KEY TAKEAWAYS

• Although open access initiatives have been on the increase in low-income countries, global disparities persist in terms of who benefits the most from open access publication.
• As one major funder moves to mandatory preprints, could this help redress the balance in terms of research dissemination and citation?

With increasing numbers of open access initiatives established worldwide, why are the benefits of open access not felt by all researchers equally? Recently, Holly Else reported for Nature on why, even though paywalls are falling, researchers from low-income countries are still struggling to be visible in the academic space.

Imbalances

Else and contributor Susan Murray (Executive Director, African Journals OnLine) reflected on the fact that many low-income countries have long established open access publication networks, and that these networks continue to grow. For example, Indonesia now has over 80% of its research activity freely available due to an increase in open access publishing platforms. Despite this, researchers in low-income countries tend to be subject to imbalances of power and resources to a greater degree than those in higher-income countries, which can prevent them from benefiting fully from these systems.

Inequities

Other inequities exacerbate the problem. As previously reported by The Publication Plan, a recent study by Dr Chun-Kai Huang and colleagues showed that the advantages of open access publication, such as increased and more diverse citations, are not felt evenly by researchers across the globe. In this large study of 420 million citations over 10 years, researchers from Northern Europe benefited the most from their work being published open access.

Innovations

Else highlights that, while open access is integral to ensuring the visibility of research, speed of publication is also key. Others have reported on the power of preprints to confer a citation advantage. An interesting development in this area is the move by the Bill & Melinda Gates foundation to move away from funding gold open access and instead require grant recipients to post their work on public preprint servers. It remains to be seen if such changes can help redress the balance in terms of who benefits from open access.

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KEY TAKEAWAYS

• The reasons why researchers submit to predatory journals are multifactorial.
• Institutions can counter the rise of predatory journals by educating researchers, fostering collaboration, and broadening evaluation criteria to reduce the pressure to publish.

Predatory journals pose a significant threat to scientific integrity, yet researchers continue to submit their work to them. In a recent Nature World View article, Professor Chérifa Boukacem-Zeghmouri explores the motivations behind researchers’ decisions to submit to predatory journals and suggests strategies for institutions to combat this issue.

Prof. Boukacem-Zeghmouri’s study in The Malaysian Journal of Library and Information Science surveyed 2,200 researchers who had authored articles in journals by the publisher OMICS. This publisher was ordered in 2018 to pay $50.1 million to the US government for “unfair and deceptive practices”. Many of the 86 survey respondents were from low- and middle-income countries (LMICs). Some admitted to knowingly submitting to predatory journals, possibly viewing them as a means to succeed in an unfair academic system. Alternatively, authors may unknowingly fall into the trap of predatory publishing because of language barriers or limited knowledge of publishing standards, with changing open access models further complicating matters.

Authors may unknowingly fall into the trap of predatory publishing because of language barriers or limited knowledge of publishing standards.

Prof. Boukacem-Zeghmouri proposes several approaches that institutions could adopt to help prevent this:

• Provide education on scholarly publishing norms and guidance on navigating the complex publishing landscape, especially for researchers in LMICs.
• Offer resources, such as the Think Check Submit checklist, in local languages and forums for knowledge exchange to empower researchers and reduce their vulnerability to predatory publishers.
• Create partnerships between institutions in LMICs and wealthier countries to facilitate access to reputable publications and integration within the global scientific community.
• Alleviate the pressure to publish by broadening the criteria for evaluating researchers beyond publications and acknowledging contributions in teaching, outreach, and other knowledge-sharing activities.

Prof. Boukacem-Zeghmouri highlights the open access publishing model in Latin America as an example of how things can be done successfully, with local open access journals that are recognised by the entire research ecosystem. She concludes that by creating a supportive environment that prioritises research integrity, institutions can protect researchers from exploitation and ensure that legitimate research reaches the world, advancing scientific knowledge for the benefit of all.

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KEY TAKEAWAYS

• The ‘diversity factor’ has been proposed as a new, more equitable metric for assessing journal quality and the impact of health research.
• The index takes into account the diversity of the authors, study participants, and departmental affiliations to promote a wider range of perspectives in research.

The impact factor remains the dominant metric among researchers for assessing journal and (indirectly) research paper quality, despite multiple calls for it to be superseded by alternative measures. Recently, a novel metric claimed the spotlight in an MIT News article. The article describes a study by Dr Jack Gallifant et al., published in PLOS Global Public Health, which suggests that the impact factor misses the mark in capturing a paper’s impact on health. The researchers argue that, for a more accurate understanding of impact, journal metrics should take into account the diversity of the authors and of the study participants. They propose a novel metric, termed the ‘diversity factor’.

