Bill Gates and Mayor Michael R. Bloomberg announced on Wednesday that they would spend $500 million to stop people around the world from smoking.

By DONALD G. MCNEIL JR
Published: July 24, 2008

The World Health Organization estimates that tobacco will kill up to a billion people in the 21st century, 10 times as many as it killed in the 20th.

This time, most are expected to be in poor countries like Bangladesh and middle-income countries like Russia. In an effort to cut that number, Mr. Bloomberg’s foundation plans to commit $250 million over four years on top of a $125 million gift he announced two years ago. The Bill and Melinda Gates Foundation is allocating $125 million over five years.

Since 1999, the Gates Foundation has spent more than $2 billion on AIDS programs and about $1.2 billion on malaria. Mr. Gates has just left his Microsoft post for full-time foundation work and said he intends to form partnerships with other philanthropists.

The announcement was made at a joint news conference at TheTimesCenter in Midtown Manhattan attended by foundation staffers and foreign students enrolled in a tobacco control program at Johns Hopkins University that is supported by Mr. Bloomberg. He has campaigned against smoking for years, but this is a new direction for the Gates Foundation.

Thanking Mr. Gates, Mr. Bloomberg said, “I’m an optimist, but I’m also a realist.”

“All the money in the world will never eradicate tobacco,” he added. “But this partnership underscores how much the tide is turning against this deadly epidemic.” The new donations far outstrip current spending of about $20 million a year on antismoking campaigns in poor and middle-income countries, according to a recent W.H.O. report.

The $500 million would be spent on a multipronged campaign — nicknamed Mpower — that Mr. Bloomberg and Dr. Margaret Chan, director of the health organization, outlined in February. It coordinates efforts by the Bloomberg Initiative to Reduce Tobacco Use, the World Health Organization, the World Lung Foundation, the Johns Hopkins Bloomberg School of Public Health, the foundation of the Centers for Disease Control and Prevention and the Campaign for Tobacco-Free Kids.

It will urge governments to sharply raise tobacco taxes, prohibit smoking in public places, outlaw advertising to children and cigarette giveaways, start antismoking advertising campaigns and offer people nicotine patches or other help quitting. Health officials, consumer advocates, journalists, tax officers and others from third world countries will be brought to the United States for workshops on topics like lobbying, public service advertising, catching cigarette smugglers and running telephone help lines for smokers wanting to quit. A list of grants is at tobaccocontrolgrants.org.

Dr. Richard Peto, an Oxford epidemiologist who leads studies on the effects of smoking in the developing world, called the announcement “excellent news.”

“I reckon this will avoid tens of millions of deaths in my lifetime and hundreds of millions in my kids’ lifetimes,” he said.

Catherine Armstrong, a spokeswoman for British American Tobacco — one of the Western tobacco companies that focuses on sales to the third world — would not comment directly on the new initiative. But she said, “We have no problem with government organizations educating people on the risks of tobacco.”

A spokesman for Philip Morris, which makes Marlboro, the world’s most popular cigarette brand, said the company agreed that children should be kept from smoking but thought that raising cigarette taxes promoted smuggling and counterfeiting.

Mr. Bloomberg, founder of the financial news company bearing his name and creator of the Bloomberg Family Foundation, has long been known for his antipathy to tobacco. During his administration, New York has adopted several antismoking measures, including a ban on smoking in bars and restaurants, and significant increases in cigarette taxes.

The global campaign promises to be a struggle. Cigarettes not only are highly addictive and supported by huge advertising campaigns, they are also an important source of income for many foreign governments. In China and other countries, tobacco is a state-owned monopoly, and low- and middle-income countries collect $66 billion a year in tobacco taxes.

Only about 5 percent of the world’s countries have any antismoking measures like those the campaign envisions. But Dr. Peto said antismoking campaigns were already having some effects, even in countries where no-smoking signs are often ignored. He surveyed thousands of tobacco users in China in the 1990s — “before the government was taking it seriously,” he said — and found 4 percent who identified themselves as former smokers. Now, he said, 20 percent do.

In India, where people have long chewed tobacco but widespread smoking is more recent, Dr. Peto said he found almost no one who had quit. “India is where China was in the mid-1990s,” he said.

Smoking is not widespread in most of Africa, where only about 20 percent of men smoke, and Mr. Gates said on Wednesday that he hoped to prevent a surge in smoking there.

Waves of lung cancer deaths — which typically begin about 40 years after smoking takes hold in a society — help convince the next generation that smoking is dangerous, as in the United States in the 1960s, Dr. Peto said. And, he added, “When doctors and journalists start to take it seriously, things start to change.”

The Gates Foundation’s main focus has been global health, but up until now it has concentrated mostly on infectious diseases. Mr. Gates said he had been “looking at” tobacco deaths but was unsure what to do. “We were thrilled when Michael and his experts took the lead,” he said.
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