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Building sustainability into the Belt and Road Initiative’s Traditional Chinese Medicine trade


A little-known aim of China’s Belt and Road Initiative (BRI) is ‘people-to-people cultural exchange’, including active promotion of Traditional Chinese Medicine (TCM) in BRI countries. On a global scale, this is likely to increase both TCM demand and the sourcing of wildlife-based TCM ingredients from new areas. Any rapid increase in wildlife demand risks exacerbating illegal and unsustainable trade but, with careful management, BRI–TCM could also present opportunities for well-governed supply chains, creating sustainable livelihoods for rural harvesters. With China reaching out to BRI countries to cooperate on the marketing, registration and promotion of TCM products, there is now a critical short-term window for the identification of these risks and opportunities, and to ensure that sustainability is built into these markets from the start.

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Fig. 1: Four-step approach to evidence-based sustainability strategies for BRI–TCM development.

Amy Hinsley (a,g); Andrey Giljov / Stepnoi Nature Sanctuary (b); Pixabay (d,e,h,i); William Rafti of the William Rafti Institute, under a Creative Commons license CC BY 2.5 (f)

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  1. List of BRI Countries (Chinese State Information Centre, 2019);

  2. Belt and Road Initiative (World Bank, 2019);

  3. Baniya, S., Rocha, N. & Ruta, M. Trade Effects of the New Silk Road: A Gravity Analysis Working Paper No. 8694 (World Bank, 2019).

  4. Building the Belt and Road Initiative: Progress, Contribution and Prospects (The State Council Information Office of the Peoples Republic of China, 2019);

  5. Chen, J. Chinese Medicine Popular Along BRI Routes (Chinese State Information Centre, 2018);

  6. Zhang, X. et al. Discussion on exploitation of foreign traditional Chinese medicine resources based on “the Belt and Road”. Zhongguo Zhong Yao Za Zhi 43, 1501–1506 (2018).

    Google Scholar 

  7. Cyranoski, D. Why Chinese medicine is heading for clinics around the world. Nature 561, 448–450 (2018).

    Article  CAS  Google Scholar 

  8. Hsu, E. ‘The medicine from China has rapid effects’: Chinese medicine patients in Tanzania. Anthropol. Med. 9, 291–313 (2002).

    Article  Google Scholar 

  9. De Prince Pokam, H. Chinese medicine in Cameroon. China Perspect. 3, 9 (2011).

    Google Scholar 

  10. Hsu, E. in Medicine, Mobility, and Power in Global Africa: Transnational Health and Healing (eds Dilger, H. et al.) 295–315 (Indiana University Press, 2012).

  11. Jamaludin, S. S. S. & Aloysius, M. in Silk Road to Belt Road: Reinventing the Past and Shaping the Future (ed. Islam, M. N.) 261–278 (Springer, 2019).

  12. The World Health Organization’s decision about traditional Chinese medicine could backfire. Nature 570, 5 (2019).

  13. Esmail, N. et al. Emerging illegal wildlife trade issues in 2018: a global horizon scan. Preprint at SocArXiv (2019).

  14. Lechner, A. M., Chan, F. K. S. & Campos-Arceiz, A. Biodiversity conservation should be a core value of China’s Belt and Road Initiative. Nat. Ecol. Evol. 2, 408–409 (2018).

    Article  Google Scholar 

  15. Tracy, E. F., Shvarts, E., Simonov, E. & Babenko, M. China’s new Eurasian ambitions: the environmental risks of the Silk Road Economic Belt. Eurasia. Geogr. Econ. 58, 56–88 (2017).

    Article  Google Scholar 

  16. Ascensão, F. et al. Environmental challenges for the Belt and Road Initiative. Nat. Sustain. 1, 206–209 (2018).

    Article  Google Scholar 

  17. Zhou, L., Gilbert, S., Wang, Y., Cabré, M. M. & Gallagher, K. P. Moving the Green Belt and Road Initiative: From Words to Actions (World Resources Institute, 2018).

