Backing out of HINARI

Ed: Laura Janneck is currently in a Harvard Affiliated Emergency Medicine Residency at Brigham and Women’s Hospital and Massachusetts General Hospital in Boston, Massachusetts.  She has been a leading student voice within the Open Access movement and was involved in the founding of the Right to Research Coalition.

One of the areas in which open access can make a substantial impact is in the field of international medicine and public health. It is the nature of medical science that what is applicable in one corner of the globe is applicable anywhere. A drug that reduces blood pressure will work on human beings from France as well as Zambia. Despite this potential for the global application of medical science, many challenges arise in the implementation, from funding the purchase of medications, to creating supply chains, and training health care workers. One of the most basic challenges is simply disseminating knowledge of these medical advances to the practitioners that may use it. What use is a new treatment for malaria if most doctors treating malaria don’t know about it? Knowledge is also necessary to modify such technologies to resource poor settings. Will an HIV drug developed in New York work as effectively for undernourished refugees in Liberia? Such a question is best asked and answered by those whose patients are undernourished refugees in Liberia. If medical science is to be applicable to the poorest and sickest people on earth, their health care providers need access to that science.

One attempt to address this need has been HINARI: the Health Inter-Network for Access to Research Initiative. This program, started by WHO in 2002, was a means by which health care practitioners and academics in poor countries could access many leading biomedical and public health journals. The program has many flaws. It limits access to workers only with certain institutional affiliations, thus excluding many rural and community-based practitioners. It also excludes researchers in middle-income countries such as India and Indonesia who, despite their higher national GDP, are generally themselves impoverished by first-world standards, and can far from afford journal subscriptions. Despite these criticisms, HINARI has been successful in enabling scholars around the world to learn and implement new medical technologies, and inform their own research and development.

But on January 11, 2011, an article in the British Medical Journal announced that five major publishers would withdraw free access to more than 2500 of their health and biomedical online journals from HINARI in Bangladesh. The explanation given was that publishers were establishing “active sales” in the country.

The global health community responded with understandable outrage and anxiety. And while the BMJ article was the first major publicity of such pull-outs, the phenomenon is not new and is not limited to Bangladesh. Correspondences from researchers in Nigeria and Kenya reveal that publishers have been pulling access to their journals from other countries for years.

The motivations of the publishers are apparently profit-driven. If sales of subscriptions are possible in a developing country, they will withdraw free access in order to force researchers to purchase subscriptions. Correspondences to HINARI users have stated: “Please note that one of the conditions of HINARI, the publishers have the right to protect their existing business, and may choose not offer their journals to countries where they have significant sales or local sales agents” (email correspondence). The consequence is the removal of access for an entire nation’s researchers, so that a handful of wealthy libraries or institutions, likely limited to the major cities, may pay for subscriptions and increase the publishers’ bottom lines.

Researchers and health care providers affected by these changes responded quickly criticizing the change, as did editors of some of the journals that were pulled. In response to this outrage, most of the publishers have begun to reverse their decision and reinstate access to their journals in Bangladesh. Despite this small success thanks to the vigilance of the global health community, the underlying issue is far from resolved. Many international scholars have taken this as a wake-up call to push forward the open access movement. They recognize that HINARI is not a sustainable solution to the information access problem. This will hasten the call for all who publish research to publish in open access journals, and for the global health community to revolutionize the way academic information is published. Producers and consumers of academic research must work together toward long-term open access solutions. Only then will producers of research be able to ensure that their work is disseminated, and consumers will be able to utilize the fruits of their labors to heal the world’s destitute sick.


developing world,


medical students

World’s largest medical student organization joins Right to Research Coalition

For immediate release
January 19, 2011

For more information, contact:

Nick Shockey
Director, Right to Research Coalition
+01 202 296 2296
nick [at] arl [dot] org 

Margot Weggemans
Liaison Officer for Medical Education Issues, International Federation of Medical Students’ Associations (IFMSA)
+31 6 52020717
lme [at] ifmsa [dot] org

World’s largest medical student organization throws weight behind Open Access; Student-led Right to Research Coalition now represents nearly 7 million students internationally

WASHINGTON DC, USA and AMSTERDAM, THE NETHERLANDS – In a move that demonstrates the building global momentum for student commitment to Open Access, the International Federation of Medical Students’ Associations (IFMSA) today announced its membership in the Right to Research Coalition, an international alliance of undergraduate and graduate student organizations that promotes a more open scholarly publishing system through advocacy and education.           

