The Leadership Moment Roy Vagelos & Alfredo Cristiani Roy Vagelos and Alfredo Cristiani faced two very different dilemmas, but in the end both proved to be great leaders by standing for what they believed in while also taking the effect their decisions would have on others into consideration. Another aspect that makes Vagelos and Cristiani great leaders is that they both started off with a mission or goal and kept a focus until that goal was achieved. In the case of Roy Vagelos a question of moral responsibility is brought to surface when as an executive at Merck & Company he has to decide between providing millions of people treatment for river blindness without gaining any profit, and with high expenses for the company or shelving the drug because of it’s lack in financial gain potential. If looking at this situation from a humanitarian point of view, the decision may seem obvious. However, when shareholders have invested in a company and expect to receive profitable returns, the decision is slightly more complicated, because as Milton Friedman says, “There is one and only one social responsibility for business, [and it is] to use it’s resources and engage in activities designed to increase its profits” (Useem, pg. 27). Nonetheless, Vagelos manages to make the right choice, by completely ignoring Friedman’s advice. Though Vagelos had a tough decision to make, one of the things that helped him most was that he was that he had a clear idea of what his job meant, what his responsibilities were, and what was expected of him. “‘The mission of Merck & Co., Inc., is to provide society with products and services, [and it is also to render] investors with a superior rate of return’ but that will come only on realization of the first” (Pg. 29). Vagelos refers back to the company’s mission statement, so that he knows whether his decision is accurately representing the company and helping in acting on that mission. It seems like Vagelos has decided how to handle the situation, but Vagelos does not discard the second half of the mission statement, instead he finds a way to use the company’s short-term financial loss and use it for building trust with clients by building a favorable reputation. Ultimately, Vagelos decides that Merck will give the drug away for free forever. After discussing with colleagues for a long time, Vagelos made the decision on his own without informing the governing board before making the public announcement. Vagelos could be criticized for not communicating fully with his peers, but he asks, “would anybody around the table have made a different decision?” No one around the table said they would have made a different decision, which also highlights another thing Vagelos did correctly. Sometimes leaders talk to their colleagues too much and cannot come to a decision on his or her own, and sometimes they try to please everyone which has proven very difficult and in some instances seemed impossible, but Vagelos listened to hi ...

1. The Leadership Moment
Roy Vagelos & Alfredo Cristiani
Roy Vagelos and Alfredo Cristiani faced two very
different dilemmas, but in the end both proved to be great
leaders by standing for what they believed in while also taking
the effect their decisions would have on others into
consideration. Another aspect that makes Vagelos and Cristiani
great leaders is that they both started off with a mission or goal
and kept a focus until that goal was achieved.
In the case of Roy Vagelos a question of moral
responsibility is brought to surface when as an executive at
Merck & Company he has to decide between providing millions
of people treatment for river blindness without gaining any
profit, and with high expenses for the company or shelving the
drug because of it’s lack in financial gain potential. If looking
at this situation from a humanitarian point of view, the decision
may seem obvious. However, when shareholders have invested
in a company and expect to receive profitable returns, the
decision is slightly more complicated, because as Milton
Friedman says, “There is one and only one social responsibility
for business, [and it is] to use it’s resources and engage in
activities designed to increase its profits” (Useem, pg. 27).
Nonetheless, Vagelos manages to make the right choice, by
completely ignoring Friedman’s advice.
Though Vagelos had a tough decision to make, one of the
things that helped him most was that he was that he had a clear
idea of what his job meant, what his responsibilities were, and
what was expected of him. “‘The mission of Merck & Co., Inc.,
is to provide society with products and services, [and it is also
to render] investors with a superior rate of return’ but that will
come only on realization of the first” (Pg. 29). Vagelos refers
back to the company’s mission statement, so that he knows

2. whether his decision is accurately representing the company and
helping in acting on that mission.
It seems like Vagelos has decided how to handle the
situation, but Vagelos does not discard the second half of the
mission statement, instead he finds a way to use the company’s
short-term financial loss and use it for building trust with
clients by building a favorable reputation. Ultimately, Vagelos
decides that Merck will give the drug away for free forever.
After discussing with colleagues for a long time, Vagelos made
the decision on his own without informing the governing board
before making the public announcement. Vagelos could be
criticized for not communicating fully with his peers, but he
asks, “would anybody around the table have made a different
decision?” No one around the table said they would have made a
different decision, which also highlights another thing Vagelos
did correctly. Sometimes leaders talk to their colleagues too
much and cannot come to a decision on his or her own, and
sometimes they try to please everyone which has proven very
difficult and in some instances seemed impossible, but Vagelos
listened to his peers, used the mission statement, and made a
decision, fully believing that it was the correct choice to make.
Vagelos used the company’s mission statement to come to
a conclusion, which shows that not only is a leaders’ individual
philosophy important, but that it makes a big difference when a
company has a philosophy that unites everybody working for it,
which is proven not only with Merck & Co., but with Johnson &
Johnson and the Tylenol product recall. Although recalling the
Tylenol products cost J & J a lot of money, every employee
knew what their responsibility as a whole included, and that
what mattered most was the well being of those who used the
products.
What makes this story admirable is that Vagelos opted to
serve millions of others in need though it was not financially
beneficial in the short term by “stepping beyond the confines of
narrow, short-term interest and accepting a broader, global
responsibility” as President Jimmy Carter said (Pg. 37). This

