Written by Varshini Odayar and Ria Parikh
A simple Google search for “papers on the COVID-19 vaccine” reveals pages of numerous journal publications in highly-cited journals such as Nature, Lancet, and New England Journal of Medicine among others. As one may expect, the production of such highly influential scientific knowledge also brings much acclamation and honor for the contributing authors. Such an array of journals so committed to the pursuit of scientific discovery have been widely seen as vehicles of change and innovation. But to conclude the conversation on such a pervasive statement would mean ignoring years of inequity in knowledge production, research dissemination, and bias.
Journal publication confers specific privileges to a select few authors, while neglecting multiple groups, individuals, and most importantly, voices. Specifically, non-English speaking scholars as well as those in low-to-middle income countries (LMICs) are often excluded from the larger research conversation. The impact of such neglect reflects blatant bias and discrimination within the scientific community. It specifically highlights the containment of scientific ideas not derived from higher income countries such as the U.S. and U.K. This paradigm raises some larger questions which are often ignored:
Who can create and disseminate knowledge? What is considered true knowledge by the scientific and research community?
“Knowledge is only knowledge if it is written in English and in turn, if it comes from a high-income country. There are insurmountable barriers for someone from an LMIC (low-middle income country) to submit research, and often, it would not be considered “valid” knowledge. And if it was written in Creole, people assumed they likely didn’t know what they were talking about,” said Yadurshini Raveendran, recent graduate student of the Duke University Master’s of Global Health Program, and one of the founders of the Duke Decolonizing Global Health Working Group.
Yadurshini’s statement highlights the utter discrimination towards research and knowledge cultivated by those in non-English speaking countries. Her words are further reflective of the sheer lack of multilingual journals. Currently, the number of multilingual science journals are so few that they could be counted using your hand. The International Multilingual Journal of Science and Technology as well as the International Multilingual Journal of Contemporary Research are one among these few.
University of Cincinnati Professor of Communication and Bioethics Dr. John Lynch cites the English language as a cause of bias in science communication. “The most prominent journals are in English,” Lynch said. “English language becomes a bar during the review process. If you are not writing in English, that is immediately a barrier.” He then explains that, in such higher income countries, a cycle continues where “research written in English leads to more individuals publishing from English-speaking countries, and those individuals keep accruing the citations and grant money. If you are in a privileged position, you will continue to accrue privilege.” It is thus important to recognize that financial resources pose a significant barrier to research dissemination and science.
Yadurshini Raveendran echoes this sentiment, explaining that “publishing in high-impact journals such as Nature costs around 9,500 Euros, a fee that only scholars from high-income countries can afford to pay.”
9,500 Euros translates to roughly $11,500. This gap finds itself in a self-fulfilling cycle: the rich, with more financial resources and accessibility, develop perspectives only beneficial to themselves and gain more resources. The publishing process, full of bias and favorability towards high-income countries, only catalyzes this cycle already so prominent in science and medicine. As Raveendran describes, such bias can be characterized as the “stuck in the middle” pattern whereby collaborators from the Global South are often listed as authors in the middle of a line of contributors.
However, the bias embedded in science and research is not exclusive to the publishing process, as it extends to the diseases studied and the forums through which they are discussed. To illustrate such ideas, Raveendran cites the example of malaria, a disease which is transmitted through mosquitoes and that which invades red blood cells. Malaria commonly infects individuals in various countries such as East Africa, South America, and regions of Southeast Asia. She voices concerns conferences surrounding malarial research are almost often held in wealthier countries such as Switzerland. While malarial research is significant, she points to the need to also ground and center these conversations surrounding malaria in the countries most impacted. Raveendran further presents a biosocial argument as she explains how there are a number of different barriers to presenting at such conferences, primarily of which is the financial barrier. However, she also explains that even if such a financial barrier were in fact nonexistent, there are numerous other factors which may prevent certain individuals from gaining access to these larger conferences. Specifically, professors must take time out of their days and duties in order to travel. For instance, female professors and scholars may experience caregiver burden. A study in Nature highlights such gender disparities, and describes a research study by Cassidy Sugimoto, an information scientist at Indiana University Bloomington studying gender disparities in research. In this study, 14,000 reports were analyzed, and the team discovered a “decrease in the proportion of submissions by female principal investigators from March and April of 2019 to the same months in 2020 when the lockdowns started.” The results of such studies prove how COVID-19 has only played a role in exacerbating these various inequities.
Such biases in research publication and communication ultimately stem from colonial roots and practices of colonial medicine. Due to such ideas rooted in colonialism, research published in these high-income countries tends to gain more notoriety and merit than research published in the majority of LMICs. In addition, research written by scholars in higher-income countries regarding LMICs neglect to understand the cultural and social implications of their research on-the-ground in LMICs. In these scenarios, research about LMICs published by scholars in higher-income countries often becomes inaccessible to those living and working in LMICs. By contrast, the research published by scholars in LMICs that usually goes underrecognized is not only culturally and socially sensitive, but also beneficial to the multitude of scholars and patients living in these countries and under these conditions. The initiative of global health comes with a responsibility to recognize and represent each part of the world as accurately as possible, striving to publish literature with minimized bias and misconstrued ideas. Logically, achieving this goal would involve the representation of scholars around the world.
This, however, is not the case, and has resulted in research that not only neglects the experiences of people from LMICs, but also offers fewer practical solutions to treat diseases that affect people around the world, and often people from LMICs in larger proportions. For instance, an article on the magnification of colonial attitudes in global health cites that “colonizing refers to the idea that Western researchers and practitioners impose solutions and decisions on countries that are under resourced without involving people from those places.” However, progress can only be made to alter such colonial attitudes, if individuals and stakeholders begin by recognizing and understanding privilege.
When asked about approaches we can take towards dismantling such structures and inequities,
Raveendran explains that we need to “put anti-colonial approaches in place and move towards a knowledge shift, whereby there is not a unilateral, but rather a multilateral flow of knowledge.”
Lynch goes on to explain that “we need translators, and more active efforts need to be made to establish and integrate the vital research done by non-English speakers.”
Now, more than ever, it is imperative that published scientific research equally and accurately represents scholars from across the globe. As science continues to evolve, and as health disparities continue to prevail, scientific advances made by those from LMICs must also be recognized for its importance and merit similarly to the work done by scholars in higher-income countries.
Edited by Kenneth Li