Based in Amsterdam, IFMSA is one of the world’s leading student organizations, representing over 1.2 million medical students, and aims to serve medical students all over the world.  Starting this month, IFMSA will begin working with the coalition’s 30 other member organizations to promote a more open scholarly publishing system by educating students about Open Access and advocating for policies that expand access to the results of research.

“We fully support the initiative of the Right to Research Coalition and the tenets of the Student Statement on the Right to Research,” said Chijioke Kaduru, IFMSA’s President.  “We believe that Open Access to research will positively benefit all aspects of health care; it will improve the knowledge of health care workers, researchers and medical students by making crucial information easy to access. Open Access will also improve and democratize medical education by expanding access to research articles so crucial to students’ training, strengthening the IFMSA vision of equity for medical students worldwide.  We look forward to working with the Right to Research Coalition and its other members to improve access to research and make Open Access to the full scholarly record a reality.”

Founded in 2009, the Right to Research Coalition has expanded rapidly into an international alliance of student organizations representing a wide variety of disciplines.  With IFMSA, the members of the Right to Research Coalition now represent nearly 7 million students throughout the world and continue to grow as a powerful force in expanding access to research.

“IFMSA brings a real global presence to our coalition,” said Nick Shockey, Director of the Right to Research Coalition.  “Students in every corner of the globe are affected by limited access to research.  We hope to expand our membership to reflect the global importance of Open Access and to help forge a global solution.  We’re excited to begin collaborating with IFMSA on this issue of such importance to both medical and non-medical students alike.”



About IFMSA 

IFMSA is an independent, non-governmental and non-political federation of medical students’ associations throughout the world. In 2010, IFMSA consists of national medical student associations in 97 countries on six continents.  IFMSA’s members represent around 1,200,000 medical students worldwide.

Since 1951, IFMSA has been run for and by medical students on a non-profit basis. Officially recognized as a Non Governmental Organization within the United Nations’ system, it is recognized by the World Health Organization as the international forum for medical students.  IFMSA is registered as a charitable organization in the Netherlands.

About the Right to Research Coalition 

Founded by students in the summer of 2009, the Right to Research Coalition is an international alliance of 31 undergraduate and graduate student organizations, representing nearly 7 million students, that promotes a more open scholarly publishing system.  The Right to Research Coalition believes that no student should be denied access to the scholarly articles they need, because they or their institution cannot afford access.  The coalition works to educate the next generation of scholars and researchers about Open Access and to advocate for policies at the campus, national, and international levels that expand access to the results of research.


medical students,


R2RC expansion

Access Around the World: Portugal

Ed: For the second installment of our Access Around the World series, I’d like to introduce Luís Machado. Luís recently graduated from medical school in Portugal and is the European Medical Students’ Association’s liaison officer to the Standing Committee of European Doctors (CPME).

In my country, Portugal, and those in Central Europe with which I’m familiar, medical textbooks are still the main resources students use to learn about any issue.  However, within the context of the current Bologna framework, medical curricula in Europe are changing to put more and more emphasis on scientific research.  For example, in Portugal, every medical student is required to do a final research project on a topic chosen by the student to develop research skills.

While my colleagues and I face a variety of challenges in conducting research, the one I hear complaints about most often is lack of access to the scientific articles we need for our work.  Indeed, our institutions have paid for access to the majority of the “relevant” publications, but that gives rise to questions such as, what if I need to work from home where I don’t have access?  Or what if other colleagues are using the several school computers, which often happens?  Or what if I need to use an article published by a “not so relevant” journal (according to the university), which the school doesn’t pay for?  We face these problems and many others when trying to access research.

I support the Right to Research Coalition, because I believe science and education should be available to all.  Knowledge must be public; scientific content must be Open Access, in order to reach everyone without boundaries.  The world is becoming more interconnected everyday, so let us make the results of scientific research free for all!  The sharing of all resources is vital, especially for young scientists and students.

Within my organizations, the European Medical Students’ Association (EMSA) and the Standing Committee of European Doctors (CPME), I believe there is an outstanding opportunity to cooperate and promote Open Access.  Both organizations have widespread European networks of active members, which is a key factor in bringing about change on such a huge scale, and I believe having doctors on our side would be an amazing achievement.

EMSA has recently addressed Open Access during a CPME General Assembly, drawing interest from quite a few doctors.  We must continue raising awareness and engaging doctors and medical students to bring them to our side!  We have many major milestones ahead of us, but with great effort and a strong sense of purpose, we will accomplish them!

The frame to develop a global network of students, doctors, researchers, and others to promote Open Access exists, but now we must ACT to accomplish this hard task.  Let us advocate NOW and GLOBALLY and take further steps in the path toward a world where science has no limits!


Access Around the World,

medical students