Brief Report of PLoS/HIFA2015 Webinar, 28th March 2012

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1 Brief Report of PLoS/HIFA2015 Webinar, 28th March 2012 INTRODUCTION We are delighted to report that we had a very successful Webinar on 28th March, supported by PLoS, the leading open access publisher and one of more than 130 HIFA2015 Supporting Organisations ( We invite other HIFA2015 Supporting Organisations to contact us if they would like to discuss the possibility of similarly supporting a HIFA webinar and/or HIFA discussion in the future, on any topic relevant to the HIFA2015 remit. Our thanks to HIFA member Professor Tom Cook who provided technical support and showed participants how to use the amazing Elluminate Live! web conferencing software, made available to us through to the end of 2012, and hopefully beyond, thanks to the University of Iowa, USA. We had more than 50 HIFA members and others from around the world, discussing the question: "Can Open Access publishing provide Healthcare Information For All by 2015?" The Webinar focused especially on the role of Open Access journals in meetnig the information needs of frontline healthcare providers in low-income countries. We invite other HIFA2015 Supporting Organisations to collaborate on a second webinar on other aspects of Open Access publishing at a later date. PRESENTATION 1 Ginny Barbour, Chief Editor of PLoS Medicine and Medicine Editorial Director, PLoS, gave the first presentation: "Open Access: necessary but not sufficient for the goals of HIFA2015" She started by clarifying the difference between 'free' and 'open' access. Open is more than Free What is 'free access'? 1

2 - The article/journal is free to read, but possibly after an embargo period - You may not reuse unless reuse rights are also granted - You may be charged if you copy large numbers of the article - The 'free' rights may be withdrawn at any time What is 'open access' - Free, immediate access online - Unrestricted distribution and re-use - Author retains rights to attribution - Papers are immediately deposited in a public online archive such as PubMed Central Why open access is now possible Just 20 years since the first web page. There are three things that we need to understand about the web. First, it is more amazing than we think. Second, the conjunction of technologies that made the web successful was extremely unlikely. Third, we probably would not create it, or any technology like it, today. In fact, we would be more likely to cripple it, or declare it illegal.james Boyle, Webs never-to-be-repeated revolution, Financial Times, November 2, 2005 Why must we grasp the opportunities of open access? "Developing countries are poorer not only because they have fewer resources, but because there is a gap in knowledge. That is why access to knowledge is so important." "Even as an international NGO, we don't have enough money in our budget to take subscriptions to all the interesting journals we might wish for" The director of one of the world's largest medical research charities [Wellcome Trust] receives notification from one of his funded investigators in Africa reporting exciting progress toward the development of a malaria vaccine. Perhaps the most depressing story of all: "I met a physician from SA, engaged in preventing mother-to-child HIV transmission, whose primary access to information was abstracts online. Based on a single abstract, they had altered their perinatal HIV prevention program from an effective therapy to one with lesser efficacy... Their decision to alter treatment based solely on the abstract's conclusions may have resulted in increased perinatal HIV transmission." This is sadly, not news: "Providing access to reliable health information for health workers in developing countries is potentially the single most cost effective and achievable strategy for sustainable improvement in health care." Pakenham-Walsh et al BMJ :90 Current barriers to information access cause multiple problems: Impeding global health Harder for researchers in low income countries to contribute to global discussions 2

3 Impedes research efforts globally Gets in the way of capacity building in low income countries Health policymakers dont have all the information they need Clinicians and patients cant make decisions based on all the available information Open access solves the access problem Open access also makes new things possible Final observations Open access tells you about: - method of dissemination - whether you can reuse the information - whether the article is archived Open access does NOT tell you about: - The scope of the journal - The quality of the journal - The language of the journal - The review process of the journal Ongoing questions How to make OA feasible beyond the developed world Ensuring that we do not remove barriers to access only to have publication fees become a barrier to publish Enabling new OA journals that serve local needs to become established Building a knowledge infrastructure so that information does not just flow in one direction How can we make the published literature useful (not just accessible) to healthcare providers so as to fulfill the goals of HIFA2015? Further information on OA journals/publishers: Public Library of Science (PLoS) BioMedCentral (BMC) Directory of Open Access Journals (DOAJ) Open Access Scholarly Publishers Association (OASPA) International Network for the Availability of Scientific Publication (INASP) Scholarly Publishing and Academic Resources Coalition (SPARC) Bioline International PRESENTATION 2 Neil Pakenham-Walsh, Coordinator, HIFA2015, gave the next presentation, with three key messages: 1. OA journals provide direct benefits for some 3

