InciSioN Global · EQUITY IN RESEARCH
Who gets to publish?
Open access transformed who can read scientific research. But when publication costs move to authors, a different question emerges: who can afford to contribute to it?
Exploring article processing charges, global surgery authorship, fair financing and epistemic justice—without treating all publication fees or journals as the same.
01 / THE PROBLEM
Removing one barrier should not create another.
Scientific knowledge has public value. Publishing systems determine both who gets to access that knowledge and whose questions, experiences and evidence enter the scientific record.
Article processing charges (APCs) are fees often associated with publishing an accepted paper as open access. They may be paid by funders or universities—or directly by researchers. A flat fee can be manageable in a well-funded laboratory but prohibitive in an under-resourced hospital, university or independent research setting.
Our concern is not that every APC is intrinsically unethical. It is whether publishing rules and financial arrangements fairly distribute opportunity, preserve editorial independence, and support scholarship from the places where health needs are greatest.
02 / UNDERSTAND THE OPTIONS
Open access does not always mean an APC.
The financing model matters. An open article can be supported through author payments, institutional funding, collective infrastructure or permitted repository sharing.
Gold open access
Articles are free to read immediately. Some gold OA journals charge APCs; others do not.
Hybrid publishing
Subscription journals offer an optional APC-funded open-access choice for individual articles. Authors may have a non-OA route.
Diamond open access
Readers and authors pay no access or publication fee. Other institutions must sustainably finance the work.
Green open access
Permitted manuscript versions can be shared through repositories, subject to copyright, embargo and funder policies.
Subscription journals can have no APC but limit reader access. Read-and-publish contracts can cover eligible authors’ fees centrally, though access to such contracts is itself unequal. There is no single financing model that automatically guarantees equitable participation.
03 / WHAT THE RESEARCH SHOWS
APC barriers are measurable—but the evidence must be interpreted carefully.
The 2026 general-surgery journal study reports advertised fee policies. Other studies investigate author geography, funding and publication decisions. They answer related but different questions.
Feres et al., sample of 40 general-surgery journals, 2026. [1]
This is not a fee every author necessarily pays. [1]
42% of APC-charging journals in this sample. [1]
HOW THE 40 SURGERY JOURNALS WERE CLASSIFIED
The 90% figure refers to APC-funded options, not 90% of surgical papers requiring author payment. [1]
Listed fees are not identical to actual payments.
The U.S. GAO reported that average listed prices across a six-publisher panel rose by 29.6% for gold OA and 18.8% for hybrid OA from 2019–2023. Inflation-adjusted increases were 10.2% and 1.0%, respectively. [4]
Price lists, discounts, waivers and publisher contracts produce different figures. These changes should not be generalized to every journal or publisher.
More than 37,000 articles
Smith and colleagues compared Elsevier parent and mirror journals with closely related editorial arrangements. Open-access articles had less geographical diversity than non-OA articles, and none of the mirror-journal articles had a lead author from a low-income country. The findings are consistent with a fee barrier; selection and funding differences may still matter. [2]
3,422 surveyed scholars
Segado-Boj and colleagues found associations between grant/institutional resources and willingness to pay APCs. Researchers earlier in their careers and scholars with less financial support faced greater perceived barriers. The survey captures attitudes and experiences, not a causal experiment. [3]
04 / WHY WAIVERS ARE NOT ENOUGH
“Waiver available” does not always mean “publishing affordable.”
Waivers and discounts can make open access possible. But eligibility based on national income alone can overlook researchers without grants, even in countries classified as middle- or high-income.
Other barriers include partial reductions that leave large balances, unclear criteria, administrative burdens and payment systems that exclude researchers in conflict-affected or under-resourced settings. Eligibility can also depend on the corresponding author’s affiliation, rather than the actual distribution of the research work. [5]
The strongest proposals assess research funding, institutional capacity, structural vulnerability and meaningful contribution—not country classification alone. These are proposals for reform, not evidence that a particular new waiver system has already succeeded.
