Traditional medicine is integral to many cultures and plays an essential role in healthcare in Africa.
The Chinese Government has been ramping up its expansion of traditional Chinese medicine (TCM) in Africa as a key part of its controversial Belt and Road Initiative (BRI). Major TCM companies and countless clinics have already been established across Africa, with further plans to construct full supply chains from sourcing to sales.
A wider range of TCM products has never been more easily accessible in Africa, with pharmaceutical companies setting their sights on an emerging African market and consumer base, as well as seeing the continent as a potential source of TCM ingredients.
Unfettered growth of TCM, however, poses a serious threat to biodiversity in Africa, all in the name of short-term profit. Any utilisation of threatened species in TCM could stimulate further demand, incentivise wildlife crime and ultimately lead to overexploitation. High-level meetings such as the triennial Forum on China-Africa Cooperation (FOCAC) summit, expected to take place in late 2021, are important opportunities to address these concerns.
Executive summary
Traditional medicine is integral to many cultures and plays an essential role in healthcare in Africa.
The Chinese Government has been ramping up its expansion of traditional Chinese medicine (TCM) in Africa as a key part of its controversial Belt and Road Initiative (BRI). Major TCM companies and countless clinics have already been established across Africa, with further plans to construct full supply chains from sourcing to sales.
A wider range of TCM products has never been more easily accessible in Africa, with pharmaceutical companies setting their sights on an emerging African market and consumer base, as well as seeing the continent as a potential source of TCM ingredients.
Unfettered growth of TCM, however, poses a serious threat to biodiversity in Africa, all in the name of short- term profit. Any utilisation of threatened species in TCM could stimulate further demand, incentivise wildlife crime and ultimately lead to overexploitation. High-level meetings such as the triennial Forum on China-Africa Cooperation (FOCAC) summit, expected to take place in late 2021, are important opportunities to address theseconcerns.
Key findings of EIA research include:
- TCM is gaining ground in Africa, with an increasing number of African governments entering into official agreements with the Government of China to support TCM development;
- TCM is being further endorsed under national laws in certain African countries, as seen in Namibia and South Africa;
- TCM products containing animal parts are openly available for sale in retail outlets in Africa;
- the COVID-19 pandemic has enabled the Chinese Government to strengthen its promotion of TCM in Africa;
- there is an urgent need to address the risks posed by popularising TCM in Africa, notably resulting from
the expansion of TCM pharmaceutical companies targeting traditional African medicine (TAfM) and TCM consumers.This briefing is based on the key findings of preliminary desk-based research carried out between 2019-21; a brief field visit to Johannesburg, South Africa also verified some of these findings.
Background
According to the World Health Organisation, as much as 80 per cent of the African population relies on traditional medicine as their primary health care.1 Traditional medicine also plays a significant role in the preservation of cultural heritage and knowledge- sharing. With the widespreaduse of herbal and animal- derived remedies that resonate with local traditions, it is no surprise that millennia-old traditional Chinese medicine is gaining traction on the African continent.
TCM has a long history of expansion and of influencing the traditional medicine of other regions. Asian countries such as Korea, Japan, Laos and Vietnam all have traditional medicine which incorporate TCM philosophy 2, 3, 4 that continues to affect local thinking and consumption today. The expansion of TCM has also traditionally been coupled with the introduction of foreign medicinal species to enrich existing formulas.5
While only a small portion of TCM formulas use animal ingredients, the sheer size of the consumer base has made consumption of TCM a significant cause for the decline of species including tigers, leopards, pangolins and rhinoceros.6 As TCM expands in Africa, it could potentially change wildlife consumption patterns of local populations and exacerbate the pressure on these species and others.
EIA is concerned that the Chinese Government’s promotion of TCM in Africa will stimulate demand from both Asian and African consumers and increase the risk of poaching and habitat degradation.
China’s promotion of TCM in Africa
In a bid to build diplomatic relations and provide healthcare, the Chinese Government has been sending medical teams to Africa since 1963.
At least 21,000 medical professionals, including more than 2,000 TCM practitioners, have provided services in 45 countries including Cameroon, Malawi, Tanzania, Uganda, Zambia and Zimbabwe.7, 8 These efforts have formed a pivotal element of the Government’s foreign policy strategy in Africa.
