AFRO-NETS> Developing countries electronic access to leading biomedical journals

["Irene Bertrand"<bertrandi@who.ch>]

Developing countries electronic access to leading biomedical journals
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Herewith several news items on the meeting taking place in London today
on the Health Internet work project - the announcement of the develop-
ing countries electronic access to leading biomedical journals- Boston
Globe, Washingon Post, Wall St journal

(WHO Press release 32)

Irene Bertrand
***
1.Medical journals give poor nations Net access-Washington Globe
2.Health-Washington Post Staff Writer
3.Publishers to Assist Poor Nations With Accessing Medical Journals
4.Who Press Release Who/32


1.Medical journals give poor nations Net access
By John Donnelly, Globe Staff,
7/9/2001

Washington - Seeking to bridge a vast digital divide between rich and
poor nations, the publishers of the six biggest medical journals today
will give scientists in the developing world free Internet access to
nearly 1,000 research publications.

The World Health Organization called the offer of free access to the
journals, some of which cost thousands of dollars a year for a single
subscription, a breakthrough for scientists and doctors in Africa,
Asia, and Latin America battling an array of diseases.

" All of a sudden what has become a closed rich boys' club is now wel-
coming in scientists in poor countries," said Barbara Aronson, the
collection development librarian at the World Health Organization in
Geneva. " Even those scientists out in the bush, they can now e-mail
the publications or the scientists and say, `You got any more on this?'
or, `This is what I've found out here.' It opens up the world to
them."

The six publishing companies - Elsevier Science, Springer Verlag, Wolt-
ers Kluwer International Health and Science, Harcourt General, Black-
well, and John Wiley - approached the World Health Organization with an
offer of free Internet access to public institutions in 62 countries.

After several discussions, the companies agreed to give the material
free to public institutions in countries with a gross national product
of less than $1,000 per capita, and at slashed rates to nations with
GNP per capita between $1,000 and $3,000 - another 34 countries. But
the offer, which will be announced today in London, doesn't extend to
some countries hardest hit by the AIDS pandemic, notably South Africa
and Botswana, because their GNP per capita is over $3,000.

The development is part of a movement in global health of pricing prod-
ucts at vastly reduced levels, or at no cost, in the developing world,
while maintaining high profit margins in rich countries.

The publishers of the journals preempted a public battle - some scien-
tists have been asking that past articles be made available free of
charge - in contrast to pharmaceutical companies, which engaged in
heated debates with activists and politicians over cutting prices for
their drugs in poor countries.

"In this case, nobody from Oxfam had to write a polemic, nobody had to
sue anybody," Aronson said. " This may very well have been a preemp-
tive move, but if so, it's an elegant one, a gracious one, and a gener-
ous one."

The offer follows a call last September by United Nations Secretary
General Kofi Annan to use the Internet to strengthen public health ser-
vices around the world. Called the Health Internet work, the project's
fundamental principle is equity of access to information.

George Ayittey, an economist at American University in Washington and a
native of Ghana, said that the offer for free scientific and clinical
articles was a crucial step for African public health workers, but said
many more initiatives were needed to build infrastructure.

" My main concern is to accelerate this in Africa you need to expand
and strengthen the telecommunications infrastructure," said Ayittey.
" In many places, they have crumbled. In Nigeria, the most populous
country, telephones don't work. In Zimbabwe, it takes three months to
get a new telephone line. In the long run, these are some of the things
we need to do to accelerate the flow of information into Africa."

But he applauded the initiative. "It's amazing the debt of information
there," he said. " New research knowledge always has been a problem in
Africa. Anything that brings new information is a good thing."

The initiative is expected to last at least three years, when the pub-
lishers will decide whether to continue it. Access will begin in Janu-
ary. The journals include the African Journal of Ecology, Wound Repair
and Regeneration, Annals of Botany, and Regional Anesthesia and Pain
Medicine, among the nearly 1,000.

The list doesn't include the New England Journal of Medicine or the
Journal of the American Medical Association because those publishers
weren't approached, Aronson said." We just took the six largest pub-
lishers at this time," she said. She added that some publishers, in-
cluding the British Medical Journal and the American Journal of Epide-
miology, already were providing their content free to the poorest coun-
tries.

