Violence Against Women in Kenya

Taylor Poor, Staff Writer

The night after Kenya’s hotly contested presidential elections of December 30, 2007, confirmed President Mwai Kibaki for his second term and threw the country into vicious ethnic turmoil, Sarah Maluu was raped by three security officers in full uniform.[1] In the violent aftermath of the elections that lasted into the spring of 2008, Florence Mukambi lost her two children and part of her face to arson,[2] Jacqueline Imakokha and her mother were gang raped by 20 rioters, and thousands of other Kenyan women suffered sadistic brutality at the hands of angry protesters.[3]

A report by the UN Population Fund (UNFPA), The UN Children’s Fund (UNICEF), and the Christian Children’s Fund (CCF) from February 2008 announced the continued use of sexual and gender-based violence as a weapon of ethnic tension in the aftermath of Kenya’s December 2007 elections.[4]

This post-election devastation is perhaps the best thing that could have happened to the battered women of Nairobi—it carries stories of rape and gender-based violence to the rest of the world. The type of gender-based violence (or GBV) seen in post-election Nairobi is not a new problem for female Kenyans. It is a symptom of a much larger concern, to which nobody has been paying any attention.

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Can America Learn from Japan’s Success in Cutting Healthcare Costs?

Yuying Luo, Staff Writer

There is little debate that the United States health care system is broken: it is one of the most expensive and inefficient of its kind in the developed world.

The National Health Expenditure Accounts estimates that health care spending in the US increased by an average of 7.7 percent per year between 1985 and 2006.[1] In 2006, health care cost the United States some $2.1 trillion, or a staggering 16 percent of the gross domestic product1. This figure is more than six percentage points higher than the average for other OECD (Organisation for Economic Cooperation and Development) countries including Japan, where health expenditures increased by a mere 0.1 percent in 2006.[2]

Experts estimate that a driving force behind the escalating health care costs is medical technology, which contributes between 38 percent to more than 65 percent to the rise in healthcare spending.[2]

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Vaccines and Postage Stamps in Pakistan

Jessica Villegas, Staff Writer

Receive a letter from Pakistan, and chances are your stamp will feature a touching picture of former Prime Minister Benazir Bhutto immunizing her youngest daughter, Aseefa Bhutto Zardari, with the oral polio vaccine. Pakistan’s President Asif Ali Zardari, Ms. Bhutto’s widower, has requested that this photograph of his late wife be issued as a postage stamp to raise awareness of Pakistan’s polio eradication efforts amidst an alarming resurgence of the crippling disease.[1]

Pakistan is one of four countries worldwide where polio is still endemic, the others being Afghanistan, Nigeria and India. In 2008, Pakistan reported 118 cases of polio, up from 32 in 2007.[2,3] In the first nine months of 2009, health officials reported 62 new cases of the disease.[4]

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Annemarie Ryu, Contributing Writer

Two infectious disease pandemics, two global eradication campaigns. The results? For one, complete eradication by 1970, within thirteen years of the campaign’s inauguration—there are no deaths today resulting from smallpox. And the other? The global malaria eradication campaign, begun in 1955, was abandoned in 1965, when goals shrank to “malaria control.”[1] Today, malaria, though preventable and curable, causes between one and three million deaths per year and is among the top ten causes of death in developing countries.[2]

Why haven’t we eradicated malaria when we did eradicate smallpox? Comparing the two campaigns teaches us about past successes and failures and informs today’s eradication efforts. The drastic divergence in health outcomes is partly a result of differences in disease characteristics. One key difference between smallpox and malaria is that a smallpox survivor is immune to the disease for life while a malaria survivor may reacquire the infection. Whereas the smallpox vaccine could ensure lifelong protection from smallpox, malaria interventions and preventative measures required continuous management in all at-risk areas to actually eliminate malaria. Such management required restructuring fundamental health services, whereas smallpox programs could simply be administered temporarily by external groups.[3]