This decades-long initiative has reinforced local acceptance of TCM and has paved the way for the expansion of TCM in Africa. Chinese media andacademics have repeatedly pointed to Africa as a place of great potential for the development of TCM.9, 10, 11
TCM has been a staple feature at FOCAC, a high-level platform which brings together 53 African countries and China. This year’s summit is being hosted by Senegal, and healthcare cooperation is expected to be high on the agenda.
One of the multilateral agreements signed by members of FOCAC is the Beijing Action Plan, which calls for strengthening collaboration in the development of agriculture, infrastructure, trade, education and healthcare. The latest edition of the Action Plan with strategic plans for 2019-21 states that members will “support the collaboration between TCM and TAfM, strengthen high-level exchange, encourage TCM and TAfM institutions to set up centres in Africa to provide medical service, education, research, and cooperation with the industries.” 12
Another notice issued by China’s State Council, China’s cabinet and its chief administrative authority reiterated that global TCM expansion was part of the country’s 2016-30 national strategy.13 The long list of ambitious global objectives set out in the strategy includes the construction of international TCM centres, the training of TCM practitioners locally, the registration of TCM products, the recruitment of new consumer groups and the expansion of the TCM industry to explore and source ingredients. With inter-governmental MoUs on cooperation for TCM signed and TCM pharmaceutical companies encouraged to set up factories in Africa, these top-down policies are beginning to be implemented on the ground.
Promoting the international trade in TCM products has become a key foreign trade objective. This ambition is partly being realised through China’s contentious BRI, President Xi Jinping’s multi-billion dollar infrastructure investment project. At the core of the initiative are five pillars – policy coordination, infrastructure development, unrestricted investment and trade, financial integration, and cultural and social exchange. According to a Government notice on the strategic plans for TCM from 2016-20, TCM is to be an integral part of each of these pillars.14
EIA has, however, noted cautionary tales about how transnational criminal syndicates and TCM traders
can exploit vulnerabilities in these BRI pillars, namely corruption and lack of law enforcement, to facilitate wildlife trafficking and other illicit activities.15, 16, 17 There is considerable risk that TCM expansion under the BRI could exacerbate the involvement of criminal networks in wildlife trafficking in Africa.
Opposite, and above: China has been increasing its investment and collaborations in Africa through the BRI and FOCAC. The Government has used the Covid-19 crisis to promote TCM across the continent.
Species under threat
The rapid population growth and rising demand for TCM in China has led to the unsustainable exploitation of wildlife, which has accelerated the decline of a range of species both in Asia and Africa. Notable species impacted include bears, rhinos, big cats, and pangolins.
Historically, when the supply of a TCM ingredient became scarce in China, traders set their sights on regions further afield. The supply of ingredients such as saiga horn, seahorses, tokay gecko and rhino horn has depended on their availability for importation into China. When the availability of a species becomes extremely scarce, related species may be exploited, as in the case of African lion bones being traded as tiger bones in TCM markets in Asia.18, 19
The risk to African flora and fauna is further exacerbated by the fact that there are key overlaps in the plant and animal species used in TAfM and TCM. Certain plant species used in TAfM formulas share the same genus as those used in TCM, while rhino, pangolin, tortoise, hedgehog and porcupine are all used as ingredients in both traditions.20 Such interlinkages could make relatively unexploited and less expensive African species attractive to the TCM industry, resulting in their exploitation by profit-driven TCM traders and pharmaceutical companies.
The Chinese Pharmacopeia, the official compendium which sets out the standards for the identification, processing and usage of TCM and conventional drugs, is updated every five years to reflect developments in the medical sector and changes in demand.21 New species can be added if there is sufficient consumer demand; for example, African plant species such as myrrh and frankincense were included as new ingredients in the official Chinese Pharmacopeia in 2010.
The exclusion of a species from the TCM ingredients section of the Pharmacopeia does not mean that the species is excluded from use as it could still be listed in the patent medicines (finished products) section.22 Moreover, TCM ingredients and patent medicines not listed in the Pharmacopeia can still be used in compliance with provincial standards and drug safety regulations.23 Consequently, threatened species such as elephants, leopards, lions and pangolins can still be utilised by the pharmaceutical industry regardless of whether or not they are listed in the official Pharmacopeia.