'This is going to be very big,' Aronson said. As an example of the
need, she said that when scientists from Africa attend WHO meetings in
Geneva, they almost always rush to see her on their lunch breaks and
'plead with me to have things photocopied from the journals.'

'As another example, in Africa, the way it works now, medical students
need to write a thesis in their last year based on practical applica-
tions,'she said. 'They study from outdated textbooks where there is
no access to journals. So they write to our regional office in Zimbabwe
and ask for them to send a few articles on a subject. They write with
whatever they get. Imagine what this initiative can do to doctor train-
ing in Africa.'

John Donnelly
Mailto:donnelly@globe.com
This story ran on page A1 of the Boston Globe on 7/9/2001.
A9 Copyright 2001 Globe Newspaper Company.


2.Health-Washington Post Staff Writer
Monday, July 9, 2001; Page A12
By David Brown

Six giant publishing houses will announce today that they will provide
free electronic access to about 1,000 medical journals to medical
schools, research laboratories and government health departments in
poor countries.

Piloted by the World Health Organization, the program will benefit
about 600 institutions, principally in Africa. It will also include
training in techniques for researching the vast amount of medical lit-
erature by computer.

The initiative is the publishing world's counterpart to the drug indus-
try's newfound commitment to make medicines for AIDS, malaria and tu-
berculosis more widely available to Third World countries. The democra-
tization of medical information, however, is likely to be far easier
and cheaper than the democratization of pharmaceutical therapy.

In addition to aiding research scientists in the developing world, the
program may help spread the "evidence-based medicine" revolution, in
which doctors are increasingly expected to search medical literature to
answer their questions and help them make decisions, rather than rely-
ing on memory, customary practice or the advice of authority figures.

"It is perhaps the biggest step ever taken towards reducing the health
information gap between rich and poor countries," Gro Harlem
Brundtland, director general of the WHO, said of the agreement.

Although journals have been the main outlets for medical research for
more than 50 years, many institutions in poor countries have little ac-
cess to them. The average specialty publication costs about $1,500 a
year, but popular, clinically-oriented journals are often available for
less than $200. Even when subscriptions are affordable, the copies of-
ten arrive months late. Because of that, researchers and practitioners
in the poorest countries often must rely on librarians elsewhere to
cull the scientific literature for them and forward photocopied arti-
cles.

"This is wonderful news," said Vinand Nantulya, a Ugandan physician and
researcher who is a visiting scholar at the Harvard School of Public
Health. "The scarcity of journals in educational institutions is a big
issue."

Nantulya, 55, paid for subscriptions to six journals for the library at
Makerere University Medical School, in Kampala, in the late 1970s when
the Ugandan economy was in a state of near collapse and the library was
getting no current journals.

Barbara Aronson, a librarian at the WHO's Geneva headquarters and a
prime mover behind the program, said most medical schools in developing
countries get fewer than 100 journals, and many only a few dozen, com-
pared with 1,000 or more in most American medical schools.

Libraries and research institutions often must pay a higher price for a
subscription than individuals. The Lancet, a popular weekly European
journal, costs a person $134 a year, while a library is charged $495.
Some subscriptions are significantly more expensive.

The most extreme example is Brain Research, which is published three
times a week by Elsevier Science, headquartered in Amsterdam. Each is-
sue contains about 200 pages, and about 2,700 research articles appear
between its covers annually. The journal costs $17,000 -- and will be
among the hundreds of journals Elsevier is making available.

"The developing countries are going to be getting something that a top
university in the United States would be happy to have," Aronson said
of the total package.

The cost to the publishers is likely to be minimal, as they won't have
to print or mail more copies than they do now. (The press run for many
highly technical journals is fewer than 1,000 copies.) But the value of
the material is high. Elsevier's package is worth "at least $500,000"
in terms of what electronic subscriptions for all the titles would
cost, said Karen Hunter, an executive of the company.

Under the proposed rules, institutions in countries where the per cap-
ita gross national product (GNP) is less than $1,000 a year would get
the journals free. In countries where the per capita GNP is $1,000 to
$3,000, there would be a minimal charge. Companies do not have to agree
to give away electronic subscriptions in countries where they have sub-
stantial sales now, although some have indicated they may be willing
to.