Another crucial distinction between smallpox and malaria is in ease of diagnosis and containment. Smallpox spreads through saliva droplets from coughing, sneezing, and speaking, as well as fluids contained in pustules of the infected individual. Fortunately, anyone with smallpox was easily recognizable due to smallpox’s main symptom: innumerable skin lesions. This easy recognition facilitated disease containment, as vaccinators and community members could readily identify individuals requiring treatment. In addition, vaccinators could administer preventative treatment to community members deemed at-risk due to contact with diseased individuals. The efficient containment and treatment of infected individuals was sufficient to control the spread of disease.[3]

Malaria, on the other hand, is far more difficult to recognize and contain because it is transmitted by mosquitoes carrying one of four types of malaria parasites. Thus, for malaria to be eradicated, not only did infected individuals need to be identified and treated, but infected mosquitoes also needed to be eliminated. Malaria-infected individuals were difficult to identify because common first symptoms of malaria include  headache, chills, fever, and vomiting—symptoms similar to those of many other infections—and can appear seven days to several months after exposure, depending on the incubation period of the parasite. Furthermore, due to the life cycle of malaria parasites, malaria-infected individuals often exhibit symptoms in cyclic patterns, with symptoms of different intensities appearing and disappearing.[5]

A major complication for malaria eradication was the need to prevent infected mosquitoes from transmitting the parasite to humans. The main strategy was mass spraying of the insecticide DDT inside homes. This strategy, coupled with administration of chloroquine, a drug that kills malarial parasites, led to significant decreases in mortality rates during the first decade of the eradication campaign. However, DDT and chloroquine as applied were insufficient to halt infection by mosquitoes, which flourished in the fields and swamps often located near villages. It became clear that difficult environmental reconstruction would be necessary to eradicate malaria.[3]

Support for the malaria eradication campaign waned for several reasons. First, increasing mosquito resistance to DDT and parasite resistance to chloroquine meant higher costs and slower progress. The initial popularity of the campaign was tied to the post-WWII faith of Americans in easy solutions provided by new science and technology. Western enthusiasm dwindled as DDT failed to efficiently solve the malaria problem.[3]

Second, economic considerations played a significant role in the decline of the campaign. Initial support for the campaign was partly founded on the belief that the eradication of malaria would lead to great economic benefits for developing countries, where a significant expansion in the healthy labor force would heighten productivity, and developed countries, which could utilize the new foreign markets. In addition, campaign proponents promoted malaria eradication as a way to increase agricultural production and address the world food shortage. However, the increasing costs associated with the campaign, as well as the poor agricultural conditions induced by extensive application of insecticides, diminished hopes for economic gains. Other economic problems included pressure from pharmaceutical firms and chemical companies for continued use of DDT and drugs that were losing effectiveness. The practice of pesticide-intensive cash cropping in developing countries also encouraged mosquito growth and conflicted with much needed environmental transformation.[1]

Third, the political atmosphere ceased to favor the campaign. The United States had strongly supported the campaign at its inception as a straightforward way to win over nonaligned developing countries during the Cold War.[3] However, when over a decade of exhaustive campaign efforts met with decreasing rates of improvement rather than complete success, the campaign faced international criticism. Changes in foreign relations and public health caused WHO to broaden its focus to development of primary health services rather than simply malaria eradication, and this change led to a weakening in traditional malaria control programs.[4] With such decreases in global support of malaria eradication, malaria prevalence began to climb again by the 1970s.[3]

Today, malaria has nonetheless has been eradicated from many regions of the world. In developed countries, fundamental changes in living conditions and agricultural practices have led to environmental transformation. Socialist countries, such as Romania and Poland, eradicated malaria by means of strong health delivery systems that upheld intervention programs. Islands such as Jamaica and Taiwan have benefited from geographical barriers hindering re-introduction of the disease.[1] Still, malaria continues to thrive in developing countries. Fortunately, there is much hope for its future eradication. The latter decades of the twentieth century contributed new developments and advances in disease vector control, vaccines and drugs, and insecticide-treated mosquito nets. In addition, today we have a much better understanding of the cultural, economic, and social dimensions of malaria, as well as renewed financial support and enthusiasm for malaria eradication.[6] With the Roll Back Malaria campaign targeting 50% decreases in malaria mortality by 2010 and 2015, and the Millennium Development Goal of zero malaria incidence by 2015, the goal of global malaria eradication has returned to our vision for the future.

