The paper, ‘Can we achieve health information for all by 2015?’ by Godlee, Packenham-Walsh, Ncayiyana, Cohen and Packer (http://image.thelancet.com/extras/04art6112web.pdf) highlights the current inadequacy of health information available to practitioners in the developing world. It proposes a major international collaborative effort, led by WHO, to redress the problem by 2015 and makes a number of sound proposals. The Electronic Publishing Trust for Development applauds this call, but wishes to indicate a major omission that can do much to improve access to health information by 2005. We refer to Open Access Archiving of published research and associated material.

Access to the world’s published and refereed research is the fundamental building block to all subsequent health-care publications. Although it is very true that many practitioners require syntheses of these publications and manuals of best practice rather than the basic research on which such publications are based, denial of access to the research itself forms a barrier to the development of a strong science base in developing countries and to strengthened economies less dependent on hand-outs.

The Meaning of Open Access

There is much misunderstanding about ‘open access’. Many equate open access with open access publishing (OA=OAP). While the new OAP developments (Public Library of Science, BioMedCentral, etc) are pioneering this new publishing model (whereby the authors’ institutes pay the costs of document management), many contributors to the debate are ignoring Open Access Archiving (OAA) (whereby already refereed and published research is archived in interoperable institutional archives). So whereas many believe OA=OAP, the reality is that OA =OAP or OAA. For a definition of this twin-pronged approach to Open Access advocated by the Budapest Open Access Initiative, see http://www.soros.org/openaccess/read.shtml

Why is it so important for developing countries to adopt OAA?

The establishment of open access archives is easy, almost cost-free and changes nothing else. Authors continue to publish in journals as before. Some 86% of nearly 9,000 journals surveyed have agreed that authors may archive their published work in institutional archives. Since such archived papers are free of cost barriers, studies so far carried out are showing improved impact approaching 300% http://www.dlib.org/dlib/june04/harnad/06harnad.html.

Currently, considerable effort is being made in developing countries to raise awareness of the benefits of Open Access Archives. It is increasingly recognised that regional research published in costly overseas journals, as well as that published in local journals, becomes freely accessible to all through OA Archiving. Policy discussions and workshops have taken place (for example, four OAA hands-on workshops have taken place in India, designed to show how to set up interoperable institutional archives). Some 21 institutional archives set up in developing/emerging countries are already registered with the Institutional Archives Registry (http://eprints.archives.org). The Bioline International eprints archive (http://bioline.utsc.utoronto.ca) is available for any developing country researcher to use and already contains some 2000 research articles from over 30 journals published in developing countries. The publishers of these OA journals recognise that international visibility has a far greater impact on their research programmes than does the limited income that the ‘paid for’ journals previously generated.

OA Archives thus begin to close the south to north, south to south and north to south information gaps. Research generated in the poorer countries, often of great importance to neighbouring countries experiencing similar health problems - but also ‘missing’ from the global knowledge pool from which international health programmes are designed - thus becomes mainstream and accessible worldwide on an equal basis.

The connectivity problem remains in most developing countries, but there is evidence that things are improving steadily as the benefits are better recognised among policy makers. Internet access centres are generally available in major institutes, which can serve as information nodes for outlying regions. The resistance to the use of computers among health professionals is often a generational problem and, as the younger computer-literate scientists and doctors themselves become policy makers, attitudes change. The problem should not be used as a reason to exclude developing countries from the great benefits offered by OAA, especially at a time when both computers and connectivity are becoming more and more affordable.

A Supplementary Proposal

We submit that in addition to proposals made in the Godlee paper, the WHO immediately considers the impact that support for the low-cost establishment of OA Archives would achieve. The setting up of such archives can be done in perhaps a week of computer-personnel time, followed by local training for the people that will enter the data (perhaps the computer department of institutes or library staff). There are many organisations willing to help with this work and all software is free of charge.

The consequences of the establishment of a rapidly growing volume of free scientific and medical literature is incalculable. The Archives can be used equally for refereed research papers, handbooks, best-practice documentation and other essential medical publications.

All are interoperable and can be searched as a seamless resource, free to all.

First must be undone the many misunderstandings of what ‘Open Access’ is. We repeat that OA is not only Open Access Publishing, but also Open Access Archiving. Open Access Archiving has already started, has been recommended to be mandatory for UK publicly-funded research and in the USA for the National Institutes of Health research output, has been approved by government and institutional signatories to the Berlin Declaration (http://www.zim.mpg.de/openaccess-berlin/berlindeclaration.html) and is already being implemented in such countries as India, Brazil, China and, just recently, Namibia. It is cheap, easy and, as it does not affect the status quo of academic publishing, there are no ‘issues’ to be resolved. The information-famine can start to be reversed at once and the world would be a better place far before 2015. With the support of such international organisations as WHO, much can be achieved during 2005.

Subbiah Arunachalam, M S Swaminathan Research Foundation, India
Leslie Chan, University of Toronto, Bioline International, Canada
Barbara Kirsop, Electronic Publishing Trust for Development, UK
F. O. Okonofua, Editor African Journal of Reproductive Health, Nigeria