Article Processing Charges Threaten Global Health Equity: Open Access is Closed Science.

IntroductionThe shift from subscription-based to open-access (OA) publishing sought to democratize scientific knowledge by eliminating access barriers. However, article processing charges (APCs) have raised concerns about equity, particularly for researchers from low- and middle-income countries (LMICs). APCs shift costs from readers to authors, potentially limiting the ability of researchers to disseminate their work. This study aimed to quantify the effect of APCs on equity in global surgery by examining current APC costs and their association with journal metrics and LMIC authorship. MethodsA structured review was conducted on journals APCs and bibliometrics using data from the Scientific Journal Rankings (SJR) and PubMed. Journals were included if they actively published human health research and had at least 100 articles with first author information. APC data were obtained from five major publishers (Elsevier, Wiley, Oxford, Sage, and Springer Nature) and supplemented manually. Journals were categorized into surgery, public health, and other groups. Data on APCs, bibliometrics (SJR ranking, H-index), and first author affiliations were analyzed using linear regression models to assess their relationship with APC costs and LMIC authorship. ResultsThe study included 2,001 journals with a median APC of $3,700 USD showing no significant cost differences across journal categories. The median percentage of LMIC first authors was 4%, with a significant negative association between APCs and LMIC authorship: each $500 increase in APC was linked to a 0.7% decrease in LMIC first authorship. While higher APCs correlated with slightly higher bibliometric indices, the academic impact was limited. ConclusionAPCs present a significant barrier to LMIC authors, undermining the equity goals of OA publishing. Alternative funding models, such as tiered pricing or expanded waivers, are needed to ensure OA remains accessible and equitable across all economic contexts.