Voices in the wilderness: how exclusionist article processing charge policies of academic journals underscore what is wrong with global health

The global health landscape has increasingly come under intense scrutiny in the last two years for diverse reasons, traceable to its colonial and, by extension, Western-dominated structure. From foreign gaze of research, poor diversity composition editorial boards journals, tendency high article processing charges (APCs) journals that exclude contribution researchers from low-income countries, these issues have been a subject public discourse.1Abimbola S gaze: authorship academic health.BMJ Glob Health. 2019; 4e002068Crossref PubMed Scopus (105) Google Scholar, 2Abimbola Pai M Will survive decolonisation?.Lancet. 2020; 396: 1627-1628Summary Full Text PDF (67) 3Nafade V Sen P Global need address equity, and inclusion.BMJ 4e002018Crossref (23) Scholar There is health. Who tells stories counts perhaps as much what being said; concept might be an essential aspect movement decolonise health.2Abimbola Currently, scholarly articles are mainly published peer-reviewed they disseminate results experiments or research projects funded through grants include funds cover APCs open access journals. In some cases, manuscripts eligible APC waiver encourage contributions countries. However, many continue face double jeopardy not externally ineligible waivers publish their self-funded research. It therefore surprising only 1·3% annual outputs Africa, with just three countries (Kenya, Nigeria, South Africa) accounting 52% Africa's output.4Uthman OA Wiysonge CS Ota MO et al.Increasing value WHO African Region beyond 2015–reflecting on past, celebrating present building future: bibliometric analysis.BMJ Open. 2015; 5e006340-eCrossref (71) this Commentary, we explore dilemma such researchers, who refer voices wilderness. response Lancet Health's call wrong health,5The HealthGlobal 2021: story?.Lancet 2021; 9: e99Summary (21) reviewed conditions discount 13 major We decided look at updating original list 12 identified Nafade colleagues,3Nafade which was based subgroup explicitly had ‘global health’ ‘international part journal title. One author (OW) searched website each extracted information journal's waivers, crosschecked accuracy second (EN). found broad were stated authors qualify discount. These authors’ affiliations institution middle-income country (LMIC), corresponding LMIC, availability (or absence thereof) funding. To capture range scenarios, created eight groups combination discounts. figure shows every group do qualify. Two (15%) out offer full all scenarios. For most when (group 1) waiver, whereas LMIC 2) discount, irrespective Articles included any high-income 4) form LMICs 3). Four (31%) offered if country, LMIC. different scenarios our figure, identify key implications policies pose early career First, already faced challenges scarce funding, governmental institutional support science, infrastructure, substantially hampers progress. Having pay seen exacerbating existing challenges.6Pai How prestige remain elite, exclusive exclusionary.https://www.forbes.com/sites/madhukarpai/2020/11/30/how-prestige-journals-remain-elite-exclusive-and-exclusionary/?sh=241e79804d48Date: Nov 30, 2020Date accessed: May 3, 2021Google Moreover, earn too little income meagre consider publishing top tier With salaries scientists cannot miss visibility needed compete landscape,7Nabyonga-Orem J Asamani JA Nyirenda T Abimbola Article stalling progress researchers: urgent reforms.BMJ 5e003650Crossref (11) then puts them further disadvantage it comes competing thus resulting vicious cycle. Second, current hamper desire collaboration amongst LMICs. As ourselves, recognise peers even though situations partnering would alter eligibility put us less favourable position. acknowledge privileged simply because living working gives impact Nonetheless, also hinder whose heard geography. agree colleagues8Abimbola Asthana Montenegro C al.Addressing power asymmetries health: imperatives wake COVID-19 pandemic.PLoS Med. 18e1003604Crossref (20) crude dichotomies used define gets does not, classifications, obscuring more than reveal. Such perpetuate serious asymmetry privilege, truly representative so-called south. Lastly, exclusionist deeply entrenched imbalance story apparent underrepresentation contribute mainstream will tilt imbalance, underscores health.5The 9Sumathipala A Siribaddana Patel Under-representation developing literature: ethical arising survey five leading medical journals.BMC Med Ethics. 2004; 5: E5Crossref (130) Even appear mostly established can afford APC, usually stuck somewhere middle list, flanked both ends prominent collaborators countries.10Hedt-Gauthier BL Jeufack HM Neufeld NH al.Stuck middle: systematic review collaborative 2014–2016.BMJ 4e001853Crossref rarely attain roles, opportunities meaningfully discourse.5The 11Iyer AR Authorship trends Health.Lancet 2018; 6: e142Summary (39) ourselves lucky location, luxury doing good quality afford. wilderness make up large proportion unheard neither funding grants, luck geographical nor prominence allow heard. expected, always depend telling it. expect should equitable about luck. But then, way forward achieve expectation? think addressing constraints outlined Commentary require multifaceted approach. Since remains crucial health, advocate additional criterion without external ensure dissemination determined ability pay. Additionally, governments philanthropists must step done 2021 Nigerian billionaire announced fund US$100 million development priorities, including research.12Rakhetsi $100 yearly Africa 2021.Available from: https://www.globalcitizen.org/en/content/nigeria-billionaire-abdul-samad-rabiu-fund-africa/#:~:text=Nigerian%20businessman%20and%20philanthropist%20Abdul,to%20help%20boost%20African%20developmentDate: March 26, 2021Date This laudable initiative encouraged emulated other billionaires Africa. If addressed urgency, LMICs, like those far away, lost. All contributed equally conceptualisation, writing, refinement Commentary. declare no interests.