Bill Gates, the world's second-richest man, wants more money.
The co-founder and former chief of Microsoft Corp., who has recast himself as a philanthropist, doesn't want the money for himself. Instead, as the world economic crisis drags into a fifth year and increasingly takes on the pallor of a chronic condition, Mr. Gates frets that some debt-straddled governments will reduce their financial support for health programs in developing countries.
"I don't see us getting the same type of [aid] increases that we had from 2000 to 2010—that's just not realistic," said Mr. Gates in an interview here on Monday. "The question is now whether we can sustain modest increases so that people, for example, who need AIDS drugs, are able to receive them."
On Wednesday, Mr. Gates will be at the World Economic Forum meeting in Davos, Switzerland, where he plans to exhort wealthy donors—especially governments—to keep funding a range of crucial projects in the developing world, from tuberculosis drugs and antimalaria bed nets to maternal care and vaccines. His plans to make his case by showcasing ideas, backed by his foundation, that have helped cost-effectively tackle problems in global health.
As co-founder of the Bill and Melinda Gates Foundation, Mr. Gates says he travels extensively and keeps an eye on the scores of projects supported by his Microsoft wealth.
"I get a sort of ringside seat to see where innovation really is having an impact," said Mr. Gates. "I'm getting to see probably more than the political leaders and hopefully that will get them to see this choice, in favor of the poorest."
These are tough times for global health aid. The boom years ran from 2002 to 2008, when double-digit increases in total spending were recorded each year, according to research done at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, Wash.
Although the economic crisis hit in 2007, it didn't have an immediate impact; total funding for global health rose 17% from 2007 to 2008, for example. However, the level of annual increase fell to 4% from 2009 to 2011, according to preliminary estimates done by the institute and recently published in the journal Health Affairs.
"It's been very hard for politicians to convince their populations to increase the amount of money they give to poor countries," said Katherine Leach-Kemon of the Seattle institute, a co-author of the journal study.
Ms. Leach-Kemon estimates that spending in 2011 from all donors for health aid to developing countries totaled $28 billion, about what Americans spend on Black Friday, the big shopping day after Thanksgiving.
Development assistance from the United Nations agencies fell slightly from 2010 to 2011. Growth in such spending from government-funded entities also slipped to 4%, partly reflecting lower growth in U.S. government contributions.
Not all countries have been belt-tightening. While debt-strapped Italy has recently made sizable cuts, Britain still plans to meet its original commitments, Mr. Gates said.
One story that enlivens Mr. Gates is the vaccine-led fight against polio in India, where not a single case has been recorded in the past 12 months. Not so long ago, the country of 1.2 billion was regarded as the epicenter of the disease and one of the biggest obstacles in the drive to eradicate it.
Globally, the number of polio cases has dropped to 1,349 in 2010 from an estimated 350,000 in 1998, according to the World Health Organization. As a result, "there have been over three million kids in the last decade who haven't been crippled by the disease," said Mr. Gates, whose foundation pays about a fifth of the $1 billion annual cost of polio vaccinations globally. Eradicating the disease could re-energize vaccine campaigns against other diseases that are currently falling short. "I'd hope that we could get vaccination coverage from 70% [today] to 90% and get some of the newer vaccines into the delivery system" for other major diseases, said Mr. Gates.
Cutbacks in global health spending could hurt programs that treat HIV/AIDS, especially in Africa. The cost of providing lifesaving AIDS drugs in a well-run program has dropped to $300 per patient per year, according to Mr. Gates. But unlike the case with malaria or tuberculosis, AIDS drugs need to be provided over the patient's lifetime.
"That's a tough situation where you have to pick which people get the drugs—a terrible situation where people are fighting over the drugs and nobody is getting a full" course of treatment, said Mr. Gates.
In recent months, Mr. Gates has made an effort to persuade other billionaires to give away most of their wealth in their lifetime or in their will. In the latest annual letter detailing his foundation's activities, he notes that 69 people have signed up to the idea so far. One is Mark Zuckerberg, co-founder of Facebook. The Gates Foundation, whose endowment includes contributions of more than $9.5 billion so far from Warren Buffett, has made total grant commitments of $26.19 billion since its inception in 1994.
"We make mistakes, we have dead ends," said Mr. Gates. "But enough of it works that we have a real sense of excitement, just as there was at Microsoft."
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