Substitutability of CITES-listed species in traditional Chinese medicine amongst the general public in Hong Kong

While most medicinal ingredients used in TCM are derived from plants, the use of animal-based medicines from threatened and endangered species has raised significant conservation concerns. We conducted a quantitative survey in 2023 with a population-based sample (n = 1556) in Hong Kong. In addition to gathering baseline data about TCM attitudes and use, we used an experimental vignette survey to assess the willingness to accept substitutes for five products: a) tiger bone, b) bear bile, c) tokay gecko, d) seahorse, and e) saiga antelope horn. We examined how acceptance for substitutes is impacted by the combination of five factors: price, the legality of the original product, the type of substitute (domestic animal, synthetic, or plant-based), availability of the substitute, and conservation status of the species. 72.1 % of respondents believed that TCM is effective and 28.7 % used wildlife supplements as part of TCM. However, the use of synthetic and plant-based TCM supplements was higher than that of wildlife-based ones, and past consumption of substitutes ranged from moderate (34.6 % for saiga) to high (61.9 % for seahorse). In logistic regression models, factors that increased substitutability acceptance differed by species. For bear bile and tokay gecko, having an easily available substitute increased substitutability. For tiger bone, the conservation status of wild tigers impacted substitutability. Price was a significant factor for both saiga and seahorse. We discuss how approaches tailored to specific products, as well as preexistent attitudes towards TCM, can increase the sustainability of TCM and the protection of CITES-listed species in Hong Kong.