Nicoli Nattrass
It is economically illiterate and shockingly ill-informed to argue that we cannot afford to give pregnant women AZT. This is apparent from the most basic cost-benefit analysis.
Taking the narrowest possible approach, the government simply has to ask whether the cost of administering AZT is more or less than the costs of treating children with Aids over their short lives. AZT costs about R500 a month, and a pregnant woman needs to be treated during the last three months of pregnancy to reduce the risks of passing HIV on to the child from about 63% to 13%.
So, if the state treats 100 women in order to save an additional 50 children, this will cost R3 000 per saved child.
The average cost per patient per day in the Red Cross Children’s Hospital is about R900. Poor patients are charged R44 per 30 days, so practically the entire cost of treating most African children with Aids falls on the state. Any child that spends more than four days in hospital with Aids-related problems has cost the state more than it would have done to save that child through the use of AZT.
According to sources in the Red Cross Children’s Hospital, children with Aids live for about five years, and they are likely to spend at least five weeks a year in hospital. If so, each child will cost the state R54 000 – that is, 18 times the cost which would have been incurred had the state administered AZT to enough pregnant women to save that child.
If we widen the ambit of the cost-benefit calculation to include welfare expenditure, then the case for giving AZT should become even more compelling to government. Child support of R100 a month is payable for up to six years. Children living for five years with HIV will thus cost the state R6 000. This expenditure alone is twice the amount the state needs to spend on AZT to save the child! These costs will never be recovered as children with Aids do not live long enough to become productive, tax-paying adults.
In short, the government should have realised that withholding AZT was not only immoral, but was also a false economy – even within the confines of the narrowest fiscal calculus.
One could argue that economists should only look at the numbers of care-givers who are likely to take Aids orphans to hospital. This way, we can discount all those families in rural areas who cannot get to hospitals, and where children with Aids are likely to die earlier. Taking this further, if hospitals are instructed not to treat children with HIV, then the costs fall accordingly.
But this kind of calculation puts no value on human life, and depends on denying people access to adequate health care. It is based on a triage formulation where health care resources are allocated first to those with the chances of surviving – but where the decision not to provide AZT determines such chances.
Some people even take seriously the notion that it is better for children borne of HIV mothers to die with, or shortly after, their mothers. The argument goes that as there is no one to care for them, their quality of life is likely to be poor and they will probably end up as criminals. This disgusting calculus assumes that no one remains behind after the mother dies to love and care for the child. While this situation may arise in the future as the Aids pandemic increases, it is not the case at present.
A very small percentage of Aids babies are abandoned. Most appear to be looked after by grandmothers and other relatives.
If one factors in the costs borne by these care-givers, then the case for providing AZT is unanswerable. Grandmothers and aunts do not make triage-type calculations when the baby gets sick. Out of human compassion, they stay away from work to look after the sick child, and take their hard- earned savings and spend them on medicines, taxis to clinics and hospitals, etcetera. By saving money on AZT, the state is effectively passing on the costs of Aids to such people.
And no one can even begin to count the emotional costs of watching a toddler learn to walk, smile and talk – only to die of an illness you can do nothing about, and which the state was too stupid and immoral to prevent.
Dr Nicoli Nattrass is an associate professor at the School of Economics, University of Cape Town