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1 Turshen, Meredith. The Politics of Public Health. New Brunswick: Rutgers University Press, 1989.

2 Millennium Project. “Global Burden of Malaria.” 2006. 28 Sept. 2009 <http://www.unmillenniumproject.org/documents/ GlobalBurdenofMalaria.pdf>.
3 Farmer, Paul. “A Social Analysis of Past Global Medicine.” Northwest Biolabs B103, Cambridge. 17 Sept. 2009. Lecture.
4 Cueto, Marcos. The origins of primary health care and selective primary health care. American Journal of Public Health. 2004;94(11)
5 “Malaria.” Drugs.com. 2009. 28 Sept. 2009 <http://www.drugs.com/cg/malaria.html>.

6 World Health Organization. “Malaria Eradication Back on the Table.” Bulletin of the World Health Organization. 2008;86(2)

The Anatomy of a Campaign

Abby Schiff, Contributing Writer

Global health work occurs on many scales, from policy rooms to rural health clinics, from research laboratories to pharmacies in far-flung parts of the world, and each setting has its own language and challenges. As students, we are most comfortable in the world of the university. We can use our position to change the way Harvard licenses drugs developed here to increase access in developing countries. This fall, the Harvard College Global Health and AIDS Coalition (HCGHAC) teamed up with four other on-campus organizations (the Harvard South Asian Men’s Collective, the Association of Black Harvard Women, the Harvard South Asian Women’s Collective, and the Harvard Black Men’s Forum) for the “Say Yes to Drugs” campaign, which focused on putting pressure on Harvard to change its licensing policies. The campaign quickly gained visibility on campus, got 943 signatures on a petition that will be delivered to administrators, and raised about $5000 for global health non-profits Asha and Partners in Health. This campaign can serve as a model for raising global health awareness, working with many different sectors of the university, and taking action on what can be a complicated technical issue.

The cause is pressing. 10 million people die every year from treatable diseases. These are deaths that could be prevented if there were greater access to existing medicines, many of which are developed at universities. In fact, every vaccine in the last 25 years and 35% of all HIV drugs were developed at universities. Harvard made $24 million in 2004 from the sale of medical technologies, and continues to be a leader in research. When a potential therapy is developed by Harvard researchers, the Office of Technology Development helps the research team sign a license with pharmaceutical companies, who then price the product according to a profit-maximizing strategy. Universities Allied for Essential Medicines (UAEM), a national student group, is working to change this situation by pushing for universities to write licenses that allow for generic competition in developing countries. Because drug sales in developing countries only make up a small percentage of pharmaceutical companies’ profits (Africa is 1.3% of the pharmaceutical market),licensing for essential medicines is an innovation that would increase access to medicines without significantly harming pharmaceutical companies’ or universities’ incentive to innovate.

HCGHAC, which is the undergraduate chapter of UAEM, worked on licensing during the 2008-2009 school year, but decided to intensify its efforts and focus on the issue for the fall of 2009. In addition to continuing to hold conversations with faculty and administration, we decided to launch a high-profile student campaign to get the administration’s attention and show the importance of this issue to the student body. We also sought to build off the groundbreaking work on this issue initiated by Yale’s UAEM chapter in 2001. Their student campaign, which included mobilizing student support and working directly with the inventor of the HIV drug D4T, led to the drug becoming available as a generic antiretroviral in developing countries. 800,000 people since then have been placed on treatment with the medicine. After settling on a catchy name—Say Yes to Drugs—we got to work, with emails flying back and forth over the summer.

In order to target the three constituencies, we decided to meet with the Office of Technology Transfer and other administration figures; meet with professors and researchers; and plan a campaign with a dance launch to gain student support. We also held a speaker event in order to raise more informed awareness about the issue.

