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Dear Dr Abimbola,
We read with interest the article ‘How global is global health Research? A large-scale analysis of tends in authorship’ by Dimitris and colleagues published in BMJ Global Health January 2021.1 The authors’ research highlights the slow progress in proportion of studies with any, first, and, last authors affiliated with a low- or middle-income country (LMICs), particularly in first and last authorship. The authors welcome and have called for a thorough discussion about the implications of these findings, particularly in identifying the barriers and facilitators to diversity in authorship.
Reflecting on our experience of international research in infectious diseases and antimicrobial resistance we present here some of the barriers we have faced together with the solutions which we have identified. Recognising however, that addressing this inequity requires broader inclusion and participation from academic institutions, scientific journals and funders, we propose remedial steps at every level which will require a different approach to scientific research funding and communication.
There is a culture and hierarchy within academia which manifests itself in the authorship order. It is accepted that the first leads the writing and last author leads the research with all authors contributing to the final manuscript. There are of course the guidelines from the International Committee of medical Journal Editors which clearly stipulate the rol...
There is a culture and hierarchy within academia which manifests itself in the authorship order. It is accepted that the first leads the writing and last author leads the research with all authors contributing to the final manuscript. There are of course the guidelines from the International Committee of medical Journal Editors which clearly stipulate the roles of authors and contributors.2 Writing manuscripts requires not only the skills to undertake research but to communicate it. Barriers to inclusion of LMICs first and last authors often is due to the inexperience of junior researchers writing research to a standard that is accepted by mainstream scientific journals, the majority of which are in English. Hence, writing scientific literature requires not only expertise in research but also in English. In collaborative, international research projects it is imperative to enable space for growth, learning and capacity building within country, and move away from the culture of well-funded high income research institutes dispatching researchers to LMICs to conduct research, leaving little opportunity for knowledge exchange and development. To do this effectively capacity building must be core to research collaborations, including investment in workforce and training.3 We have found success in developing mentorship programmes in our research collaborations which ensure that researchers are employed locally and trained by the extended research team. The mentorship has included supporting junior researchers to participate in writing research papers and have the opportunity to be first authors on work that they have driven locally. This has meant a conscious effort to consistently scrutinise and evaluate the equity and balance in representation in every piece of work that is submitted. As a rule of thumb a baseline expectation should be to ensure that one of either first or last authorship is assigned to LMICs partners for work being carried out in or in collaboration with LMICs. This means that from the outset there are clear expectations on work from each partner and decisions about authorship are not left to the last minute. This approach also clarifies the level of involvement and work that each person in the research team has to contribute to be acknowledged as an author. To do this effectively and sustainably there has to be capacity building in place to ensure that knowledge and skills are developed alongside data gathering and analysis (Figure 1).
Figure 1 The steps required to address barrier to and facilitate equity in authorship of global health research
Another barrier which is increasingly more difficult to address is the costs of publication and unfamiliarity with the submission process, which means that much of the world is not equitably represented in academic publishing. Additionally, the current predominantly anonymised peer review process limits the learning potential from the academic peer review dialogue that often helps transform manuscripts into published articles. Publication costs are an enormous barrier, particularly in LMICs where institutions often do not benefit from the block funding available to many high-income academic institutions to cover costs of publication for their researchers. What this means that occasionally the LMICs researchers have to rely on out-of-pocket expenses which range between £1200 to over £2000 for open access publishing. As we write this letter, we are in the process of trying to reverse one such cost inflicted on colleagues who were invited to submit research undertaken in Uganda. The solution to this lies in part with scientific journals, academic institutions, and funders. Scientific journals need to have clear policies for submitted research from LMICs where there is no institutional support for open access funding, with reduced LMICs fees and options for waiving publication fees from researchers who do not have grant funding or institutional support. Reviewers and editors need to call out academic manuscripts which do not have equitable representation of authors from countries where the research is conducted, and question submitting authors on this. Academic institutions in high income countries need to relax their rules around funding research articles for publications where the first, last, and/or corresponding author is not from their institution. Funders should stipulate a condition of their grant to be that for research that involves LMICs partners the authorship should be equitable and balanced in first, last, and corresponding authorship. Furthermore, they need to recognise that capacity building and research communication costs need to be adequately detailed and costed in international grant applications and be part of the monitoring and evaluation process.
Only when the need for equitable funding is recognised at all these levels, can we address the current disparities in representation in research from LMICs partners.
1. Dimitris MC, Gittings M, King N. How global is global health Research? A large-scale analysis of tends in authorship. BMJ Global Health 2021;6:e003758.
2. International Committee of Medical Journal Editors. Defining the role of Authors and Contributors. Website: http://www.icmje.org/recommendations/browse/roles-and-responsibilities/d... Date accessed: 05 February 2021
3. P Veepanattu, S Singh, M Mendelson, V Nampoothiri, F Edathadatil, S Surendran, C Bonaconsa, O Mbamalu, S Ahuja, G Birgand, C Tarrant, N Sevdalis, R Ahmad, A Holmes, E Charani. Building resilient and responsive research collaborations to tackle antimicrobial resistance – lessons learnt from India, South Africa and UK. Int J of Infect Dis 2020;100:278-282.