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The public and societal importance of the field of Health led to it being one of the first fields to switch from paper to digital journals in the late 1990s. As Momen [MOM 03] points out,

Health is perhaps the area of most intense demand for greater access to scientific and technical information, partly because failure to obtain it can be literally fatal.

When experimenting with the first electronic journal projects, publishers always included biomedical titles in their corpus [WIL 94]. This is not insignificant because, perhaps more than in any other field, the high financial stakes that govern health research place the scientific publication system at the heart of the mechanisms of permanent competition. With the deployment of the Web in the early 2000s and the rules of its attention economy [CIT 13], Open Access to scientific information has even become a value [RIF 05] around which public policies have turned to reach out to researchers, with recommendations and requirements. As a reminder, according to the Budapest Declaration of 2002⁴, Open Access is defined by two complementary channels. The Green Road – or self-archiving – characterized by archiving and online publication of a copy of articles in an open archive, possibly with an embargo period. The Gold Road, characterized by a publication with free, open and immediate access in an Open Access journal.

In the early 2000s, the United States developed and ultimately mobilized open access to health information. The famous National Institute of Health (NIH), a government agency directly dependent on the Department of Health, was a major player and in 2004 adopted a policy in favor of Open Access, supported by the PubMed Central database, essential for researchers in the field. Researchers were invited to archive a copy of their published article on PubMed Central no later than 6 months after its publication [ZER 04]. Four years later, in 2004, this incentive became mandatory, with a 12-month period. As Moorhead et al. [MOO 15] point out,

As a policy leader and major funder of health research, the NIH has, through its Public Access Policy, placed health literature at the forefront of the move toward open access to research.

In fact, unlike fields such as high-energy physics, where communities have mobilized around the principles of Open Access and have set up Open Repositories [GIN 97], in Health, it is public policies that, in light of the public health issue, have placed Open Access at the heart of thinking behind models for the dissemination of validated scientific information. Peter Suber [SUB 08] emphasizes the unprecedented nature of the approach, which was initiated by United States legislation and implemented by funding agencies.

The pioneering approach of the NIH spread like wildfire and saw other repository mandates and similar policies develop around the world [PIW 18]; the National Science Foundation (NSF), the European Commission (EC), the Wellcome Trust and, even more recently, the Bill & Melinda Gates Foundation [BUT 17] to name just a few of the funding agencies embracing the same Open Access policy principles for the researchers they fund.

A few months after the launch of the compulsory mandate of the NIH, the European Commission launched its own Open Access pilot project as part of the 7th European Framework Program⁵. This pilot project – which accounted for 20% of the total budget of the framework program – was allocated to seven research themes considered priorities in the context of the construction of the European Research Area, including Health. Researchers receiving European funds had to:

Strive to provide open access to these articles within six or twelve months – set according to the field of research – after publication.

In the framework of Horizon 2020 where Health is a major strategic focus, Open Access to research results (publications and data) has become the new standard for scientific and technical information (STI) dissemination. Commission Recommendation (EU) 2018/790 of April 25, 2018 on access to and preservation of scientific information⁶ asked member states to:

Define and implement clear policies […] for the dissemination of and open access to scientific publications resulting from publicly funded research.

The success of these aligned policies can be measured by the 5.9 million articles published worldwide. And as has been pointed out [TEN 16], the cumulative number of Open Access articles has increased far more than the number of non-full-text articles. Meanwhile, during the pandemic, downloads of articles indexed with the keyword “Covid-19” were in the millions [KOU 20] and were not generated by researchers alone. Members of the general population, wanting to be informed, accessed these articles using search engines.