Recognizing the fact that licensing can be opaque, we talked about how to best present it to other students, administrators, and professors. We held teach-ins with the Harvard Law School chapter of UAEM, learned about legal details of licensing, and practiced giving mock presentations to student groups before dispersing to spread the message. Developing this part of the campaign was difficult. As Krishna Prabhu ’11 said, “It’s a different thing having to make an argument on a test and having to convince your peers about the urgency, importance, and gravity of an issue like access to medicines. It’s required me to think critically about how to deliver a complex message.” Teams of HCGHAC and other group members split off into groups of two to present to student organizations and gain broader support. At times, the groups were asked challenging questions. Alyssa Yamamoto ’12 reflected that “receiving critical responses to my presentations of the campaign has been especially worthwhile—forcing me to comprehend common critiques of our cause and still defend the campaign.”

At the same time, we started meeting with co-organizers SAMC, SAWC, BMF and ABHW to plan the dance, the petition, the speaker event, and the surrounding campaign. Prabhu explained that “probably one of the best things that is materializing from this campaign is the alliances we’re making with other student groups… to not only inform students about the issues, but create a support base for future actions.” The five groups designed and ordered shirts, and everyone took shifts to poster, build two giant pill bottles representing the amount of generic or brand-name pills available for the same cost, sell tickets, and staff our booth outside of the Science Center for a week to solicit petition signatures. Crowds of people wearing trademark bold black tshirts could be seen dancing to music in the middle of the Science Center courtyard, handing out flyers and shouting “Say Yes to Drugs!” While the work was completely elective, some students threw themselves completely into the campaign—Yamamoto said “there certainly came to be a point at which I put more effort into SYTD than my own academic work or social life.” The hours spent together caused the group to become closer while working for a cause.

Student response to the campaign was mostly positive. By the end of the week, the campus was covered in “Say Yes to Drugs” posters, and most large classes were peppered with students wearing the t-shirts. Margie Thorp ’11 adds, “It’s very tough to disagree with the things for which SYTD is asking, so we have been able to get a high degree of approval from students across campus.” People came up to campaign members in dining halls and sparked conversations about Harvard’s pharmaceutical licensing policy. Jason Shah ’10 said, “From blog posts at each end of Harvard’s political spectrum, to confused stares outside of the public display, I have seen an overwhelming amount of interest sparked from this campaign. While the messaging initially is just catchy, the student population has come to see the true substance behind the campaign and has latched onto it.” We received positive reviews from both the campus Democrats and Republicans. A speaker event with Dr. Matt Craven of Support for International Change and Partners in Health attracted interested students. It’s debatable whether all of the 600 students who attended the benefit dance can hold their own about licensing policy, but we were able to raise money and awareness and collect signatures for the student petition. The dance created publicity in a way that postering and speaker events could not, because it reached out to a larger segment of the Harvard population.

The whole process involved a fair amount of delegating, and we were only able to get much of the work done thanks to the organizing power of a few individuals, especially Jason Shah. Having so many people involved in the process meant that it was easy to get large numbers of volunteers, but that it was a more difficult to administratively oversee progress. However, we benefited from having a wide distribution of talents and from having cooperation between groups. On a campus such as Harvard’s, where most people are busy and breaking through to the average student’s consciousness is particularly difficult, it was a huge help to have student cooperation. As the campaign progresses, the momentum from the kick-off and the partnerships that we have built will serve us well in convincing the administration to change its policy. We hope to build on the groundwork of this student movement in order to make essential medicines available to people who need them in the developing world.

The WHO Joins the Fight Against Obesity

Neda Shahriari, Staff Writer

There is a bit of irony in thinking about obesity in developing countries: it was only recently that health advocates were raising awareness about malnutrition in middle-income to low-income nations. Unfortunately, rapid industrialization has created a burgeoning population afflicted with obesity in these countries, forcing their healthcare systems to deal with alarming increases in non-communicable diseases—from cardiovascular diseases to diabetes and cancer. Taking cognizance of this, the World Health Organization (WHO) has created an antiobesity strategy that is now starting to take effect.

The correlation between obesity and morbidity is quite apparent in Egypt, a developing country where cardiovascular disease-related mortalities have increased from 5% of deaths to 39.1% in males and 2.9% of deaths to 27.2% in females between 1961 and 1985.[1] In an effort to bring this emergent issue to light the WHO developed the Global Strategy on Diet, Physical Activity, and Health (DPAS) in 2004. As its name suggests, DPAS seeks to address two risk factors—diet and physical activity—that play a hand in promulgating obesity.[2]

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Susan Wang, Staff Writer

According to the United Nations, in 2008 nearly 536,000 women died worldwide from preventable and treatable child-bearing and pregnancy-related causes. Half of these women live in Africa. In the United States, 1 in 4800 dies from a prenatal or birthing complication. In Liberia, however, the rate of maternal death is 1 in 12.