THE AFFORDABILITY GAP
A discount is only useful if the remaining amount is payable.
Researchers can be eligible for support and still lack grant funding, institutional budgets, banking access or a straightforward mechanism to claim it.
Publisher terms differ. Eligibility and editorial assessment must remain separate. [5] [15]
Can the researcher pay?
Income classifications do not tell us whether a specific department, grant or researcher has a usable publication budget.
Are criteria fair?
Corresponding-author rules, selective discounts and timing requirements can exclude collaborators whose need is real.
Is payment even possible?
International banking constraints, administrative hurdles or unfamiliar processes can make a fee impossible to settle.
05 / WHY GLOBAL SURGERY HAS A STAKE
Research about communities should include knowledge from those communities.
Global surgery studies describe operating systems, workforce, access, outcomes and locally specific implementation challenges. Equitable authorship matters because researchers close to those contexts bring indispensable knowledge of systems and constraints.
A 2023 systematic mapping review of 2,298 global surgery studies found that 45.6% had no in-country author and substantial representation of high-income-country affiliations in lead and senior authorship. [6]
This finding does not show that APCs caused the authorship gap. Funding, collaboration power, language, editorial norms, prestige metrics and research leadership also shape who participates. Addressing payment barriers is necessary within a broader equity agenda—not a substitute for it. [7] [8]
06 / FOUR LENSES OF FAIRNESS
Publishing equity is more than price.
A credible equity agenda asks not only who pays, but who makes decisions, whose expertise is recognized, and whose future careers are supported.
Who bears the cost?
Flat charges create unequal burdens where salaries, research grants and institutional support differ sharply.
Are the rules transparent?
Fee waivers, appeals, contracts and editorial decisions should be predictable, fair and independent of ability to pay.
Whose knowledge counts?
Researchers with local expertise should help determine questions, authorship, interpretation and dissemination—not merely supply data.
Who gets a future in research?
Early-career and independent researchers may lack the resources and networks available to established academics.
07 / PRACTICAL ALTERNATIVES
Fair publishing is possible. Sustainable publishing still needs investment.
Changing the way research is financed, evaluated and governed can make publication more accessible without compromising editorial quality or financial sustainability.
Enable green OA routes
Help researchers deposit permitted versions in repositories while respecting licensing, embargoes, funding rules and differences between preprints and peer-reviewed manuscripts.
Make waiver support predictable
Publish eligibility clearly, consider researcher and institutional resources, simplify decisions, explain appeals and evaluate who actually benefits. [5]
Finance equitable collaboration
Budget dissemination and translation, strengthen regional journals, and agree fair authorship and research leadership before collaborative work begins.
Trade-offs matter: Diamond journals still have operating costs; repositories depend on permissions and infrastructure; institutional publishing contracts can exclude less-resourced institutions; and waivers reduce individual barriers without necessarily changing the underlying market.
08 / FROM EVIDENCE TO PRACTICE
Who can help make publishing fairer?
Make the rules and outcomes visible.
- Publish transparent prices, eligibility and waiver procedures.
- Keep editorial judgments independent of author payments.
- Monitor participation across geography, career stage and institutions.
- Strengthen diverse editorial boards, language support and accessible submission.
Fund the ability to disseminate.
- Provide realistic publication budgets without rewarding expensive journals.
- Invest in no-fee scholarly infrastructure and regional journals.
- Ensure institutional agreements serve under-resourced partners.
- Resource translation, editing and open repositories.
Share credit and decision-making.
- Plan authorship and leadership equitably from the outset.
- Recognize substantial local contributions to design and interpretation.
- Use appropriate repositories and rights-retention pathways.
- Protect integrity and avoid honorary or token authorship.
FOR InciSioN’S ADVOCACY CONVERSATION
What could InciSioN champion?
Evidence-grounded priorities worth considering include transparent APC policies, meaningful support for unfunded researchers, stronger regional and diamond publishing options, and fair local authorship in global surgery partnerships.
