Risks and opportunities for sustainability as Traditional Chinese Medicine expands along the Belt & Road

Amy Hinsley and Tien Ming Lee

Promoted as a 21st century version of the ancient Silk Roads, China’s Belt & Road Initiative (BRI) is a multi-billion-dollar project that will link China with countries in Southeast and Central Asia, East Africa, Europe and beyond, building a network that will include almost two thirds of the world’s population. The BRI is best known as an infrastructure project, building roads, railways and shipping links between China and countries around the world. However, the BRI also includes the expansion of Traditional Chinese Medicine (TCM), a key part of the Initiative’s aim to foster ‘people-to-people exchange’ through cultural connectivity.

From a conservation and sustainability perspective, the roads, railways and ports that form the land ‘belts’ and marine ‘roads’ of the BRI have received some attention but the aim to expand TCM to the world has not. These rapidly growing markets could put pressure on the plant, animal and fungal species used as TCM ingredients, and may also promote illegal trade to supply informal markets for wildlife products used as medicines. In our new paper in Nature Sustainability (which is also available in Chinese) we evaluate the potential risks and opportunities of Traditional Chinese Medicine expansion via the BRI, with a focus on developing strategies for well-managed, sustainable wildlife trade chains.

An informal TCM market in Guangzhou, China selling products including bear gallbladders (potentially fake), caterpillar fungus, and orchid tubers.

The idea for this paper came when we were in China in 2018, collecting data for a collaborative project focussed on the sustainability of TCM trade. That week we had been reading in Chinese State media about the great opportunities that the BRI would bring for the expansion of demand and supply for the TCM industry, and were surprised this was not being discussed more widely for its potential implications for wildlife trade. A week later in Beijing we met with representatives of the Chinese Association of TCM, who work with the TCM industry, including on BRI expansion. In that meeting we established that there was interest in developing more sustainable TCM supply-chains in BRI countries. However, we also realised that the situation was going to be highly complex, with both supply and demand of TCM products likely to vary greatly between different countries and regions.

To best assess the risks and opportunities, we invited authors from different disciplines and sectors to help develop a strategy for sustainability that could account for the complexity of BRI TCM markets. The final author team includes academics and practitioners working on wildlife trade, livelihoods, and sustainable supply-chains for medicinal plants, as well as a policy-maker in China with experience of working on TCM and conservation. Together, we developed a four-step process to identify BRI TCM risks and opportunities, and highlight the importance of Chinese leadership in this process, which aligns with the country’s goals of a green BRI.


As the BRI enters its seventh year China is reaching out to more countries to cooperate on the marketing, registration and promotion of Traditional Chinese Medicine products. There is now a critical short-term window for the identification of potential risks and opportunities, to ensure that sustainability is built into these markets from the start.