An inspiring teacher of mine, the late Carl Taylor from the Johns Hopkins Bloomberg School of Public Health used to test us with a story. A major vaccine program is planned in a remote mountainous village that takes 4 days to get to. Families from far-off villages assemble there only once a year. The vaccine campaign is known to prevent several hundred cases of disease and many deaths each year. As the two person team is driving up the mountain a car rolls down a ravine in front of them. They find the driver bleeding from a fractured femur with no other injuries. If he does not get to the base hospital within 24 hours he will die. Yet if they take him, they will not make their rendezvous with the village and countless number of kids will get sick and die over the next year.
What would you do?
Is it heartless or unethical to provide only palliative treatment to the driver and continue the campaign? Is it sound public health policy to do so? Is your decision influenced by the fact that you would knowingly let a specific person die who could live? And never be quite sure who would benefit from the vaccine?
This seems an unfair trade-off. Yet it happens every day albeit with less stark outcomes every time we decide how to spend our time and where to place our investments. There is no right or wrong answer for an individual even though if we all were to have the driver fixed we would never prevent epidemics. The urgent will always be with us.
Derek Yach is former executive director of Non-Communicable Diseases and former head of the Tobacco Free Initiative, at WHO (1995-2004). He is Senior Vice President Vitality Group plc.