Photo of badges on a black computer bag. The first is a brown one, which reads, "Irony. The opposite of wrinkly." The second is one is an orange badge, with the words "OPEN ACESS" with an open access symbol (an unlocked padlock). Next to those are two badges symbolizing cartooning – cartoon thought and speech bubbles, one green, one orange.
The question keeps coming up when I discuss the challenges facing the Cochrane Collaboration: What’s happening with open access for Cochrane reviews? The short answer: They are most of the way there, and committed to going the whole way. But it’s not yet clear how, or when, they will get there. They have been pushing back the timeline for years, and choosing a realistic path has become urgent.
The transition away from a subscription-based financial structure is complex. I’ve tackled the issue in this post by breaking it down into 3 parts: The current status of access to Cochrane reviews; the economic context of open access models for journals; and potential paths for Cochrane.
Current status
Cochrane reviews are, with few exceptions, produced and maintained by a global network of groups and individuals that either volunteer their time, or are publicly funded for some or all of the work. Where there is funding, members of that network were responsible for securing it themselves. One of the products of 30+ years of the Cochrane Collaboration is an enormous pile of grant applications!
The Cochrane reviews that result from all those people’s efforts are published in the Cochrane Database of Systematic Reviews (CDSR), in English and Spanish. Tens of thousands of summaries of reviews have been translated into 20 languages.
Although the CDSR is a database of evidence to consult when you have a health-related question, it is also a journal. The CDSR is one of 3 Cochrane databases in a package called The Cochrane Library. Currently, the other components are CENTRAL, which is a register of controlled trials; and Cochrane Clinical Answers, point-of-care evidence summaries for clinicians. CENTRAL, too, is the product of a lot of Collaboration-wide effort.
The Cochrane Collaboration is a charity registered in the UK. It is the legal entity that holds ownership of Cochrane reviews and CENTRAL, as well as the software it developed for producing, maintaining, and publishing them. Cochrane has been publishing fully digitally on a subscription basis since 1995, moving onto its own internet domain, cochranelibrary.com, in 1998. At first, it worked with a small company, Update Software. Since 2003, it has had a commercial publishing arrangement with Wiley. The central Cochrane organization is heavily dependent on the royalties it gets from this deal – it was nearly 80% of their central income in their most recent published report (for 2023).
Cochrane reviews are published in stages, and authors retain copyright. Firstly, there’s a protocol, which includes the background section, and the methods for the review-to-be. Those are now open access immediately on publication, with a CC-BY 4.0 licence.
When the protocol becomes a full review, or it gets updated after a new search for studies, that version is behind a paywall for a year. After that embargo period, the review is free-to-read (“green open access”) – unless the authors or funders pay a fee for it to be open access immediately (“gold open access”). The PDF and some digital elements are also deposited in PMC. (See an example here.) Because of this, the overwhelming majority of Cochrane reviews – including the previous versions of updated reviews – aren’t behind a paywall.
For much of the world, though, there is no paywall to any part of The Cochrane Library at all. This is because a subscription has been paid for a whole country, or a region, or because the country or region is ranked by the WHO as a low- or middle-income country. People living in all those countries have instant access without any form of registration or login.
This means that subscriptions are only buying access to recently published Cochrane reviews – new or updated – and the other parts of The Cochrane Library.
The Collaboration has been aiming to transition away from subscriptions for over a decade, but missing the deadlines it has set for doing so. The last deadline missed was 2025. Now, there is no specified time for ending subscriptions.
Cochrane has another journal, Cochrane Evidence Synthesis and Methods, which is open access via charges to authors.
Open access models for journals
There are essentially 4 major ways the people running a journal can make it free to readers:
Transfer the journal’s costs to authors instead of readers – the Author Processing Charge (APC) model;
Make enough income from other activities that you can afford to subsidize the journal work. That includes research funders that run their own journals as well, eg the Wellcome Trust.
The first version – “no money” – is out of the question for high-volume journals. Shifting the costs to authors is the easiest of the other options, but it creates discriminatory barriers. Dwindling willingness by institutional and research funder levels to pay author charges may make this much less viable in the longterm than it is now – see the Gates Foundation’s new policy, for example.
That leaves finding someone else to pay, generating income in other ways so a journal doesn’t have to pay its way, or a hybrid of the two.
Finding someone else to pay is extremely complicated. Many are currently chasing this holy grail. For example, PLOS (who host this blog), is currently working on developing a journal with that kind of model. Their effort to achieve this is supplemented by $2.5 million of philanthropic funding.
