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. 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. We tackled four big questions, and here’s what came out of it all.
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.
One of our participants decided to write an article about this using a Bayesian approach. His conclusion was that open access doesn’t necessarily save lives through dramatic individual cases but rather by providing small, cumulative improvements to access across entire health systems.
We also realized that open access is a bit of a double-edged sword. While it provides broader access to evidence, it has also contributed to a surge in low-quality publications, such as those produced by paper mills, which make it harder for people synthesizing evidence to do their jobs effectively.
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. Despite this, we noted a previous paper that found one in four healthcare professionals from low- and middle-income countries (LMICs) considered abstracts alone enough to make clinical decisions.
Spoiler: they’re not. As a result, healthcare professionals may be misusing preprints and single clinical studies without considering the wider body of evidence, potentially leading to dangerous consequences.
Access varies a lot, too. Healthcare professionals in high-income countries often get journal access through their institutional subscriptions, while those in LMICs may rely on programmes such as Hinari. Even so, gaps in access exist in both cases.
The researcher’s dilemma: APCs
If there’s one thing researchers consistently complained about, it’s article processing charges (APCs). 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?
We agreed that proposed solutions need to strengthen the entire knowledge ecosystem – not just benefit researchers, publishers or readers. We need everyone working together across all stages of knowledge translation: generating, publishing, synthesizing, repackaging, and disseminating and applying evidence.
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.
We also talked about diamond open access journals (free to read, no APCs). While they are ideal in theory, the funding still needs to come from somewhere.
Artificial intelligence (AI) was discussed too. It could make publishing more efficient and cost-effective, potentially reducing APCs in the long term. In addition, open access content is a major source of content for AI systems, supporting knowledge translation.
My take on all this
For me, excessive APCs are the key issue. The question is how we tackle them.
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?
To me, capping APCs is evolutionary and strengthens the system. Refusing to pay them at all feels more revolutionary but also clumsy and counterproductive. That said, it would be helpful to learn more about the “stop paying APCs” approach and we would welcome inputs from proponents of that approach, including the Gates Foundation itself; we need to better understand the reasoning behind that second approach before dismissing it entirely.
What do you think? We would love to hear your perspective on this! You can contact us at admin@hifa.org and/or you can join the HIFA forum here: www.hifa.org/joinhifa.
The views expressed in this blog post are those of the author and do not necessarily reflect those of Open Pharma or its Members and Supporters.
Neil Pakenham-Walsh is the Coordinator of HIFA, a global campaign working to save lives and reduce suffering by improving the availability and use of reliable healthcare information. HIFA is administered by the Global Healthcare Information Network, a UK-registered non-governmental organization that has been in official relations with the World Health Organization since 2022.