With such startling statistics, it becomes evident that action must be taken in order to increase access to reproductive health care. However, to increase access, both funding and social awareness of health-related issues are needed.

Financial challenges are one of the most obvious problems with access and the problem that is on the forefront of every organization dedicated to increase access. The GDP of all of Sub-Saharan Africa was $744 billion in 20081; for comparison, the state of Florida’s GDP was also $744 in 2008.[2]

Due to this economic disparity, Sub-Saharan Africa continues to possess wide gaps in accessibility to maternal health care. A quarter of the women in Sub-Saharan Africa claim they prefer to stop having children or delay their next pregnancies but are unable to practice family planning. Furthermore, Sub- Saharan Africa also suffers from a disproportionate amount of HIV/ AIDS: 22 million people there have HIV/AIDS, which accounts for 67% of those with HIV/AIDS worldwide.[3]

However, financial challenges are merely the tip of the iceberg. Even in the United States, where the GDP is the highest in the world and people are among the richest, universal reproductive health care is not yet attainable.

In an interview with HCGHR, Lisa Maldonado, executive director of the Reproductive Health Access Project, an organization dedicated to training health care professionals about reproductive health care, claimed that part of the problem is that “clinicians are not trained sufficiently in the area of reproductive health. Less than five percent of medical schools are covering reproductive health problems so medical students must take it upon themselves to educate themselves in these issues.”[4]

Why do problems with providing reproductive health services persist globally? The reason is that besides poverty, other underlying problems are still impeding universal access to reproductive health care.

One such prominent obstruction is religious beliefs.

Female circumcision is a common practice in many Islamic countries: in fact, 80% of girls in north and central Sudan are circumcised. However, the practice of female circumcision has been shown to lead to lifelong reproductive health problems including scar formation, cyst growth, pain during urination, and difficulties with childbirth. Indeed, this contributes significantly to the high maternal mortality rate in Sudan.[5]

Even in the United States, religious beliefs can hinder women’s access to reproductive health care. Eesha Pandit, Director of Advocacy at MergerWatch, an advocacy group for women’s health care services, commented to HCGHR that in New York, religious hospitals were acquiring secular ones and “in the process of merging, the secular hospitals are obliged by the Catholic directives for health care. Therefore, those hospitals will not be able to provide emergency contraceptives, abortions, information about HIV/AIDS and a whole host of other critically important services for women.”[6]

Religious obstacles aside, many cultural beliefs also pose problems in the delivery of reproductive health care.

Newly-wed wives in India are under considerable pressure from parents and relatives to have children quickly because it is believed that fertility decreases with age.[7] These women also receive false information from village doctors that causes them to mistrust spacing methods such as the pill and Intrauterine Devices, which are contraceptives devices for women similar to condoms for men.[7] This reduces these women’s likelihood of using such methods to space their pregnancies and may contribute to more complications related to pregnancies and childbirths.

Around the world, many stigmas persist in obstructing universal access to reproductive health care.

Eesha Pandit noted that “abortion services are the only health care service that is both safe and legal in most developed countries that is singled out for exclusion under bills such as the Hyde amendment, which prohibits the use of federal funding for abortion care.”[6]

Globally, unsafe abortions kill approximately 70,000 women each year. Three million women who experience serious complications from unsafe procedures are left untreated.[8]

What does this mean for attempts to increase reproductive health care access? As Dr. Yves Bergevin commented to the HCGHR, “medical services must be offered in a way that is socially and culturally acceptable and welcomed in a community.”[9]

These obstacles may also require creative solutions tailored to each individual community or country. Eesha Pandit gives her account of how MergerWatch helped a merger of a secular and religious hospital in New York keep critical reproductive health services for women: “We discovered money available to alleviate the process of this merger and we brought the community together to protest about this issue. Therefore, the hospital ended up keeping the services in the Ambulatory Care building which was in a separate building, so the hospital could still comply with the directive and still keep the services.”[6]

Indeed, without these creative solutions, dedicated organizations, politicians, and individuals, and sufficient funding, situations such as the one described by Dr. Bergevin may become commonplace.