  18. Xiao, L. & Zhao, R. China’s new era of ecological civilization. Science 358, 1008–1009 (2017).

    CAS  Google Scholar 

  19. Meng, X., Liu, D., Feng, J. & Meng, Z. Asian medicine: exploitation of wildlife. Science 335, 1168 (2012).

    Article  CAS  Google Scholar 

  20. Kling, J. Protecting medicine’s wild pharmacy. Nat. Plants 2, 16064 (2016).

    Article  Google Scholar 

  21. Coghlan, M. L. et al. Deep sequencing of plant and animal DNA contained within traditional Chinese medicines reveals legality issues and health safety concerns. PLoS Genet. 8, e1002657 (2012).

    Article  CAS  Google Scholar 

  22. Liu, H., Luo, Y.-B., Heinen, J., Bhat, M. & Liu, Z.-J. Eat your orchid and have it too: a potentially new conservation formula for Chinese epiphytic medicinal orchids. Biodivers. Conserv. 23, 1215–1228 (2014).

    Article  Google Scholar 

  23. He, J., Yang, B., Dong, M. & Wang, Y. Crossing the roof of the world: trade in medicinal plants from Nepal to China. J. Ethnopharmacol. 224, 100–110 (2018).

    Article  Google Scholar 

  24. Anderson, S. C., Flemming, J. M., Watson, R. & Lotze, H. K. Serial exploitation of global sea cucumber fisheries. Fish. Fish. 12, 317–339 (2011).

    Article  Google Scholar 

  25. Graham-Rowe, D. Biodiversity: endangered and in demand. Nature 480, S101–S103 (2011).

    Article  CAS  Google Scholar 

  26. Xu, L., Guan, J., Lau, W. & Xiao, Y. An Overview of Pangolin Trade in China (TRAFFIC, 2016).

  27. Theng, M., Glikman, J. A. & Milner-Gulland, E. J. Exploring saiga horn consumption in Singapore. Oryx 52, 736–743 (2018).

    Article  Google Scholar 

  28. Farhadinia, M. S. et al. Belt and Road Initiative may create new supplies for illegal wildlife trade in large carnivores. Nat. Ecol. Evol. 3, 1267–1268 (2019).

    Article  Google Scholar 

  29. Williams, V. L. & Sas-Rolfes, M. J. T. Born captive: a survey of the lion breeding, keeping and hunting industries in South Africa. PLoS ONE 14, e0217409 (2019).

    Article  CAS  Google Scholar 

  30. Zhao, Z., Guo, P. & Brand, E. The formation of daodi medicinal materials. J. Ethnopharmacol. 140, 476–481 (2012).

    Article  Google Scholar 

  31. Brinckmann, J. Geographical indications for medicinal plants:globalization, climate change, quality and market implications for geo-authentic botanicals. World J. Tradit. Chin. Med. 1, 16–23 (2015).

    Article  Google Scholar 

  32. Schwabl, H. & van der Valk, J. Challenging the biomedical notion of ‘active substance’: the botanical plasticity of Tibetan medical formulas. HIMALAYA 39, 1 (2019).

    Google Scholar 

  33. Challender, D. W. S., Harrop, S. R. & MacMillan, D. C. Understanding markets to conserve trade-threatened species in CITES. Biol. Conserv. 187, 249–259 (2015).

    Article  Google Scholar 

  34. Winkler, D. Caterpillar fungus (Ophiocordyceps sinensis) production and sustainability on the Tibetan Plateau and in the Himalayas. Asian Med. 5, 291–316 (2009).

    Article  Google Scholar 

  35. Yadav, P. K. & Badola, S. Challenges in Conservation and Sustainable Trade of Caterpillar Fungus in India (TRAFFIC, 2019).

