Lead authors from low-income countries on the decrease

Although research and publications in the field of infectious diseases are increasing in low-income countries, authorship equity from these countries in high-impact infectious disease journals has been lacking. Trends in a subset of the publications show that the exclusion of low-income country-affiliated investigators as lead authors is increasing.

A new study reported that 49.8% of articles about infectious disease research conducted in Africa featured an African first author and 41.3% an African last author and most of these authors were affiliated with countries considered ‘English-speaking’, such as South Africa, Ethiopia, Kenya and Nigeria.

The study also showed that “Among 1,308 publications identified, 50% had either a first or last low-income country-affiliated author. Among these authors, 48% of low-income country-affiliated first authors and 52% of low-income country-affiliated last authors also reported an affiliation with an institution that is not in a low-income country.

“These imbalances extend to other components of the publication process, including submission and selection for publication. The high cost of publishing in global health journals widens the access gap for underfunded low-income country investigators who also face significant restrictions in access to much of the academic and medical literature,” according to the authors of the article ‘Authorship trends in infectious diseases society of America affiliated journal articles conducted in low-income countries, 1998–2018’ that was published in PLOS Global Public Health on 10 June 2022.

Collaboration increases imbalances

Further obstacles the researchers identified include a lack of promotion and leadership opportunities for low-income country investigators and less emphasis on local health priorities. Research that is the result of collaboration between high- and low-income institutions is a predominant model for international health research.

However, inequity between collaborators can increase imbalances, since the high-income partner often provides funding and drives the primary research objectives, according to the article.

The authors performed a literature search for primary research conducted either within low-income countries or using samples from low-income country participants published between 1998 and 2017 in the Infectious Disease Society of America-affiliated journals Clinical Infectious Diseases, Journal of Infectious Diseases, and Open Forum Infectious Diseases and found that, while the absolute number of articles by low-income country-affiliated lead authors increased over the 20-year period, the proportion of articles with low-income country-affiliated lead authors decreased.

“This means that the increase in publications is mostly attributable to non-low income-affiliated authorship, the vast majority of which are authors from high-income countries,” the authors said.

They said the most frequent affiliations for non low-income countries first and last authors, respectively, were the United States (55% and 52%), United Kingdom (13% and 15%), France (6% and 7%) and other high-income countries (22% for both low- and high-income countries).

Authors from low-income countries remain at a disadvantage

According to the study, high-impact research in low-income countries has historically been under-represented in the medical literature, despite social and ethical arguments for research to be based on the relevant global disease burden.

“The inequities that result in under-representation of medical research from low-income countries can also be seen in authorship trends from these areas. While trends in some journals have shown that most lead authors were from low-income countries, other analyses in low-income country authorship have demonstrated lower rates of that authorship, including within the literature for obstetrics, tropical medicine and psychiatry,” the authors said.

Large-scale metadata on global-health research over the past 20 years indicates that the proportion of non high-income lead authors has increased over time. However, the study found that this trend “was secondary to increases in authorship from upper middle- and lower middle-income countries, with low-income countries remaining under-represented”.

The researchers said their results are like the findings of an investigation of authorship trends in the journal Lancet Global Health that revealed that, while 92% of research publications were conducted in lower middle-income countries, only 35% of authors were from low-income countries.

Barriers rooted in widespread inequity

In addition, they said a study looking at lower middle-income countries, authorship of randomised control trials on HIV/Aids, malaria and tuberculosis between 1990 and 2013 found that 49.8% of publications had lower middle-income country first authors.

“While this is a higher proportion than identified by our study, others have found a similar trend that the absolute number of lower middle-income authors increased, but the proportion of lower middle-income country authors decreased over time.”

The authors said barriers to promoting low-income country authorship remain rooted in the inequities that limit research-building capacity and vary greatly between different locations, partnership structures and types of research.

“Any engagement in barrier identification and capacity-building measures should be led by low-income country investigators and communities. Such barriers include, but are not limited to, a paucity of local mentorship, lack of research leadership, insufficient financial and material resources, delays in regulatory approval or oversight, and competing work demands,” the study said.