"The idea had been around for a long time and in many ways it is an obvious idea," says BMJ Editor Richard Smith. Nine months ago WHO asked the BMJ Publishing Group, which had

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already given developing countries free access to its journals, to approach commercial publishers and invite them to participate in the initiative. According to Derk Haank, CEO of Elsevier Sciences, the largest publisher involved, the project realizes the full potential of electronic publishing: "The poorest countries cannot afford the postage or printing costs of paper journals," he says, but "the marginal cost of connecting one additional customer [online] is almost nil."

Smith believes recent controversy over the cost of drugs in developing countries has played a constructive role: "I think the publishers look at the pharmaceutical companies and think, 'We don't want to end up being pilloried by the international community.' " He argues that the commercial publishing industry is more vulnerable to criticism than the pharmaceutical industry because "they are not producing the raw material — the academic community is." Smith considers the initiative a partial response to demands from academics to have free access to their own product.

WHO says the final outcome is a "tiered-pricing model that will make nearly 1000 of the 1240 top international biomedical journals available to institutions in the 100 poorest countries free of charge or at significantly reduced rates."

Under the plan, the lowest-income countries will be given free access, while middle low-income countries will obtain significant discounts. The project will be evaluated in 3 years. In the short term, "it is fairly easy to measure success — how many people are accessing this material and how much they are accessing," says Smith. In the longer term the aim is to increase knowledge. "It is not just about letting material be available for free. It is also about increasing connectivity and increasing the capacity of people in the developing world to produce their own material and make that available to people in the developed world and other people in developing countries."

Nicaragua is one of the few countries in the Americas to be eligible for free access. Rafael Cabrera, director of the Department of Medicine at the Americana University in Managua, welcomed the initiative. "Each of our students has an Internet account and a significant proportion of our lectures are being given in the computer laboratory, so I think it will be a very useful tool for the students."