“Women without proper access may seek illegal means of abortive care and die from these unsafe procedures. All of these nightmares that you see in the Bronx that you do not see in Canada will all be multiplied in developing countries, simply because the government does not have enough resolve to have universal access to reproductive health care.”[9]

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1 “50 Factoids About Sub-Saharan Africa.” Africa Development Indicators, 2008. 15 Oct. 2009. Web. http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/EXTPUBREP/EXTSTATINA/0,,contentMDK:21106218~menuPK:824080~pagePK:64168445~piPK:64168309~theSitePK:824043,00.html
2 Gross Domestic Product by State. Bureau of Economic Analysis, 2008. 15 Oct. 2009. Web. http://www.bea.gov/regional/gsp/action.cfm
3 Gribble, James and Haffey, Joan. “Reproductive Health in Sub-Saharan Africa.” Population Reference Bureau, 2008.
4 Maldonado, Lisa. Personal Interview. 13 Oct. 2009.
5 Gruenbaum, Ellen. “Islam, Gender, and Reproductive Health.” Woodrow Wilson Center for International Scholars. 5 Nov. 2004. Address.
6 Pandit, Eesha. Personal Interview. 15 Oct. 2009.
7 Greydanus, Donald, Senanyake, Pramilla, and Gains, Michelé. “Reproductive Health: An International Perspective.” Indian J Pediatrics: 1999, 415-424.
8 “Abortion and Unintended Pregnancy Decline Worldwide as Contraceptive Use Increases.” Guttmacher Institute, 2006.
9 Bergevin, Yves. Personal Interview. 13 Oct. 2009.

Novartis, Gilead and Generic Drug Production

Hemali Thakkar, Staff Writer

As the prices of drugs increase, it is becoming more difficult for those living in the developing world to access generic drugs. One third of the world’s population lacks access to essential medicines, which translates to nearly one half of the population in the poorest regions.¹

In recent years, India has become one of the main sources of inexpensive drugs for those living in the world’s low-income regions. Currently, Indian pharmaceutical companies provide two of the world’s most inexpensive therapies for treating HIV/AIDS. ¹ Drugs manufactured in India cost as little as 1 – 2% of the price of those sold by large pharmaceutical companies, and a recent report on The World Medicines Situation illustrates that this is because “generic competition and differential pricing can contribute substantially to the affordability of medicines in low income countries.” ² As a result, India’s cheap drug production makes drugs such as Tenofovir, an antiretroviral drug used to treat HIV, more accessible in resource poor settings. “There are many, many reasons why people are not getting access to essential medicines. [Generic drug production] is just one of the ways people are trying to rectify that imbalance,” says Dr. Kesselheim, M.D., J.D. in the Division of Pharmacoepidemiology and Pharmacoeconomics from Brigham and Women’s Hospital.³

With the rapid escalation of the middle class in India, pharmaceutical giants are ruthlessly trying to tap into this market by filing as many patents as possible on slightly modified forms of existing drugs.3 Section 3(d) of India’s Patents Act, enacted to safeguard public health, presents these companies with the biggest obstacle in their profit-seeking venture. In March 2005, India enacted Section 3(d) to curtail the ability of pharmaceutical giants from extending their patent rights on treatments that “do not result in increased efficacy” beyond a 20-year period by simply making small adjustments to already-known medicines.^4,5 Not surprisingly, Swiss and US pharmaceutical giants Novartis and Gilead both challenged India’s Patent Act, Section 3(d) after having their patent applications for their respective drugs rejected by India’s Patent Office.⁶

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Changing University Access Policies

Jenny Chen, Staff Writer

Since the advent of the internet, the open access model of publication distribution has emerged as a serious contender in the battle over how the next generation of scientists will share their findings.

