The future of the New Zealand Medical Journal

For almost 140 years, the New Zealand Medical Journal (NZMJ) has occupied a unique place in the intellectual and professional life of Aotearoa New Zealand. Established in 1887, only 47 years after the signing of Te Tiriti o Waitangi, it is one of the oldest continuously published medical journals in the Southern Hemisphere. Through world wars, pandemics, social change and healthcare reform, it has chronicled the evolution of medicine, public health and healthcare in New Zealand.

The NZMJ has never simply been a journal. It has been a national forum where clinicians, researchers, policymakers and public health leaders have shared ideas, debated policy, challenged assumptions and disseminated research relevant to New Zealanders. It has documented the changing health needs of our population, the development of our health system and the scientific advances that have improved the lives of generations of New Zealanders.

For most of its history, the Journal was owned and supported by the New Zealand Medical Association (NZMA) and, before that, by the New Zealand Branch of the British Medical Association. My 25 years as editor-in-chief have coincided with a period of profound change in academic publishing. During that time the Journal has evolved from a traditional print publication to a modern digital journal, introduced electronic manuscript management systems, developed specialty editorial portfolios and aligned its editorial policies with international best practice through the International Committee of Medical Journal Editors (ICMJE). While these changes strengthened the Journal and expanded its reach, they were accompanied by periods of significant uncertainty. The most serious arose in 2022 when the NZMA became insolvent and ceased trading, placing the future of New Zealand’s national medical journal at risk.

At that critical moment, the Pasifika Medical Association Group (PMAG) stepped forward and acquired the NZMJ. PMAG deserves enormous credit for ensuring the Journal’s survival at a time when its future was far from certain. More than simply preserving publication, PMAG invested substantially in modernising the Journal’s infrastructure. Manuscript management systems, publishing platforms, website functionality and operational processes were upgraded and brought into line with contemporary publishing standards. The transition to a robust digital platform, together with the adoption of open-access publishing, significantly increased the Journal’s accessibility, readership and impact.

The Journal has continued to thrive. It remains New Zealand’s principal peer-reviewed medical publication and an important outlet for research addressing Māori and Pacific health, rural healthcare, workforce challenges, health services research, clinical scholarship and public health. It also maintains a strong international presence through its indexing and through membership in the ICMJE, one of the most influential organisations in global medical publishing. The editor-in-chief of the NZMJ is one of only a small number of editors worldwide who serve on the ICMJE alongside editors of many of the world’s leading medical journals. Through this membership, New Zealand contributes directly to the development of international standards for publication ethics, authorship, transparency and research integrity.

Yet despite these achievements, the NZMJ finds itself again at a crossroads. PMAG has advised that, because of financial pressures and competing organisational priorities, it is no longer in a position to provide ongoing financial support for the Journal. This is not a reflection of any failure of the NZMJ or of PMAG’s stewardship. Rather, it reflects the reality that maintaining a high-quality national medical journal requires resources, expertise and long-term institutional commitment. PMAG’s contribution has been substantial, but it was never intended that the future of a national scholarly asset should rest indefinitely with a single organisation.

To avoid disruption to publication, an interim agreement has been established to support the Journal until 31 December 2026. The Journal has been very fortunate that under this arrangement, the medical schools of The University of Auckland and the University of Otago, as well as a private donor, have agreed to provide transitional funding while future ownership, governance and operational arrangements are explored. PMAG will continue to operate and publish the Journal during this period, ensuring continuity of publication and preservation of editorial independence. A steering group will examine options for the Journal’s future and provide recommendations regarding ownership, governance and sustainable funding. While this arrangement provides breathing space, it is not a long-term solution.

The challenge facing the NZMJ is not one of relevance, quality or impact, but of governance and sustainability. The Journal serves the entire New Zealand health sector. Its authors come from universities, Health New Zealand – Te Whatu Ora, professional colleges, specialist societies and community organisations. Its readership extends across the medical profession, academia, government and the wider public.

Health New Zealand – Te Whatu Ora could also be an important stakeholder in any future arrangement. A substantial proportion of the research published in the NZMJ originates from Health New Zealand – Te Whatu Ora clinicians, researchers and services, and its staff comprise a significant proportion of the Journal’s readership. As New Zealand’s largest healthcare provider and one of its largest research-active organisations, Health New Zealand – Te Whatu Ora should have a strong interest in ensuring the continued existence of a high-quality national medical journal. There may therefore be a role for Health New Zealand – Te Whatu Ora within a future governance and funding model alongside the universities and other stakeholders.

I would hope the new University of Waikato medical school could also become part of the consortium supporting the NZMJ. While the school remains in its infancy and is understandably focussed on establishing its educational and clinical programmes, I hope that as it develops it will be able to contribute alongside New Zealand’s established medical schools. This would reinforce the Journal’s position as a truly national academic and professional resource.

Any such arrangement, however, must be accompanied by robust protections for editorial independence. The NZMJ has a long tradition of publishing research, commentaries and editorials that scrutinise government policy, health sector performance and the actions of healthcare organisations, including Health New Zealand – Te Whatu Ora itself. This independent voice is one of the Journal’s greatest strengths and a key reason for its credibility. Financial support must never be accompanied by editorial influence. The credibility of the NZMJ depends upon its ability to publish rigorous research and informed commentary irrespective of whether that work is supportive or critical of governments, healthcare organisations or professional bodies. As such any future governance structure must preserve the principle that editorial decisions remain solely the responsibility of the editor-in-chief and editorial board.

It therefore seems increasingly appropriate that responsibility for its future should be shared more broadly among the universities, Health New Zealand – Te Whatu Ora and, perhaps, professional colleges, specialist societies and other organisations that contribute to and benefit from the Journal, while maintaining absolute editorial independence. Many countries recognise their national medical journals as part of their scholarly infrastructure. Universities, professional bodies and public institutions frequently work together to support journals that serve a national purpose. Such arrangements acknowledge that journals are not merely publishing enterprises; they are repositories of knowledge, forums for debate and vehicles for professional development.

The NZMJ should be viewed in exactly those terms. It is a national asset. It contributes to research dissemination, informs health policy, supports professional education and provides an independent platform for scientific and clinical discussion. It helps ensure that research relevant to New Zealand is visible, accessible and influential within New Zealand itself. Without it, much of that work would either not be published or become fragmented across international publications, reducing its visibility and impact on local practice and policy.

The coming months therefore present an important opportunity. The temporary funding arrangement allows time for thoughtful consideration of the Journal’s future. It provides an opportunity to develop a governance structure that protects editorial independence, secures sustainable funding and reflects the broad community that the Journal serves.

For generations, the NZMJ has chronicled New Zealand’s medical history, advanced medical knowledge and contributed to improvements in health and healthcare. The responsibility now rests with us to ensure that this national institution continues to serve both current and future generations of clinicians, researchers, policymakers and patients.

Frank Frizelle,

Editor-in-Chief, NZMJ.