3. brings me to a point that is implied, but Useem did not focus as
much on, that people want a leader who is relatable and can
show human compassion, which becomes even more evident
when discussing Cristiani.
Alfredo Cristiani proves to be a great leader in many ways,
though he is less faced with moral responsibility issues than
Vagelos; Cristiani has to make decisions that will make an
entire country come together. Cristiani has to find a way to
unite a people with so many different desires, demands,
interests and philosophies to bring peace to El Salvador.
Cristiani almost single-handedly made peace in El
Salvador a plausible idea, after the toll of deaths had reached
great numbers and so many lived in fear, and the fact that he
managed to do so, without eliminating any of the political
parties shows that it is possible to coexist. One of the ways
Cristiani was able to overcome such an obstacle was by
knowing, as Vagelos did, what his responsibility was when he
became President. Cristiani was also very wise in how he
handled the situation because often we attack or reject the ideas
of others when they are unknown or inferior to our own.
President Cristiani said, “Defining a problem is key to solving a
problem […] What you have to learn is that the other guy has a
different definition of the problem” (Pg. 252). Too often, we
don’t even know what we are fighting for with each other, and
Cristiani quickly tries to find out what it is that the FMLN
want, to determine how a peaceful compromise could be made.
Cristiani also said, “We had to know what they want, what we
want, and how it is possible to come together.” (Pg. 252)
seeking an agreement, rather than to impose his own beliefs on
everybody else.
Cristiani did not only show leadership skills once he was
formally a leader as President, but also in the process of
becoming one. Though Cristiani lacked the draw of attention
that President Ronald Reagan, or “The Great Communicator”
had, Cristiani made up for it by, for example, speaking in the
first person plural. Always speaking using “we” and “us”,

4. making sure to let his people know that he was on their “side”
and that everyone was a part of this team.
Alfredo Cristiani could have been criticized for leaving El
Salvador in the hands of others a number of times during the
civil war, but Cristiani states, “I picked good ministers, I told
them to do the job without my interference” (Pg. 255). Cristiani
avoided micromanaging, and showed his team that he had
complete confidence and trust in what they were doing.
Cristiani distributed power not only within his governing team,
but also throughout El Salvador when he decided that it was
time for a peaceful El Salvador, that was meant to be governed
not by one interest but by everybody, and when he demonstrated
that every voice should be heard, whether it be of the rebels or
others. Useem accurately states, “Pick your associates well,
back them fully, empower them with both accountability and
responsibility, and they will produce far more than you ever
will achieve on your own” (Pg. 257). Cristiani does just that,
just as Johnson & Johnson had done so in the Tylenol recall.
The most important thing Cristiani did was stop and listen
to what others wanted, Useem says, “Consistent, unrelenting
efforts to hear and reconcile diverse positions, even when
rooted in deeply entrenched and immensely powerful interests,
are prerequisite to overcoming any conflict and mobilizing the
resources that the contending parties are withholding” (Pg. 259)
and this should be applied for your board or team just as much
as it does to the “enemy” or competition, it is important that
everyone be heard.
Both Cristiani and Vagelos show that they are great
leaders, and were both successful by doing similar things like
referring back to the initial task, goal, and/or mission and
making sure that they stay focused on achieving it. Another
thing both did well was listen to others, those whom disagreed
with them, just as much as those who did not agree with them.
They both avoided micromanaging and did what was expected
of them. Being the daughter of two Salvadoran parents whom
abandoned their country due to the Civil War, I have heard the