The definition of open access publishing that is most often used is known as the Bethesda Statement on Open Access Publishing. It states that authors and copyright holders will deposit their work into open online repositories and grant universal access rights to their work, as well as the right to copy, republish, redistribute, and create derivative works as long as the authorship is properly attributed.¹

While the debate has raged on, proponents of the open access model have long called on universities to be the first to commit to the model.

In response, on February 12, 2008, Harvard became the first university in the United States to mandate the open access policy in its Faculty of Arts and Sciences. Since then, the Harvard Law School, the Harvard Kennedy School of Government, and the Harvard Graduate School of Education have adopted similar policies.

Leading the crusade for more accessible scientific dialogue is Dr. Stuart Shieber, a Harvard professor of computer science. “The goal here is twofold,” says Shieber. “First of all, to make sure that there is the broadest possible dissemination of the work of the faculty and research at Harvard, and secondly, to help scientists everywhere to research as broadly as possible.”

Critics of Harvard University’s open access policy cite that there is no true mandate on Harvard-affiliated authors. The university’s policy stipulates that faculty members and researches at Harvard must grant the rights to their publications to Harvard and deposit their papers into open depositories. However, authors may petition for the rights to a particularly paper by writing to the Dean.²

However, Professor Shieber points out that Harvard’s open access policy is the first rights retention policy at a major academic institution in the United States that uses an “opt-out” system rather than an “opt-in” one, which has been shown in various decision-making studies to be far more effective at retaining participants.³

Proponents claim that the need for open access publications in universities stems from the soaring subscription costs that consume the dwindling budgets of even the largest academic libraries.⁴ In light of the recent recession, Harvard College Library has been selective on its subscription renewals, forced to cancel print subscriptions to a variety of publications.⁵

If these prices have become problematic for a university as well endowed as Harvard, it is not difficult to imagine that they could bar access to new literature for researchers in universities of less affluent nations. “You just can’t do research if you can’t read the literature,” Professor Shieber laments.

The history of open access can be traced by to early days of the internet and the emergence of the first preprint service online in 1991 called arXiv. Significant attention was not drawn to the issue until later in 1998 when the Scholarly Publishing and Academic Resources Coalition was founded – a group that advocates strongly for alternative communication strategies between academic researchers.⁵

Soon after, online efforts to generate open access communities resulted in the development of new open access projects. Dr. David Lipman, the director of the National Center for Biotechnology Information (NCBI) was there when the NCBI began experimenting with database integrations, which resulted in Pubmed – a citation and abstract archiving database. Soon after, Pubmed Central came about as a digital archive of abstracts and full-length papers available free on the internet – a precursor to the modern online open access journal.

Dr. Lipman stresses, however, that “Pubmed Central is not open access. Readers often confuse open access with public access. Open access means content that can, except for commercial distribution, be used in any way.” In contrast, public access journals like Pubmed Central allow researchers to read the work while they cannot necessarily redistribute

it or reproduce it for other purposes.⁶

“However, what we have done is shown that this kind of [system] can be done cost effectively,” says Dr. Lipman. Forerunners like Pubmed Central “are part of the equation, but only a part. The other part is the scientists and the universities themselves,” he stresses.

As a part of this initial push, Nobel Prize winner, former NIH director and current President of the Memorial Sloan-Kettering Cancer Center, Dr. Harold Varmus co-founded the Public Library of Science (PLoS) – the largest open access journal in the world.

Dr. Varmus agrees with Dr. Lipman that there are many who criticize the financial viability of the open access business plan. “Many people say that the business model won’t work,” Dr. Varmus says. “PLoS and BioMedCentral [an open access publisher in the United Kingdom] have proved that it does work. PLoS is now breaking even.”⁷

In addition to criticisms regarding the financial sensibilities of the open access model, opponents have argued that the model will actually inhibit the dissemination of information, as it often requires authors to pay the publishing costs.

While Professor Shieber of Harvard concedes that that “sometimes there’s a fee in an open access journal,” he also notes that, “in general there’s no fee to post to, for example, the arXiv. So there’s no impediment to making articles available.”

