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.