Dear HIFA colleagues,
Thanks again to all who participated in our in-depth discussions on open access, back in October and November last year.
I have written a blog on the HIFA website with a summary of findings and a few personal reflections.
Extracts below. Read in full here: https://www.hifa.org/news/what-we-learned-about-open-access-publishing-h...
Between 13 October and 14 November 2025, Healthcare Information For All (HIFA) hosted a lively, in-depth discussion on open access publishing, sponsored by Oxford PharmaGenesis [https://www.pharmagenesis.com/]. The conversation generated 130 messages from 25 people across 12 countries, bringing together a diverse mix of voices – from frontline healthcare professionals and researchers to journal publishers and librarians...
Does open access actually save lives?
This was a tricky one. Many participants from low- and middle-income countries shared that open access is hugely valuable to their work. But here’s the thing: we couldn’t actually pin down a concrete example showing that access to the full text of a research paper – rather than just the abstract – directly saved a life. We asked around, ran some PubMed searches, even tried ChatGPT twice … but found nothing concrete...
What do healthcare professionals actually need?
Most healthcare professionals aren’t sitting around reading research papers in full. Instead, they rely on synthesized resources – drug formularies, systematic reviews, clinical guidelines, textbooks, decision tools. That’s what actually helps them make fully informed decisions. Participants in the thematic discussion agreed that free and unrestricted access to research is great, but clinical decisions shouldn’t be based on a single research paper...
APCs
If there’s one thing researchers consistently complained about, it’s article processing charges (APCs) [https://en.wikipedia.org/wiki/Article_processing_charge]. These fees can be very high and often disproportionately prevent researchers in LMICs from publishing open access. While waivers exist, they do not cover all instances in which financial support may be needed.
What’s the solution?...
There’s no one-size-fits-all answer here, and multiple models are needed. Here are the main options mentioned during the thematic discussion.
Option 1: cap APCs – This was the most popular idea. Journals play a vital role in the publishing process, and so capping – rather than abolishing – APCs while encouraging journals to ensure transparency around costs would align with Plan S’ vision.
Option 2: stop paying APCs altogether – Although this would require overhaul of journal business models, this could substantially reduce predatory publishing. However, it would also eliminate important open access journals and limit where researchers can publish, and it is therefore not an optimal solution.
Option 3: mandatory preprints – The Bill & Melinda Gates Foundation requires preprints for all its sponsored research. These can be useful for fast-moving fields, especially among researchers, but because they are not peer reviewed, they shouldn’t drive clinical decisions and are open to misinterpretation. As such, they should be seen as a partner to scholarly publishing rather than an alternative...
The capped APC approach makes the most sense to me. It’s practical, it works with the current system, and it supports those leading open access journals that many researchers want to publish in. The “stop paying APCs” approach feels more ideologically driven and actually undermines good open access publishers. It also boxes authors into predetermined choices.
One thing I learned from this discussion is the importance of embracing different approaches. We shouldn’t try to force everyone into one model – it’s not realistic and not even desirable. The key question should always be: does this strengthen or weaken the global evidence ecosystem? Does it help or hurt knowledge translation?...
We welcome further reflections on this and related topics.
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org