Years ago, when I was on the funding agency side of the street, I was heavily involved in the development of an offer like that for The Cochrane Library. (Further disclosures listed below this post.) It was clear back then that even aside from this being vital on principle, it was just a matter of time till it was imperative, with the global research funder tide shifting toward open access. However, Cochrane leadership at that point decided they would rather stick with commercial subscriptions, and kick the can down the road.
Negotiating an international consortium to make that offer to Cochrane took around 2 years. From that experience, and from watching with great interest those who have succeeded with other journals, I think these are the most difficult challenges of the get-someone-else-to-pay strategy:
Distributing the risks among a group that’s large and diverse enough, that sustainability isn’t in peril when key nodes drop out.
Having an incentive for those funding nodes to keep paying once everyone gets the benefits of a free publication, whether or not they contribute. When a publication is totally behind a paywall, the motivation to free it is high. But the model has to survive the transition longterm, when people need to justify spending money on something that’s “free.”
Developing a solid path to high quality independent publication systems that can be maintained, and at modest cost. This is pivotal, because if the costs of participation for each node in the distributed network are relatively modest, (a) groups are more able and willing to become a burden-sharing node, and (b) everyone knows if some nodes pull out, absorbing their departure won’t mean the costs skyrocket for everyone else – and it’s easier to recruit replacements.
These are daunting, but not insurmountable, challenges for Cochrane. The complexity is deepened by the fact that Cochrane needs to maintain the confidence and enthusiasm of so many stakeholders. The Cochrane charity is selling things that members have invested years of their careers developing, if not decades. And there are public funders who have invested a lot of money across decades into the production of those things – tens of millions of pounds or dollars for some of them. And the global network needs those funders to keep supporting their work.
Potential paths for Cochrane
Cochrane has reported a focus on what I called above a hybrid approach: Generating income in other ways to reduce reliance on the proceeds of selling The Cochrane Library, and getting others to pay instead of charging authors or readers.
Let’s start with the income generation. One part of that is investment income from the cash reserve it has accumulated from royalties over the years. Another is fundraising, which is described a little vaguely. Thirdly, there are income-generating activities, including its other publications and a centralized consultancy service for commissioned evidence synthesis work.
That third income-generator category involves considerable investment, and you need more detail than you get in standard public reports to have an informed opinion about the strengths and weaknesses of these activities. From what I can see, it looks as though each has been an answer to one or both of these questions: What could make The Cochrane Library a more valuable resource? What income-generating activity suits Cochrane-type skills?
The first of those questions is logical, and the answers could be in keeping with the aims of the Collaboration. I don’t think the second one is, though. It seeks to extend the Collaboration’s reach, rather than contribute to achieving its already-ambitious core tasks. Expansion of scope was explicit for Cochrane Innovations Ltd, the spin-off business that developed Cochrane Clinical Answers with Wiley.
The approach to income generation ultimately contributed to growing centralization. Cochrane’s non-royalty income, though, hasn’t been growing as fast as its expenditure on staff. According to the latest annual report, Cochrane staff costs reached over £4.4 million (approaching US$6 million). Major growth of royalty income and staff hasn’t corresponded to growth in Cochrane reviews: The annual rate of Cochrane reviews has been has been diminishing since 2012, when the royalty income began its growth from around £2.5 million per annum then, to £7 million last year. Cochrane central has been exhibiting a version of Parkinson’s Law: It expands to absorb the royalties available.
I think the starting point for income generation should be, what can the central organization do that will enhance and facilitate the production of high-quality systematic reviews by the de-centralized global network?
The many options that emerge from a de-centralized perspective would include some services that would be of such value to others, that they could be the incentive for a non-subscription-based annual contribution. For example, developing the CENTRAL trials registry and other updating support tools, which could be used to keep CDSR users better informed, reduce the workload in the distributed network, and be valuable outside the Collaboration.
What about Cochrane’s get-someone-else-to-pay strategy? In 2024, Cochrane’s then-CEO spelled out that they hoped to do this “through increased national provisions.” That means reimbursing Wiley for the costs and profit they might forego in the region. Only the royalties trickle through to the Cochrane Collaboration. Cochrane reported that last year, the amount paid for national licences to Wiley was over £11.6 million, which was way in excess of all the Collaboration’s income.
I’ve been openly critical of this approach to national licences for many years. Reduced new content coupled with Wiley’s cost increases makes me dubious about the longterm viability of this model.