These are proposed areas for public engagement and institutional discussion—not a claim that InciSioN has already adopted a binding publishing policy or can waive fees charged by external journals.
09 / FREQUENT QUESTIONS
Important distinctions.
Are all article processing charges unethical?
No. Publishing requires real editorial, preservation and technical expenditure, and APC-funded OA can benefit readers. The issue is whether payment structures are transparent, proportionate and fair to researchers with very different resources.
Does every open-access journal charge authors?
No. Diamond open-access journals charge neither authors nor readers. Green OA also provides permitted repository-based routes. Hybrid journals often offer an optional APC-funded route alongside subscription publication.
Does the 90% figure mean 90% of surgeons must pay to publish?
No. It means 36 of 40 sampled general-surgery journals offered an APC-funded publication option. Twenty-four were hybrid journals, where paying for open access was optional. The figure is not the proportion of manuscripts or authors that paid a fee.
Do APCs explain unequal global surgery authorship?
APCs may contribute to unequal opportunity, but global surgery authorship inequality also reflects collaboration structures, research financing, language, editorial gatekeeping and control of research priorities. The 45.6% figure is an authorship finding—not an estimate of causal APC effects.
Are APCs the same as predatory publishing?
No. Many reputable journals charge APCs and maintain rigorous peer review. Predatory practices are separate integrity concerns that require attention to editorial standards, transparency and deceptive conduct.
What is a useful first step for an individual author?
Check funder and institutional open-access support; confirm the journal’s actual waiver policy before submission; compare high-quality no-fee journals; and examine permitted repository or rights-retention routes. Journal quality, author rights and the version being shared all matter.
10 / EVIDENCE AND POLICY SOURCES
Explore the research behind the argument.
Studies, comparative analyses, policy commentaries and international recommendations are identified separately. The links lead to original publisher, DOI, institutional or report pages.
- 01 · Feres et al. (2026)Article processing charges in general surgery journals — cross-sectional study of 40 journals.
- 02 · Smith et al. (2022)Mirror-journal comparison across more than 37,000 articles; geography and access.
- 03 · Segado-Boj et al. (2022)Survey of 3,422 researchers on APC attitudes, resources and willingness to pay.
- 04 · U.S. GAO (2026)Federal Research: publishing costs and trends in listed fees across major publishers.
- 05 · Ibrahim & Neuner (2026)Open access, unequal access: critique of income-based APC waiver eligibility.
- 06 · Kebede et al. (2023)Systematic mapping of global surgery research and in-country authorship.
- 07 · BMJ Global Health (2021)Systematic analysis of authorship demographics in global surgery.
- 08 · BMJ Global Health (2024)Colonisation and its aftermath: power, knowledge, and research leadership in global surgery.
- 09 · UNESCO (2021)Recommendation on Open Science: inclusivity and safeguards against high publishing charges.
- 10 · Science Europe / cOAlition S (2021)OA Diamond Journals Study: financing and infrastructure for no-fee journals.
- 11 · Ayeni & Larivière (2025/2026)Qualitative interviews on publishing affordability and institutional privilege.
- 12 · DIAMAS (2023)Institutional publishing survey: capacity, infrastructure and sustainability.
- 13 · Oncology APC policiesSpecialty cross-sectional study: journal APCs and LMIC waiver policies.
- 14 · UNESCO Diamond Open AccessPolicy resource advocating support for author- and reader-fee-free publishing.
- 15 · Oxford University PressExample of publisher-specific eligibility rules for APC waivers and discounts.
- 16 · Matthias et al. (2026, preprint)Modelled APC expenditure estimate; not audited publisher revenue.
Evidence interpretation: Many studies are observational or based on published articles and journal fee policies. They cannot fully observe manuscripts never submitted because of cost, and they do not isolate APCs from all other structural determinants. Some expenditure calculations are preprints or modelled estimates, not audited receipts.