What is more compelling is that open access publications charge a median publication fee of zero dollars, points out Professor Shieber: “More than half of the journals don’t charge author fees. Only about 25% charge author side fees. In contrast, more than half of closed journals charge author side fees. What the subscription journals say is that if you can’t afford

the fees, we will waive the fees. But so do the open access journals.”

In fact, in Harvard’s implementation of the open access compact, the fund constructed to pay open access publishing fees only covers journals that waive this fee to those that cannot afford to pay, he says.

There are various other problems that stand in the way of immediately implementing the open access model of publication. However, from Dr. Harold Varmus’ perspective, there looms a larger obstacle than these criticisms.

“The biggest obstacle right now is an obstacle that faces any kind of new journal and that obstacle is deeply embedded at Harvard and every other institution. And that is that people in the sciences continually use a false metric in analyzing the success of a researcher and that false value is dependent on the success candidates have had in publishing in ‘high impact journals.’”

That is inherently different from using questions like “what has this person done” or “how important is their impact on science,” Dr. Varmus emphasizes.

In terms of the implications of open access publishing for global health issues, Professor Shieber recognizes that we do not even need to leave the first world country to understand that research is currently inaccessible to those unaffiliated with large, well-endowed academic institutions.

“Speaking even in the first world country, most of the people within the United States are not within the scope of a major research library,” Professor Shieber reminds us. “Patients who need to read studies about the effectiveness about certain medical treatments that they are considering cannot get the information they need unless they’re attached to an institution like Harvard.”

In short, the open access publishing movement hopes to expand communication of scientific research to all those who need it, whether it be researchers at a neighboring East Coast institution, doctors in third world countries or patients on the West Coast.

In this movement, “universities should have and can have a leading role,” says Dr. Lipman.

With optimism, Professor Shieber responds that Harvard appears ready to play a leading role.  “At Harvard, we want to broaden the open access policy to more faculties. We would like to make sure that certain types of student writings are available, especially dissertations and theses. We are active in helping other universities with thinking about open access and working towards their own solutions.”

“There is no one thing that will solve the problem,” says Professor Shieber. “We have to be responsive to how things change over time.” And Harvard can help lead the way.

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1 Suber, Peter. “Bethesda Statement on Open Access Publishing.” Earlham College Earlham College, 20 June 2003. Web. 1 Oct. 2009 <http://www.earlham.edu/~peters/fos/bethesda.htm>.

2 “Harvard Open-Access Policies.” Harvard University Library Harvard University, 2008. Web. 1 Oct. 2009 <http://osc.hul.harvard.edu/OpenAccess/policytexts.php>.

3 Shieber, Stuart. Personal INTERVIEW. 7th October 2009.
4 Albert, Karen. “Open access: implications for scholarly publishing and medical libraries.” Journal of the Medical Library Association 94.3 (2006): 253-62. Web.PubMed Central. 1 Oct. 2009 <http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1525322#i1536-5050-094-03-0253-b1>.

5 “Changes in Programs and Services: Journal Subscriptions.” Harvard Faculty of Arts and Sciences: FAS Planning Open access: implications for scholarly publishing and medical libraries. Harvard University, 11 May 2009. Web. 1 Oct. 2009 <https://planning.fas.harvard.edu/c/index.html>.

6 Lipman, David. Personal INTERVIEW. 5th October 2009.

7 Varmus, Harold. Personal INTERVIEW. 6th October 2009.

Justin Banerdt, Staff Writer

As the flu season arrives in the northern hemisphere, governments are preparing for a resurgence of the H1N1 pandemic as they rush to produce vaccines. Questions remain though as to whether there will be enough vaccine stock, whether will it arrive in time, and if there is a shortage, who will have access. These questions are even more disconcerting for developing countries that likely will not have the resources to vaccinate the majority, and in some cases even minority, of their population.

In what is a sobering take on history, the last time the United States government dealt with the H1N1 flu in 1976 resulted in an immunization campaign riddled with difficulties. The most fundamental of these was a striking disconnect in communication between the general populace and high-ranking health officials when a handful of vaccinated patients developed Guillain-Barré syndrome. This led to widespread panic about the safety of the vaccine. These incidences of Guillain-Barré syndrome would later prove to be unrelated to the vaccine.¹

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