  36. Yadav, P. K. et al. Yartsagunbu: transforming people’s livelihoods in the Western Himalaya. Oryx 53, 247–255 (2019).

    Article  Google Scholar 

  37. Brinckmann, J. A. et al. Sustainable harvest, people and pandas: assessing a decade of managed wild harvest and trade in Schisandra sphenanthera. J. Ethnopharmacol. 224, 522–534 (2018).

    Article  CAS  Google Scholar 

  38. Cooney, R. et al. The Trade in Wildlife: A Framework to Improve Biodiversity and Livelihood Outcomes (International Trade Centre, 2015).

  39. Sustainable Sourcing: Markets for Certified Chinese Medicinal and Aromatic Plants (International Trade Centre, 2016).

  40. Milner-Gulland, E. J. A population model for the management of the saiga antelope. J. Appl. Ecol. 31, 25–39 (1994).

    Article  Google Scholar 

  41. Memorandum of Understanding Concerning Conservation, Restoration and Sustainable Use of the Saiga Antelope (Convention on Migratory Species, 2015).

  42. Williams, S. J., Jones, J. P. G., Annewandter, R. & Gibbons, J. M. Cultivation can increase harvesting pressure on overexploited plant populations. Ecol. Appl. 24, 2050–2062 (2014).

    Article  CAS  Google Scholar 

  43. Sheng, X., Zhang, H. & Weng, Q. China’s bear farms prompt public outcry. Nature 484, 455–455 (2012).

    Article  CAS  Google Scholar 

  44. Challender, D. W. S. et al. Evaluating the feasibility of pangolin farming and its potential conservation impact. Glob. Ecol. Conserv. 20, e00714 (2019).

    Article  Google Scholar 

  45. Livingstone, E., Gomez, L. & Bouhuys, J. A review of bear farming and bear trade in Lao People’s Democratic Republic. Glob. Ecol. Conserv. 13, e00380 (2018).

    Article  Google Scholar 

  46. But, P. P., Lai-Ching, L. & Yan-Kit, T. Ethnopharmacology of rhinoceros horn. I: Antipyretic effects of rhinoceros horn and other animal horns. J. Ethnopharmacol. 30, 157–168 (1990).

    Article  CAS  Google Scholar 

  47. Liu, R. et al. Available sustainable alternatives replace endangered animal horn based on their proteomic analysis and bio-effect evaluation. Sci. Rep. 6, 36027 (2016).

    Article  CAS  Google Scholar 

  48. Dhakal, P., Paudel, D. R. & Baral, D. R. Inventory of non-timber forest products in Western Nepal and strategies for sustainable management. Int. J. Environ. 5, 87–103 (2016).

    Article  Google Scholar 

  49. Succeeding with CITES: new project aims to promote sustainable wild Jatamansi trade from Nepal. TRAFFIC (18th October 2018);

  50. Maraseni, T. N., Shivakoti, G. P., Cockfield, G. & Apan, A. Nepalese non-timber forest products: an analysis of the equitability of profit distribution across a supply chain to India. Small-Scale Econ. Manag. Policy 5, 17 (2006).

    Google Scholar 

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A.H. was funded by the Oxford Martin Programme on the Illegal Wildlife Trade, and by the Kadas Fellowship at Worcester College, Oxford. The Oxford Martin School supported a visiting fellowship for T.M.L. during which this piece was developed. We thank E. Hsu for her comments and advice.

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A.H. and T.M.L. came up with the initial idea, which was refined in discussions with all other authors. A.H. drafted the first version of the manuscript, which was then edited and revised with input from all authors. T.M.L. produced the figure. with input from all authors. All authors approved the final version.

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Correspondence to Amy Hinsley or Tien Ming Lee.

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Hinsley, A., Milner-Gulland, E.J., Cooney, R. et al. Building sustainability into the Belt and Road Initiative’s Traditional Chinese Medicine trade. Nat Sustain 3, 96–100 (2020).

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