintain quality of life. In doing so, we must also remind ourselves to ‘make haste slowly’(festina lente).

Emanuel et al 9 published a well-timed commentary suggesting the following principles for fairly allocating scarce resources during the COVID-19 crisis: equal treatment, attempts to maximise benefits and prioritising the most vulnerable. These recommendations echo prior guidance published in 2016 by the WHO on how to address future infectious disease outbreaks. 10 The report cautioned that ‘special attention should be given to ensuring that persons who face heightened susceptibility to harm or injustice during infectious disease outbreaks are able to contribute to decisions about infectious disease outbreak planning and response’. This ethical framework offers health systems a structure for approaching the use and distribution of HCQ during the COVID-19 pandemic to minimise potential impact on patients with rheumatic disease.