“We applaud the authors of this article (Chattopadhyay et al. 2017 Berger E. 2017) for tackling an important and often neglected topic in bioethics: the challenges that our underresourced colleagues face in conducting research and contributing to the literature in bioethics. Indeed, one of us (U.S.) has spent a good deal of his career attempting to draw attention to this problem and ameliorate it.

Though we are sympathetic to the concerns raised in their article there are several issues that have not been adequately addressed. The first is to be sensitive to an important distinction, namely, that between low-income and middle-income countries as defined by the Human Development Index. Low-income countries’ academic institutions have, as Chattopadhyay and colleagues point out, free access to all major bioethics journals via HINARI. There might be bureaucratic hoops and loops libraries jump through, but it can be done, provided there is sufficient interest in those countries in achieving access.

The authors point out some of the other obstacles faced by scholars in these countries, such as unreliable access to electricity or the Internet. One could add violence and gender inequality in many of these countries as serious challenges to many researchers or potential scholars. Obviously, the fundamental lack of infrastructure to support researchers in these countries is lamentable. Presumably the authors recognize that these issues are far outside the scope of the role or ability of academic journals (much as we wish we had the power to intervene on these issues).

Then there are countries such as India, Brazil, Mexico, and China that do not enjoy free access to academic journal content via HINARI. This is potentially an obstacle to access for scholars in these countries. These are countries that are not devastatingly impoverished. Parts of China have a higher gross domestic product (GDP) than certain parts of the United States. …”