My working theory is a combination of (a) my basic needs are actually quite high when you consider the many potential rainy days for which I must save, (b) I don't know enough to donate with confidence that my money is doing more good than harm (this Gates letter addresses some of my concerns here), and (c) I must simply come to terms with being selfish to the point where I would rather spend money on a candy bar than a life-saving vaccination for someone else.