From Researcher to Health Worker Through Open Access

Analysis and Comment Chan et al The chain of communication in health science: from researcher to health worker through open access Leslie Chan, Subbiah Arunachalam, Barbara Kirsop Leslie Chan is director of Bioline International and senior lecturer in the Department of Social Sciences, University of Toronto, Scarborough, Ontario, Canada. Subbiah Arunachalam is distinguished fellow at the Centre for Internet and Society, Bangalore, India. Barbara Kirsop is a trustee and secretary of the Electronic Publishing Trust for Development, a registered charity in Worksop, Nottinghamshire, UK. Competing interests: Leslie Chan joined the editorial board of Open Medicine in May 2009, a number of months after this art‐ icle was accepted for publication. Funding source: None. Correspondence: Leslie Chan, Department of Social Sciences, 1265 Military Trail, Toronto, Ontario, M1C 1A4; [email protected] LOBALLY, THE PUBLIC AND PRIVATE SECTORS Wellcome Trust believes that maximizing access to the spend billions of dollars each year on biomedical research they fund will increase the health applications and healthrelated research. Yet in many parts and benefits of that research. As a result, since 2005 the Gof the world, health care systems are far from achieving Trust has made it a condition that all those receiving the health outcomes targeted by the UN Millennium De grants must deposit electronic copies of journal articles velopment Goals The reasons for this disparity are com resulting from Wellcome funding into the UK PubMed plex, but one key factor that has been consistently Central open access repository within 6 months of pub 3 identified is the failure to translate research into effect lication. ive policy and practices. Not surprisingly, then, health One of the first groups to require deposit of articles agencies and funding bodies around the world are pay in open access institutional repositories (IRs) was Re ing closer attention to what is now generally described search Councils UK, which includes the Medical Re as “knowledge translation,” developing mechanisms search Council. More recently, the US National that “strengthen communication between health re Institutes of Health (NIH), the world’s largest medical searchers and users of health knowledge, enhance capa funding body, made it mandatory for researchers to city for knowledge uptake, and accelerate the flow of submit final peerreviewed journal manuscripts that 1 knowledge into beneficial health applications.” result from NIH funding to PubMed Central. This re At the same time, research funding agencies are re quirement was made into law by the US Congress, cognizing that a key component of the knowledge trans which passed the Public Access Policy (Consolidated 4 lation process is ensuring that the primary research Appropriations Act, 2008). Likewise, the Canadian In resulting from their funding is shared as widely as pos stitutes of Health Research (CIHR) enacted an open ac sible. As Robert Terry, a former senior policy adviser at cess policy requiring authors who received CIHR the Wellcome Trust, the largest private charitable medic funding to make their publications openly available al funding agency in the UK, said, “Just funding the re within 6 months of publication. In addition, CIHR grant search is a job only half done. A fundamental part of recipients are required to deposit bioinformatics, as [our] mission is to ensure the widest possible dissemina well as atomic and molecular coordinate data, into the 2 tion and unrestricted access to that research.” The appropriate public database immediately upon publica Open Medicine 2009 3(3):1 1 1 -1 1 9 Analysis and Comment Chan et al tion of research results (e.g., nucleic acid sequences Unfit for purpose 5 must be deposited into GenBank). These are prominent examples of agencies who under stand that "[t]imely and unrestricted access to research The chain of knowledge transfer in health care begins findings is a defining feature of science, and is essential with the research laboratories in university depart for advancing knowledge and accelerating our under ments, research institutes and health care companies, 6 standing of human health and disease." A total of 112 ma where new research knowledge is generated. From jor research organizations and funding bodies have now there it moves through peerreviewed publications to made similar requirements and are listed in the Registry the global community. The chain can be broken at any of Open Access Repository Material Archiving Policies link because of technical, social or fiscal problems, but database, with a further 14 such mandates under develop if the primary link between original researchers and 7 ment. (See Box 1 for a list of the websites of open access users is broken, nothing new can emerge to support the groups mentioned in this article.) It is recognized that re health services around the world. The global investment 9 stricted access to research publications imposed by cost made in research is wasted. and by copyright permission leads to inefficiency and Traditionally, researchers have published their find delay in discovery, isolation of researchers and, above all, ings in journals where the peer review process ensures a broken link between researchers and the research authenticity and accuracy. Today, however, journals users. Funding organizations are increasingly requiring have become less effective vehicles for knowledge dis that those applying for funding provide the website ad semination because their subscription prices have risen dresses of publications deposited in IRs, since funders do far above the cost of inflation, disenfranchising readers not always have subscriptions to all the journals holding in poorer nations. As a study by WHO showed, medical 8 articles of potential applicants. Since research users in institutes in the lowestincome countries are often un 10 clude not only other researchers but also policy and de able to purchase any journals at all, and so their re cisionmakers, frontline health workers, NGOs and searchers work in a vacuum, isolated from members of the public, open access for everyone is vital developments taking place in the rest of the world. to the overall success of the knowledge exchange process, as it vastly expands the opportunities for translating health research into improved public health. The remainder of this article further expands on the Global health concerns public health benefits of open access, points to strategies for making publications accessible and re usable, provides examples of successes so far and con Concerns about the lack of access to research informa cludes with recommendations on how best to maximize tion have stimulated many initiatives. If these efforts the return on investment for health research. are to succeed, they must build electronic publishing ca pacity and lead to research independence. In 1982, a UNESCO report stated that “assimilation of sci entific and technological information is an es sential precondition for progress in developing 11 countries,” and this has been widely accepted by many international bodies. The UN’s WHO and Food and Agriculture Organization estab lished the donation programs Access to Re search Initiative (HINARI) and Access to Global Online Research in Agriculture (AGORA), by which partner commercial journals provide free access to registered university and institute lib raries in countries with a gross national product per capita below US$1000. Although these pro grams have filled gaps, their reach is limited and they can never strengthen the national knowledge base in all disciplines of research. Research communities everywhere need freedom to access the global knowledge pool as their research needs dictate and to make known their own research findings to the international research community. Only when the current Open Medicine 2009 3(3):1 1 1 -1 1 9 Analysis and Comment Chan et al northsouth, southnorth and southsouth knowledge Gavin Yamey provides a number of instances in his gaps are closed can research accelerate to meet growing article “Excluding the poor from accessing biomedical demands. Outbreaks of emerging infectious diseases, literature: A rights violation that impedes global 12 the threat of avian influenza, the scourge of HIV/AIDS, health.” In one instance, a physician in southern the ongoing infant mortality from malaria and other dis Africa whose primary access to information was to ab eases can only be addressed through the cooperative ef stracts posted on the Internet altered a perinatal HIV forts of researchers. The urgency of climate change and prevention program based on his reading of a single ab environmental concerns, along with agricultural re stract. As Yamey reports, had the physician had access search needs, supports the importance of sharing re to the fulltext article, he would undoubtedly have real search findings with those unable to afford ever growing ized that the study results were based on shortterm fol subscription costs and permission barriers. lowup, a small pivotal group and incomplete data, and were unlikely to be applicable to the physician’s situ ation. The decision to alter treatment based solely on the abstract’s conclusions may have resulted in in Damage to health caused by inadequate access creased perinatal HIV transmission — but there were to current research no funds to purchase the fulltext document. Similar financial limitations on accessing relevant

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