The index is comprised of 3 key components:

• author demographics: the gender and geographic location of the authors
• participant demographics: the gender, ethnicity, race, language, geographic location, and age of the individuals enrolled in the study
• departmental affiliation: papers with authors from different disciplines (eg, doctors, nurses, and engineers) score more highly than papers with authors from a single field.

After settling on the metric’s components, the group used the database OpenAlex to extract metadata relating to the authors of over 100,000 medical papers, from around 7,500 journals, published in the last 20 years. A considerable number of the papers retrieved were not open access, meaning that participant demographics could not be included in the final analysis. However, as the researchers predicted, most papers did not perform well against the new metric, even when considering author information alone. Specifically, there was significant underrepresentation of female authors and of authors from low- or middle-income countries. The group hope that by quantifying and tracking diversity in this way, over time, those working in health research would be prompted to drive progress against these measures.

So, why exactly is a lack of diversity a problem for global health outcomes? Ultimately, it boils down to ‘blind spots’ in medical knowledge, explains Dr Leo Anthony Celi, senior author of the paper:

“What happens when all of the authors involved in a project are alike is that they’re going to have the same blind spots. They’re all going to see the problem from the same angle. What we need is cognitive diversity, which is predicated on lived experiences.”

Dr Celi believes that stakeholders within medical publishing — including journals, academic institutions, funding bodies, and even the media — are accountable for the inequity seen in health research. As such, each must play their part in diversifying medical research publications. To this end, Dr Celi calls for the diversity factor to prompt discussions within the medical research community and provide a first step towards a more equitable evaluation of the true impact of research.

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Article processing charges (APCs) can cost several thousand dollars and are increasing with the rise of open access publishing. A recent article by Nabyonga-Orem et al in BMJ Global Health highlights the consequences this is having on researchers from lower- and middle-income countries in Africa.

Nabyonga-Orem explains how fee waivers, created to ease the burden of APCs and typically based on the per capita income of authors’ countries, often do not adequately account for the low salaries and lack of institutional support African researchers receive. This may lead researchers to publish in lower impact or even predatory journals, resulting in their work being less widely accessible and their careers potentially suffering.

Nabyonga-Orem highlights that “if a journal levies APC of about US$2600 per article (as is common), researchers in some countries may have to give up nearly 6 months of their entire earnings (before tax) to finance one publication…”

The impact of unaffordable APCs is not limited to African authors. If researchers of a particular region are consistently unable to publish their work, the evidence available globally will become biased in favour of that published by authors in higher-income countries.

To address this issue, Nabyonga-Orem calls for:

• governments, funders and donors to increase research funding and renumeration for researchers, and to collaborate with the aim of building capacity and mentorship support
• journals to reassess APC discounts and waivers, making them more transparent and better aligned with authors’ resources
• African researchers to work with governments, funders, donors and journals to improve the accessibility and prestige of African journals.

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Summary by Kristian Clausen MPH from Aspire Scientific

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With thanks to our sponsor, Aspire Scientific Ltd

Yesterday was World Health Day, held each year to mark the World Health Organization (WHO)’s founding and to highlight a key issue relating to global health. This year, the focus is on achieving universal health coverage, in which “all individuals and communities receive the quality health services they need without suffering financial hardship”. This goal is a top priority for the WHO and forms part of the United Nations’ Sustainable Development Goals for 2030. The WHO urges us all that “universal health coverage is possible, let’s make it happen!”

World Health Day aims to raise awareness of progress but also highlight how far we still have to go to achieve universal health coverage, acting as a call to action for the general public, healthcare workers and policymakers. Everyone should arm themselves with the information needed to take care of their own health, while lobbying leaders to deliver quality healthcare for all. In turn, policy makers should prioritise health through investment and data collection to improve targeting of resources.

As highlighted by the WHO, at least half of the world’s population doesn’t have access to essential health services. Nearly 12% of people worldwide spend at least 10% of their household income on healthcare, with costs pushing 100 million people into extreme poverty each year. Unsafe and low quality healthcare has a big impact on the global economy, costing trillions of dollars a year.