"This is a way of getting to parts of the world where otherwise there
would really be no possibility," said Margaret Becker, an executive
with Wolters Kluwer, a European company that includes the Lippincott
Williams & Wilkins imprint in the United States and that publishes such
titles as AIDS, Annals of Surgery and the Pediatric Infectious Disease
Journal.

Besides Elsevier and Wolters Kluwer, the participating publishers are
Blackwell, Harcourt General, Springer-Verlag and John Wiley & Sons.

The idea for the initiative, which will be announced today in London,
arose in part from a meeting the WHO convened in April last year at
which researchers from the developing world were asked how the organi-
zation could help them. Aronson said their first request was: "We have
information problems. Help us get access to primary information."

The initiative fits with a program launched last fall by the United Na-
tions called the Health Internet work, which seeks to make statistical
data, peer-reviewed scientific publications, clinical guidelines and
health-policy recommendations, software packages that help researchers
make statistical and mathematical calculations and online training
electronically available to resource-poor countries.

The medical journals will be available through an Internet portal the
WHO is creating as part of the Health InterNetwork. The portal will
both guarantee security and provide necessary tools, such as engines
for searching the journals, said Joan Dzenowagis, the WHO project man-
ager for the Health InterNetwork.

The Open Society Institute, part of the charitable foundation directed
by George Soros, the billionaire currency trader, in recent years has
provided electronic journal access to 2,100 institutions in 39 coun-
tries, most of them in the former Soviet bloc. That program has concen-
trated on social science, economics, business and law publications. It
will make its network of contacts available to the six publishers and
the WHO, a foundation official said.

A9 2001 The Washington Post Company
July 9, 2001


3.Publishers to Assist Poor Nations With Accessing Medical Journals
By Michael M. Phillips
Date:9 July 2001
Staff Reporter of The Wall Street Journal

Washington -- Six top scientific publishers plan to announce Monday
that they will provide discounted and in some cases free access to some
1,000 pricey medical journals for hospitals, universities and research
centers in developing countries.

The initiative could provide the latest medical information to 600
medical facilities in 100 nations in sub-Saharan Africa, Asia, Latin
America and elsewhere that until now have been largely unable to afford
them, according to the World Health Organization, which is coordinating
the effort.

"These are the type of high-level, peer-reviewed research developments
reviewed regularly by physicians to learn of the latest outcomes that
might influence choices in patient treatment," said Connie Hofmann, di-
rector of communications for Wolters Kluwer International Health & Sci-
ence, a unit of Amsterdam-based Wolters Kluwer NV. "We would like all
physicians to have access to that important information, regardless of
the financial status of people in their country."

Many physicians and researchers in developing nations don't have the
latest medical research, much less the equipment or drugs to put that
knowledge into practice, a quandary that has gotten increasing public
attention with the intractability of AIDS in Africa.

The publishers' decision to slash prices follows the move by major drug
companies - which came under intense pressure from AIDS activists and
government officials - to offer poor nations deep discounts on AIDS
drug cocktails, while keeping prices unchanged for patients in the
wealthy countries.

"You can't possibly price something the same way for countries at dif-
ferent ends of the GNP spectrum," said Barbara Aronson, WHO's collec-
tion-development librarian and a prime mover behind the project.
"There's a clear parallel here with what happened with the pharmaceuti-
cal companies. I'm sure the publishers must have had their eyes on
that."

Wolters Kluwer publishes AIDS, Annals of Surgery and 373 other medical
journals. An annual subscription to AIDS for a foreign institution usu-
ally costs $1,200, while Annals of Surgery is sold to overseas univer-
sities and hospitals for $515. The company hasn't decided how steep
discounts would be under the new initiative.

Subscriptions would be delivered on the Internet; with publishers moni-
toring downloads to ensure that discounted copies don't find their way
back to wealthy countries where doctors and institutions can afford
full-priced subscriptions. Drug companies that charge different prices
in different markets face a similar challenge from the threat of re-
importation undercutting their normal prices.

Other companies joining the offer are John Wiley & Sons Inc., Harcourt
General Inc., Germany's Axel Springer Verlag AG, England's Blackwell
Publishers Ltd., and the Anglo-Dutch publishing group Reed Elsevier
PLC. Reed Elsevier is in the process of acquiring Harcourt General.

