A new viewpoint is drawing attention to a persistent challenge in open access publishing: while removing paywalls for readers, the model may be creating financial barriers for authors.
Sherry M. Wren, MD; Elliott R. Haut, MD, PhD; and Fausto Catena, MD, PhD, writing on behalf of the Surgery Journal Editors Group, describe what they characterize as an equity paradox. As open access (OA) expands, they note, publication costs have shifted from readers to authors, institutions, and funders—often in the form of article processing charges (APC).
To illustrate the disparity, the viewpoint authors cite purchasing power data showing that a standard $2,820 APC for a surgeon in the United States would represent an equivalent cost of nearly $29,000 for a surgeon in Egypt. Such differences, they argue, can limit participation in scholarly publishing for researchers in low- and middle-income countries (LMIC), as well as for unfunded investigators globally.
The transition to OA has accelerated in recent years, with approximately 50% of surgical journals now operating under fully open or hybrid models. At the same time, major medical publishers continue to report annual revenues exceeding $10 billion and operating margins above 35%.
The Surgery Journal Editors Group raises concerns that APCs may hinder career advancement and reduce global representation in the scientific literature. To address these issues, the group recommends two broad approaches:
- Waiving APCs for first, corresponding, or senior study authors from low-income countries and LMICs
- Keeping fees to a minimum for researchers without grant or institutional support, regardless of geography.
The viewpoint authors also acknowledge implementation challenges, including how to define a minimal fee, prevent misuse of authorship to avoid charges, and ensure transparency in waiver policies.
They point to transformative agreements—contracts that bundle subscription access with OA publishing—as a partial solution. By 2024, more than 1,000 such agreements across over 70 countries has supported the publication of more than 1 million OA articles. However, these agreements typically include caps, after which study authors may still be responsible for APCs.
Ultimately, the viewpoint authors frame equitable access to publishing as more than a financial issue, emphasizing its implications for scientific representation and patient care. "The current system risks perpetuating a two-tier knowledge economy, in which only those who can afford it are given a voice,” they concluded.
Disclosures are printed in the published viewpoint.
Source: JAMA Surgery