5. terror-filled stories and have myself had a chance to visit a new
El Salvador, where there is no longer a 6 pm- 6 am curfew and
it is remarkable to know how that happened, and that it was
possible thanks to a great leader. When reading about Cristiani I
felt a very optimistic sensation that maybe in this very diverse
world we could find peace and tolerance for one another, and
that maybe we are just waiting for the leaders to guide us in that
direction.
4
The drug was needed only by people who couldn't afford it."
One day in November 1988, a chief and fourteen elders, all
male, mostly in their fifties and sixties, welcomed a visitor to
the village of Sikoroni in Mali, West Africa.Several were led to
the gathering, held under a veranda, by young boys pulling the
ends of their walking sticks. Of the fourteen, twelve arrived
with lifeless eyes, victims of one of the world's most dread
diseases, river blindness.The disease is spread by tiny,
humpbacked blackflies that breed in fast moving streams.River
blindness is a source not only of human health but also of
economic development In 1978 a potential solution emerged
unexpectedly, W C Campbell, a research scientist at Merck and
Company.His team was developing what would later be marked
as Ivermectin, a potent agent no side effects, when Campbell
realises that it might also be effective against a strain of horse
worms that are biological cousins of the human parasites that
cause river blindness. Appreciating it the human potencial for
animal treatment, cam bell asked P. Roy Vagelos, his laboratory
director, for approval to develop a form of the drug for human
use.
River Blindness;

6. " When I was born, my sight was normal," recalled a 71 year
old man , it all started one day when my eyes became watery
and sticky. Then I began seeing faintly. Eventually I could not
see at all.I was eight."
Discovering a Cure:
The first evidence came from a single infected mouse fed a
broth containing the bacterium: it ate little, but it was almost
immediately worm free. " I remember the feeling of excitement
in the group," Campbell recalled.
Delivering the product;
So striking were the human benefits and so modest the medical
downsides that Roy Vagelos sought commercial approval in
1987. By now the company decision was entirely his to make.
Though Vagelos says he " never had the yearning to run a large
corporation," in 1985 the Merck board had promoted him to
chief executive officer. Vagelos looked for sponsers to produce
but non were found. Finally, Vagelos decided to give the drug
to all who need it forever, and to ensure it was delivered before
the micro worms could take their devastating toll." Sometimes
in your life," he says, " you've got to take a leadership position
and make a deception." As news of the drug's miraculous
qualities spread across the black country of West Africa, people
walked through the night to villages where it was rumoured that
the drug would be dispensed.
So, by implication Vagelos clearheaded thinking about why you
have been appointed to an office and what those who have
placed you there expect of you is prerequisite to clear minded,
if not predictable, decision making.

7. Doing well by Doing Good:
The call for an unyielding focus on shareholder value is a
powerful action principle. It is a first axiom of corporate
governance, with strategic implications and guides management
decisions. George .W Merck had the following to say, " We try
never to forget that medicine is for people. It is not for profits,
" Merck says, but he is quick to stress that the objectives are the
same: " The profits follow, and if we have remembered that,they
have never failed to appear.
So, by implication: Identifying ways of bolstering long term
investor and public interest, even if they momentarily reduce
shareholder returns, can foster a favourable culture, build a
company cadre, and establish a public reputation that can more
than compensate for any temporary shortfalls in investor value.
Just Doing:
Managers are continually taking calculated risks. Indeed, one
sign of a manager's executive promise is his or her ability to
calculate those risks better than others on the executive waiting
list. Moments arise, however, when strict analysis does not
serve well. Sometimes what is required is simple
instinct.Finally, on the eve of Mectizan's approval, knowing
that a decision would be announced that the French authorities
approved the drug Roy Vagelos brought the debate to a close:
Merck would give the drug away forever.So certain was Vagelos
that he had taken the right action, " I thought that the company
couldn't have done otherwise".
So by implication: Achieving an organization's imperative is a
leaders calling, but sometimes we confront moments when we
must do otherwise. Such decisions must be relatively unique,
otherwise the inconsistency in our organisational leadership will

8. be evident for all to see: but if they are unthinkingly bypassed,
our value as a leader may be doubted by everyone, including
ourselves.
Knowing Where You're Going:
For Vagelos, the question was not framed in either or terms. He
knew that in assisting river blindness victims, he was ultimately
building shareholder value. Vagelos did not require a leader to
reveal such purpose, it was already well inscribed in the
company's philosophy and culture. Moreover, a framework for
reaching balanced decitions was wildly shared in the company.
So by implication : Knowing where you want to go and what
your values are can be essential to getting there, to ensuring
that all of your interests and concerns are factored into fast
moving deceptions, and to avoiding later regrets about being
less than clear minded. Building that understanding into an
organisational culture can help all employees be clear minded
and fast acting as well.
A Gift of Sight:
Former U.S. President Jimmy Carter wrote in 1993 that the" the
campaign against river blindness shows how a major
international corporation can change the lives of millions of
people"by " stepping beyond the confines of narrow, short term
interest and accepting a broader, global responsibility, "
Vagelos's leadership, Carter offered a year later, has " helped
prove that a corporation can .... be deeply concerned with the
alleviation of suffering throughout the world."