The world needs an alternative to PubMed

In May the German National Library of Medicine announced its plan to develop an open, sustainable, and sovereign alternative to PubMed, the free online biomedical database housed in the National Library of Medicine at the National Institutes of Health.  

The announcement of this alternative was greeted with interest and support, particularly from those who see the need for digital sovereignty and infrastructural resilience. The project, ZB MED, has been gathering steam, pulling in European partners, publishers, and funders to turn the vision into reality. Its search engine LIVIVO is now available for literature and information in the health field.

But some are asking: Do we really need a second PubMed? Could it drain resources or even turn science infrastructure into a political football if every country builds its own?

The mixed reception underscores that the initiative is not only a technical undertaking but also a symbolic intervention in how global scientific communication is organized.

The German initiative may be a reaction to the approach the Trump administration has taken to government support of the biosciences, or it may simply be a regional adjustment. Either way, it has forced a long-overdue conversation: What happens to science when the whole world leans on one country’s library?

PubMed has never really stood alone: It already coexisted alongside Europe PMC, Embase, and other specialized databases. But it has long held symbolic and functional dominance over its field. It has also traditionally supported global accessibility and standardized searchability.

Yet recent debates have raised concerns about PubMed’s reliability, stability, and openness. Depending on a U.S.-run platform for the world’s biomedical record feels shaky given changing politics, budgets, and priorities. Questions have also been raised about the transparency of indexing and search algorithms, which influence which studies are surfaced and cited. Additional concerns relate to coverage gaps and to the future of open access when visibility is tied to a single, centralized repository. In short, when one gatekeeper controls what shows up on your screen, the risks are bigger than just missing a paper or two.

This is not merely a technical concern. It is a philosophical, political, and civic one. And it seems more acute now that the Trump administration has created concerns over political interference with science and evidence. The architecture through which scientific knowledge is expressed and disseminated in words and symbols is not neutral. It encodes values, reflects power, and configures public trust. Putting too much power into one system invites trouble: politics, bottlenecks, bias.

Consider an analogy between PubMed and the Tower of Babel, as described in Genesis 11 and brought to life on canvas in 1563 by the Dutch master Pieter von Bruegel the Elder. We see an unfinished, spiraling tower, cast in the grandeur of Roman design and surrounded by industrious builders, a portrait of human aspiration and a powerful caution against the illusion of our ability to control the world’s knowledge. Humankind, speaking a single language, set out to build a tower reaching the heavens.

This was not simply an engineering project; it was an act of hybris, an attempt to become like God, to ascend without limit, to unify power and meaning into a singular, vertical structure. The response: a scramble of languages, scattering of people, and the end of one voice for all.

Traditionally, this moment is interpreted as a divine punishment. But reading it differently, the dispersion of languages was not a curse. It was protection: against too much power in one place, against the flattening of human diversity into a single voice.

Just as no scientific theory should be immune from scrutiny, no infrastructure should be immune from rigorous alternatives. Germany’s initiative is not a rejection of standardization or coordination. It is a timely act of global stewardship, a recognition that resilience, in science as in society, requires redundancy, transparency, and structural pluralism.

Seen in this light, the German project ensures that a single fragile pipeline doesn’t bottleneck good science. It reminds us that scientific rigor (transparency, reproducibility, and peer review) is not enough if the channels through which scientific information reaches society are fragile, opaque, or monopolized. This initiative rightly challenges our once comfortable assumption that one infrastructure, however robust, can forever bear the burden of global scientific communication. The risk is not that too many voices will be heard, but that a single system may quietly determine which voices are heard at all.

Historical examples illustrate this vividly. Galileo, silenced by religious orthodoxy, found alternate paths to circulate his discoveries through coded texts and letters. Einstein, a patent clerk on the margins of academia, revolutionized physics not by rejecting rigor, but by pursuing it outside dominant institutions. Lev Landau, in the oppressive climate of Soviet science, still advanced foundational insights despite ideological scrutiny. Again and again, breakthroughs survived not because the system made room, but because someone built a workaround.

Thomas Kuhn, in “The Structure of Scientific Revolutions,” articulated this dynamic with lasting clarity. Scientific change, he argued, does not follow a linear path of accumulation. It proceeds through rupture, displacement, and reconfiguration: not from consensus, but from the productive pressure of alternative frameworks. In the digital age, the question becomes: where can those alternative frameworks even appear, if our knowledge pipelines are too narrow?

Today, the architecture of knowledge is being rebuilt through digital systems. Artificial intelligence, machine learning, and search algorithms increasingly mediate what is surfaced, trusted, and cited. These systems, including large language models, are not impartial. They are trained with implicit biases inherent in their design, which shape subsequent outputs. They don’t just deliver knowledge; they decide what counts as knowledge. They determine what counts, what circulates, and what disappears.

In such a landscape, centralized platforms risk becoming not only gatekeepers of knowledge, but monopolies of visibility. Science thrives on many doors, not one locked gate. It must be cultivated through a distributed ecosystem of access: multiple entry points, interoperable systems, and transparent governance. This is precisely what the German proposal offers: not fragmentation, but purposeful decentralization. A commitment to shared rigor without singular dependence. A hedge against infrastructural fragility, political manipulation, and the quiet erosion of intellectual diversity.

In the end, science does not demand unanimity. It demands integrity, openness, and enough imagination to protect its own future. Trust in science is not strengthened by narrowing gateways and penalizing divergent thinking, but by building transparent and plural infrastructures through which truth can be pursued and reached by many paths.

Sara Rubinelli is professor of health communication and vice-dean of health sciences at the faculty of health sciences and medicine of the University of Lucerne, Switzerland. Rebecca K. Ivic is associate dean of research and professor, College of Communication & Information Sciences, the University of Alabama. Kenneth Rabin is senior scholar, City University of New York, Graduate School of Public Health and Health Policy. Lawrence O. Gostin is distinguished university professor and director of the WHO Center on Global Health Law, Georgetown University. Scott C. Ratzan is distinguished lecturer, City University of New York, Graduate School of Public Health and Health Policy and the editor-in-chief of the Journal of Health Communication.