Achieving universal health coverage will require a concerted effort to progressively expand coverage as countries gain resources, building this on a foundation of high quality, accessible primary healthcare. In many cases, increased and restructured financing is warranted to make more treatments available and to train healthcare workers, who are particularly needed in lower- and lower–middle-income countries. Alongside this, public health measures and patient education are vital. The goal is to provide integrated care; treating people, not conditions.

The 2019 World Health Statistics Report, released for World Health Day, highlights the current state of universal health coverage and health systems. You can learn more about World Health Day here and join the conversation on social media using #HealthForAll. Health is a human right; help promote it for all!

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Summary by Beatrice Tyrrell DPhil from Aspire Scientific

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With thanks to our sponsors, Aspire Scientific Ltd and NetworkPharma Ltd

Over 18 million new cases of cancer and nearly 10 million deaths resulting from cancer are estimated to have occurred in 2018. Underlying these statistics, access to cancer care is not equal for all: survival chances are poorer in low- and middle-income countries and patients facing economic or social inequalities also suffer inequities in access to cancer services. Addressing these issues is a priority for the Union for International Cancer Control (UICC), an organisation representing cancer societies, ministries of health, and patient groups in over 160 countries. UICC leads World Cancer Day which takes place on 4 February each year. 2019 sees the launch of the ‘I Am and I Will’ theme for the next three years, encouraging everyone to make a personal commitment to get involved in the fight against cancer.

A key message of the campaign is that improving public awareness and access to early detection, screening and diagnosis of cancer can save lives, as well as facilitating less complex and more cost-effective treatment. Hundreds of activities have been taking place across the globe to mark the occasion:

• A blog post from the American Society of Clinical Oncology (ASCO) emphasised that improved public health measures, screening, and treatments are already having positive impacts on cancer incidence and outcomes. ASCO will continue to rise to the challenge of meeting global cancer care needs through education and research.
• The European Society for Medical Oncology (ESMO) highlighted the continued need for multidisciplinary collaboration – one of five urgent issues ESMO is working to address.
• The National Comprehensive Cancer Network (NCCN) announced national endorsements for guidelines to improve cancer care in Sub-Saharan Africa.
• From a policy perspective, the Members of the European Parliament (MEPs) Against Cancer (MAC) interest group launched a manifesto towards effective cancer control in Europe.
• Among healthcare professionals, the International Society of Nurses in Cancer Care (ISNCC) marked the day by profiling cancer nurses worldwide.
• Publishers have been getting involved too, with Elsevier making a special collection of articles reporting the latest oncology research free to access throughout February. A selection of free articles published in Oxford University Press journals is also available, focused on cancer prevention and risk factors, and relevant ebooks are available free-of-charge from Institute of Physics Publishing until 10 February.

There are many ways that you can get involved this World Cancer Day and beyond. Find out more here and join the conversation online using #WorldCancerDay and #IAmAndIWill.

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Summary by Beatrice Tyrrell, DPhil from Aspire Scientific

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With thanks to our sponsors, Aspire Scientific Ltd and NetworkPharma Ltd

A recent study published in BMJ Open brings to the fore a field that has been little-reported on to date: reporting and publication practices among health researchers in lower/middle income countries (LMICs; defined by the World Bank). The authors highlighted several potential areas of concern, relating to guest authorship, undeclared conflicts of interest, plagiarism and redundant publication.

Authors of Cochrane reviews working in LMICs were invited to complete a questionnaire that aimed to ascertain whether respondents thought that certain reporting practices were acceptable and whether these behaviours were common at their institutions. Further information was obtained through in-depth interviews. The study revealed that:

• Guest authorship is common, with 77% of participants reporting its occurrence at their institution. In-depth interviews revealed that although participants felt authorship rules are simple, they are not consistently applied.
• There is a lack of awareness about conflicts of interest and how they may affect research. Forty percent of participants indicated that their colleagues had not declared conflicts of interest in the past.
• As in high-income countries, academic status and power can affect behaviour. In some regions, junior researchers are obliged to include senior researchers on papers when they do not meet authorship criteria.
• Institutions and culture can fuel bad practice, due to an overemphasis on publications in career progression (as can also be seen in high-income countries).
• Plagiarism may be an issue; while most respondents (96%) agreed that it is unacceptable, many (37%) were aware of its occurrence among their colleagues.

In addition to undermining research integrity, poor reporting and publication practice may have a detrimental effect on the continued development of the scientific industry in LMICs. The study authors conclude that “future research in LMICs should explore ways to promote research integrity at various levels within institutions”.

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Summary by Philippa Flemming PhD, CMPP from Aspire Scientific