4 2. OA journals provide indirect benefits for everyone 3. OA journals need to expand further to increase access to reference and educational materials 1. Journals have an essential role in global healthcare knowledge. Their primary function is to publish peer-reviewed original research. Such content does not and cannot meet directly the needs of all users. Most OA journals, and indeed the journal literature as a whole, are most useful to: English speakers, highly educated, living in middle or highincome country, researchers/academics, and high-level health professionals/specialists. Within the overall journal literature, free and open access journals have an increasing role, with about 800 free and/or open access peer-reviewed health journals listed in the Directory of Open Access Journals. Intitiatives such as African Journals OnLine and Bioline International demonstrate that journals published in low-income countries can be at least as successful in an Open Access format as in a subscription-based format. 2. The "Elephant in the Room" is the fact that frontline healthcare providers (including health workers and citizens) need access to basic healthcare knowledge. Lack of such knowledge contributes to avoidable death and suffering. There continues to be insufficient, coordinated international effort to address this challenge. As provocatively written in the Lancet in "A community health worker may find a single copy of Where there is no doctor, adapted and written in the local language more useful than access to thousands of international journals". [XXXX] Why do people not have access to appropriate, reliable reference and educational materials?there is a disconnect between healthcare information needs and healthcare information production and distribution. The Global Healthcare Knowledge System is dysfunctional in relation to the needs of healthcare providers in low-income countries. Open Access oils this system. The fact that OA journals are accessible to all benefits not only the limited groups described above, but everybody. OA journals make it easier to assess the overall available evidence on any question, which makes it easier for those conducting systematic reviews; those who are developing clinical and policy guidelines; and those who are determining priorities for investment in new research. Funders of research also benefit (and increasingly insist on) Open Access because they know that the results of the research are more likely to be available, reproduced, discussed, and built upon. Producers of reference and educational materials benfit because they can re-use text, images and graphics from Open Access journals, and repackage, adapt and/or translate them for other end-user groups. Producers of reference and educational materials that derive from Open Access are more likely to make those materials Open Access also, thereby leading to ever-expanding benefits for all. 3. OA journals need to expand further to increase access to reference and educational materials. Journals could look at ways of attracting more OA reference and educational content. Many exciting things are happening in OA publishing generally, such as the recent announcement that Wikipedia will be freely accessible to 70 million people in Africa and the Middle East. The best is yet to come. 4

5 COMMENT Lucy Browse, UK (INASP) then gave a brief prepared commentary, looking forward to the future and identifying three priority areas: 1. Awareness of resources - signpost ways of finding and searching resources - promote what is available and how it can be re-used - include and tag grey literature 2. Accessibility - low-bandwidth design - plan for and encourage mobile use 3. Advocacy - via information specialist and health professional networks - about green and gold open access OPEN DISCUSSION We then moved on to open discussion with the questions: Q1: Do OA journals help to meet the information needs of healthcare providers in developing countries? Q2: Does OA publishing make any difference to health workers without internet? Q3: How can OA publishing be developed further to save lives in low-income countries? Q4: What other questions should we be asking? [Please note that the comments below are paraphrased - they have not been checked with each of the contributors - if there is any inadvertent misunderstanding or misrepresentation, please let us know. Thanks Neil PW, HIFA coordinator] Leslie Chan (Bioline International) pointed to the importance not only of encouraging new OA journals in low-income countries, but to help convert existing non-oa journals to become OA, and to help current OA journals to become sustainable. Ruth King (BioMed Central) said that BMC and Wellcome Trust are exploring different models of financial sustainability with African journals. James Heilman (Wikimedia Canada) said that Wikipedia might be receptive to the possibility of hosting OA journals. Charles Senessie (Afro-European Medical Research Network) underlined the importance of providing appropriate, reliable health information for frontline healthcare providers, most of whom do not have access to the internet but increasingly have mobile phones. One way to make information available is the egranary, "Internet in a Box", which consists of a 5

6 stand-alone server with millions of OA resources and resources with permission to reproduce. Michele Harms (Chartered Society of Physiotherapy) and Ginny Barbour (PLoS) discussed how important it is to find ways to make OA journals sustainable, particularly journals in low-income countries where most authors would not be able to afford to pay processing charges. There is a need to figure out new models to shift the costs of subscription charges to help pay for processing charges. Numan Majeed (Journal of Asian Medical Students Association; HIFA Country Representative, Pakistan) said that journal access in Pakistan was very limited except in the larger public universities. Open Access is highly needed, he said, otherwise it is almost impossible to do research. To retrieve just 10 articles from subscription based journals can cost 300 US dollars - it's not affordable. The same is true in India and Bangladesh. Nester Moyo (International Confederation of Midwives) said that the content of OA journals does indeed meet the needs of healthcare providers. The problem is lack of access to internet. The needs are greatest in those who do not have access. Access to OA journals through mobile phones should be a priority for the future. Ginny Barbour (PLoS) emphasised that OA journals and materials can be freely reproduced and distributed in whatever format is appropriate: paper, CD, USB stick, mobile phones... Nihi Fajimi (Livewell Initiative, Nigeria) talked about the challenge of low literacy among citizens in Nigeria, and the problem of lack of time to look for health information. Both these could be addressed through use of mobile phones. He noted there is a massive boom in Nigeria, not only in ordinary phone, but also in smartphones/blackberries. Richard Gedye (Researh4Life) reiterated the importance of funding models for journals published in lo-income countries, given the unaffordability of author fees. He also said more could be done by publishers generally to make PDFs and other e-resources more friendly to those with low bandwidth. James Heilman (Wikipedia) said that the ability to use and exchange Open Access images was a great benefit for Wikipedia and others. Dorothy Tegeler (Hesperian Foundation) pointed to the fact that Hesperian health guides can be downloaded from their website free of charge, in 26 different languages. She noted the importance for Hesperian of having access to WHO and other publications, which helped them to keep their materials up-to-date and reliable. The discussion continues on the HIFA2015 Forum: join here: 6

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