In 2002, before Wiley was the publisher, there were national licences for free internet access in the UK and another 4 countries. I checked for the trend after that by looking at Cochrane’s reports on this via the Wayback Machine. In 2019, they reported 19 national licences (counting each country in the UK separately), plus a few regional licences that have fluctuated. It has since dropped to 14. (Some of the drop is because lower income countries became eligible for free access.)
One of the pivotal national licences is for England, paid for by NICE. For its last licence, NICE had called on the higher education sector to help with the costs. NICE’s annual report shows that this yielded less than £50,000 per annum, though they don’t report how much they pay for the licence. (For perspective, Switzerland, a country a small fraction of England’s size, paid over US$200,000 for their 2024 licence.)
On the other hand, these arrangements show a lot of commitment to bearing access costs. For some funders, support for the research network and licence come from the same pot. In Australia, for example, synthesizing evidence and making the results accessible are explicitly the shared goals of a single grant from the National Health and Medical Research Council (roughly US$1.4 million last year).
Unusual funder commitments to access stemmed from the special status that comes with the uniqueness of the Collaboration’s core goal: Developing and maintaining a database of evidence syntheses to be a reliable source for decision-makers. There were a lot of new and updated Cochrane reviews, and they gained a reputation that justified the special treatment.
However, Cochrane has recently been peeling away critical features that made Cochrane reviews unique. In mid-2023, for example, they curtailed editorial responsibility for being responsive to criticisms of reviews. Sometime in late 2024, they abandoned longstanding policy around notifying readers of the update status of reviews. I and others are having a debate with them about this direction, which they describe as a move to “align with standard publishing practices for academic journals.” These recent policy decisions fundamentally change the nature of Cochrane reviews. At the same time, inflammatory decisions about high-profile reviews has been chipping away at its reputation.
Cochrane argues “We have to balance our open access ambitions with our responsibility to run the charity sustainably.” I think they could step up to that ambition, and gain a lot from doing so. I don’t think it’s open access that threatens Cochrane’s longterm sustainability. I think it’s over-centralization, and losing the status that came from the exceptional nature and reputation of Cochrane reviews. The debate over its recent decisions, and now the sudden departure of its CEO this month, offer Cochrane’s leadership a valuable opportunity to change course.
Absolutely Maybe posts tagged Cochrane are here. I have a page calledCochrane Stuff, tracking media and my recent posts across platforms about these debates.
You can keep up with my work at my newsletter,Living With Evidence. I’m active on Mastodon: @hildabast@mastodon.online and on Bluesky.
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Disclosures: I am an Emeritus Member of the Cochrane Collaboration. I did a lot of legwork to develop a publicly funded open access offer for The Cochrane Library years ago. That offer was rejected by the Collaboration in 2012. I have a long history of involvement with the organization. I was a member of its founding group, and founder of its Consumer Network (1993). I was a member of its governing board (then called the Steering Committee) as well as Coordinator of the Consumer Network from the inception of both until 2001, and the editor of the quarterly Cochrane News from 1994 to 2000. I was the coordinating editor of a Cochrane review group for 7 years, involved in some Cochrane methods groups, and was an employee of the Australasian Cochrane Centre. My PhD research was on some factors affecting the reliability of systematic reviews, including a focus on post-publication events (such as retractions and updates) and Cochrane reviews. I began studying updates of Cochrane reviews in 2002.
I am currently the lead of an Independent Advisory Group for a pair of Cochrane reviews on the HPV vaccine (a network meta-analysis [protocol] and a review on effects on community rates of related disease and vaccination harms [protocol]), with some financial support from 2021 to 2023. I was also appointed the lead of the Independent Advisory Group (IAG) for the review on exercise and ME/CFS in February 2020, with some financial support from 2020 to 2022, resuming in 2024. I have been the spokesperson for the IAG. I have a talk page that I began for responding to questions about the Cochrane ME/CFS project, and a page called Cochrane Stuff, where I am keeping track of what I post about Cochrane in various platforms.
I have frequently written about the Cochrane Collaboration and Cochrane reviews, both in support (such as a series of 6 posts here on the controversy around a previous HPV vaccine review) and critically, including strong criticism of both of the reviews mentioned in this post (the controversial pandemic-related review, for example here and here, and ME/CFS, for example here and here). I have also participated in criticism of policy in recent years, especially in a January 2025 blog post, and, for example, as a co-signatory of aletter to the BMJ. With this decades-long involvement, I have a considerable track record with many individuals, including staff and authors of Cochrane reviews. I keep my financial disclosures up-to-date here.
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