Such is the severe ecological damage caused by the use of threatened species in TCM that the central bank of Norway has decided to exclude four major TCM companies from its Government Pension Fund Global investment, one of the largest sovereign wealth funds in the world.24
Some traders in China are already marketing TAfM ingredients, such as moringa seeds and yohimbe bark sourced in Africa, as health supplements (“bao jian pin” 保 健品).25 This points to a clear money-making opportunity at the TAfM-TCM nexus. Without essential safeguarding regulations in place, the extraction of African wildlife and plants could quickly outstrip their populations in order to feed the expanding global demand for TCM.
Opposite, and above: Some of the world’s most iconic endangered species have suffered from the exploitation for TCM. It is pivotal to stop the use of threatened species in traditional medicine for the health of us all.
Risk of spread of zoonotic diseases
Since the start of the COVID-19 pandemic, the concept of One Health has gained traction,32 an approach to public health which recognises the interdependency of the wellbeing of people, animals and the environment.
Biodiversity is essential for a healthy environment. Overexploitation of any wildlife species, regardless of legality, disrupts the delicate balance of our global ecosystems, which in turn negatively impacts the stability of water sources, food production and the climate.
To meet the needs of the TCM industry, whether through sourcing from captive facilities or from the wild, animals need to be moved across large distances in unnaturally high concentrations at the supply, transit and processing levels of the trade chain. This brings different species into close contact one other and with humans, a known risk for zoonotic and emerging infectious diseases, as the COVID-19 pandemic has brought to light.33
Popularisation of TCM in Africa
Many African governments have welcomed large-scale investment from China andhave joined China’s BRI.34,35 This has enabled China to wield considerable diplomatic influence and power in Africa, paving the way for the expansion of TCM on the continent.
Among those which have agreements with China to develop traditional medicine are Cameroon, Mozambique, Nigeria, South Africa, Tanzania and Togo.36, 37, 38 By officially signing up to promote TCM domestically, these countries have endorsed TCM for use by their citizens. For example, South Africa and Namibia have officially endorsed TCM by recognising TCM treatments as part of their public healthcare systems,39, 40 while Uganda has actively sought cooperation with China to promote and integrate TCM into its healthcare framework.41 Even in other FOCAC member countries such as Zambia, where no official endorsement of TCM or bilateral agreement has been publicised, TCM clinics have been established and TCM products are openly available for sale.42 Crucially, all FOCAC countries are countries of concern due their involvement in illegal wildlife trade.
In the past two years, the COVID-19 pandemic presented the Chinese Government with an unexpected opportunity to globalise TCM and accelerate its promotion, both at home and abroad. The Government pushed TCM as an effective way to treat the coronavirus and among the products officially recommended was one that contained bear bile as an ingredient. In a bid to assist countries to combat COVID-19, the Chinese Government has further been sending TCM products and practitioners to Africa, Central Asia and Europe.43
Additionally, Chinese ministries and medical specialists held a series of video conferences with their counterparts from more than 40 African countries to advise on effective diagnostics and treatments for COVID-19, which included the application of TCM.44, 45 Lianhua Qingwen capsules, a herbal TCM patent drug endorsed by the Chinese Government for the treatment of COVID-19, has been registered for sale in Kenya, Mauritius, Mozambique, Uganda and Zimbabwe.46
A 2020 study showed that products made in Asia containing pangolin scales, tortoise shell or bear bile have been trafficked into South Africa for domestic consumption47 for both traditional Asian medicine and TAfM consumers. As TCM continues to gain traction on the continent, there is a risk that TAfM consumers, who are already accustomed to products with herbal ingredients or wildlife derivatives, could become a target market for TCM pharmaceuticals.
Many African countries face challenges from weak governance, poverty and corruption. An unfettered growth of TCM in these countries would pose a serious risk to the rich biodiversity found in these jurisdictions, potentially exacerbating poaching and creating a channel for illegal trade.
Above: TCM shops are becoming more common in Africa, such as this one in Johannesburg, South Africa.
Opposite, left: Commercial trade brings a range of wild animals in unnatural close contact with humans, increasing the risk of novel diseases.
Opposite, right: Traffickers capitalise on the expansion of TCM to Africa and exploit threatened species for this market.
Original report: https://eia-international.org/wp-content/uploads/2021-Lethal-Remedy-SINGLE-PAGES.pdf