‘Open-access publication’ is a complex and multi-layered term that can be confusing and perceived differently by various stakeholders. The term open-access has been defined in variable ways in the Berlin, Bethesda, and Budapest Declarations of the early 2000s (BBB or triple B declarations).1, 2, 3 In a broad sense open access (OA) papers are those where the authors and the publishers provide free access to any reader who has internet access. Essentially it is a publishing model that provides research as ‘free to read’ and re-use provided the source is appropriately attributed. So, if anyone can have access to a particular paper and the authors of it can distribute their work freely, how would the publisher be compensated for the cost involved in publishing? Publishing houses are not charitable organizations, and they usually make profits from the article subscription charges. Hence in open-access publishing, the cost of the publication and the loss of subscription profits are compensated by article processing charges (APC), which are levied by the publishers on the authors or their institutions. The typical APCs for most journals range from $1500 - $5000 but may be higher for more prestigious journals.1, 3 OA papers are published with different types of Creative Commons licence (CC BY, CC BY-NC, CC BY-NC-ND, CC BY-NC-ND-SA) by which the authors retain their copyrights and what others can do with the research work provided full credit is given to the original source.