Wiley plans to adjust its prices depending on the buyer, with the poor-
est African labs to receive the journals at no charge, said Eric Swan-
son, Wiley's senior vice president for scientific, technical and medi-
cal publishing.

"These aren't even potential revenue opportunities in the next genera-
tion or more," Mr. Swanson said. "We have no interest in charging
them." Major medical journals are generally supported by advertising
and subscription revenue in the U.S. and other industrialized coun-
tries.

Mr. Swanson said the relatively small medical-publishing industry has
so far faced none of the public pressure exerted on the drug companies.

Write to Michael M. Phillips
mailto:michael.phillips@wsj.com1
URL for this Article:
http://interactive.wsj.com/archive/retrieve.cgi?idSB994620505412961975.
djm


4.Who Press Release Who/32
Date:9 July 2001

London - The World Health Organization and the world's six biggest
medical journal publishers - Access to Leading Biomedical Journals

London - The World Health Organization and the world's six biggest
medical journal publishers today announce a new initiative, which will
enable close to 100 developing countries to gain access to vital scien-
tific information that they otherwise could not afford. The arrangement
agreed to by the six publishers would allow almost 1000 of the world's
leading medical and scientific journals to become available through the
Internet to medical schools and research institutions in developing
countries for free or at deeply-reduced rates. Overseeing the signing
of the Statement of Intent by senior executives of the publishers, Dr
Gro Harlem Brundtland, Director-General of WHO, said: "As a direct con-
sequence of this arrangement, many thousands of doctors, researchers
and health policy-makers among others will be able to use the best-
available scientific evidence to an unprecedented degree to help them
improve the health of their populations. It is perhaps the biggest step
ever taken towards reducing the health information gap between rich and
poor countries."

Until now, biomedical journal subscriptions, both electronic and print,
have been priced uniformly for medical schools, research centres and
similar institutions irrespective of geographical location. Annual sub-
scription prices cost on average several hundred dollars per title.
Many key titles cost more than $1500 per year. This has made it all but
impossible for the large majority of health and research institutions
in the poorest countries to access critical scientific information.
Scheduled to start in January 2002, the initiative is expected to last
for at least 3 years while being monitored for progress. It will bene-
fit bona fide academic and research institutions, which depend on
timely access to biomedical journals. Between now and the end of this
year, these institutions will be identified individually and the proc-
ess put in place so that they can receive and use access authentica-
tion. All parties-the publishers and the participating institutions
will learn from this experience. Decisions about how to proceed after
the initiative will grow from the precedents it sets, and will be in-
formed by the working relationships, which have developed among the
partners.

The initiative is an important step in the establishment of the Health
InterNetwork, a project introduced by United Nations' Secretary-General
Kofi Annan at the UN Millennium Summit last year. Led by WHO, the
Health InterNetwork aims to strengthen public health services by pro-
viding public health workers, researchers and policy makers access to
high-quality, relevant and timely health information through an Inter-
net portal. It further aims to improve communication and networking. As
key components, the project will provide training as well as informa-
tion and communication technology applications for public health. Work-
ing with the British Medical Journal and the Open Society Institute of
the Soros foundation network, WHO approached the 6 biggest medical
journal publishers, Blackwell, Elsevier Science, the Harcourt Worldwide
STM Group, Wolters Kluwer International Health & Science, Springer Ver-
lag and John Wiley, with the aim of bringing them together with the
countries concerned to seek a more affordable pricing structure for
online access to their international biomedical journals. The outcome
is a tiered-pricing model developed by the publishers that will make
nearly 1000 of the 1240 top international biomedical journals available
to institutions in the 100 poorest countries free of charge or at sig-
nificantly reduced rates.

For further information, journalists can contact
Mr Gregory Hartl,
WHO Spokesperson,
WHO,
Geneva.
Tel: +41 22 791 4458
Fax: +41 22 791 4858
Mailto:hartlg@who.int
All WHO Press Releases, Fact Sheets and Features as well as other in-
formation on this subject can be obtained on Internet on the WHO home
page http://www.who.int/

Posted by
Irene Bertrand
mailto:bertrandi@who.ch


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