Studies have shown that access to published health research by the research communities in developing countries is no longer “fit for purpose”.2 As has been well documented, rising costs of subscriptions and permission barriers imposed by publishers have barred access to the extent that local health research and health care have been damaged through lack of information.3,4 For example, Yamey5 tells of a physician in southern Africa who could not afford full access to journals but based a decision to alter a perinatal HIV prevention programme on one single abstract. The full text article would have shown that the findings were not relevant to the country’s situation. With the advent of the internet there is little justification for continuing to create barriers to access. Richard Smith, as the former editor of the British Medical Journal, said, “Most research is publicly funded, and when the internet appeared it made no sense for research funders to allow publishers to profit from restricting access to their research”.6 This is true not only for publicly funded research but for private health charities around the world. As the Open Access Policy of the Wellcome Trust states, “We . . . support unrestricted access to the published output of research as a fundamental part of its charitable mission and a public benefit to be encouraged wherever possible”.7 Science is a collaborative process and openness is fundamental to knowledge advancement.

Impaired access to research information in health-related fields is not solely the preserve of developing countries but it is hugely exacerbated in poorer regions of the world. While these regions bear the brunt of the world’s health problems, only 10% of health research effort goes into these areas (referred to as the “10/90 gap”).1 If we are going to achieve what the World Conference on Science held by UNESCO and the International Council for Science in 1999 termed the true “orienting of scientific progress towards meeting the needs of humankind”, then we must improve the research effort on the health problems that afflict the greatest part of the world’s population. That cannot happen until research communication is optimized: at the turn of the new millennium more than half of research-based institutions in lower-income countries had no current subscriptions at all to international research journals.2

will open access build a bridge to reduce health inequity? The potential is certainly great but the digital divide remains large, with estimates that only 13% of the developing world use the Internet, often on slow and expensive connections.9 Therefore, the inequity in accessing information and communication technology infrastructure will need to improve to allow people to get a foot onto the information bridge. But even once they are there, they will still only be able to access information that has been paid for – even when that information was created using taxpayers’ money. There is a role for more research funders and donors to support open access as an integral cost of undertaking the research itself to ensure public access.10