Ejiao and the donkey skin trade: An urgent One Health concern

The purpose of this column is to call your attention to a serious, yet largely unseen issue that contravenes virtually every animal welfare requirement that most countries regulate and that all veterinarians should hold as foundational to the work that we do; namely, the donkey skin trade and ejiao. The donkey skin trade is a growing global issue impacting the health and welfare of humans, animals, and the environment. The veterinary profession holds a responsibility for raising awareness of this matter and in calling for regulations necessary to minimize its impacts.

What is ejiao?

Ejiao, a gelatin product obtained from boiling donkey skin, is popular in traditional Chinese medicine. Originally marketed as an expensive delicacy with widespread healing properties, it has been diluted over time with various products that reduced its cost and therefore exponentially increased consumption and demand (1).

Although Africa is currently the primary source of donkey skins (legally or illegally obtained), this is a global issue on all fronts. Increasing demand has reached unsustainable levels, with more than 4.8 million skins estimated to be required annually to meet demand (2). At current growth rates, the global donkey population could be halved within 5 y — assuming, of course, that demand does not further increase (2).

Why should the veterinary profession be concerned?

Animal and human welfare, public health, and the environment have all been impacted by the unethical and illicit activities associated with obtaining donkey skins. Health risks apply to both humans and animals, including potential exposure to tetanus, anthrax, and other zoonotic diseases (2,3). The 2019 equine influenza outbreak in West Africa, for example, resulted in 60 000 Nigerian donkey deaths and has been attributed in part to illegal cross-border donkey transport (2).

There are negative consequences for donkey welfare as a result of these increasing practices, including neglect, mistreatment, starvation, transportation, and inhumane slaughter (2). Up to 20% of donkeys arrive deceased following transport and a “natural” death is often favored in lieu of humane slaughter or euthanasia and the expenses they incur (3). The hide of a donkey is not influenced by the overall condition of the animal, so there is no financial incentive to ensure positive health states (1).

Social and economic implications of the loss of donkeys also affect some of the world’s most vulnerable human communities. Donkeys are estimated to support the livelihoods of up to 500 million people, largely in poorer populations and, disproportionately, women (3). They are relied on for movement of goods and necessities (e.g., drinking water), access to education, and as an income source (2,3). The loss of even a single donkey can thus restructure the burdens and roles of family caretakers, presenting a potential equity concern as well.

Increased breeding is not sufficient to keep up with current rates of population loss, considering this species’ long gestation, low fecundity, and propensity for abortion and death in response to stress (4). Although difficult to accurately define demand increases due to the illegal and unregulated nature of the trade, annual industry growth rates have reached double digits in the past (e.g., 3200 to 5400 tons from 2013–2016 or > 20% annual increase) (3). This is in contrast to an approximately 1% annual population growth rate for donkeys in countries such as Kenya (2).

What actions have been taken?

In November 2023, the African Union endorsed a report urging a moratorium on the donkey skin trade. The report, produced by the African Union-Interafrican Bureau for Animal Resources (AU-IBAR) and authored with the support of numerous equine welfare agencies, underscored the extent of population decline in donkeys, and highlighted both the welfare and socio-economic impacts of the growing ejiao market (5). As of the time of writing, the report’s recommendations are set to be put forward for adoption by the Assembly of Heads of States and Governments in early 2024 (5). Although the potential for an African moratorium is promising, Canada must remain cognizant of the inevitable attempts by market players to circumvent regulations and should implement its own regulatory safeguards to prevent the sale and purchase of illicit products.

The United States, which is the largest importer after China and Hong Kong (6), has taken some actions, including the American Veterinary Medical Association’s (AVMA) 2018 vote to endorse an American Association of Equine Practitioners (AAEP) statement condemning the donkey skin trade (7), and Representative Don Beyer’s introduction of the Ejiao Act (H.R. 5203) to prohibit the sale or transport of products made from donkey skins (6). However, these efforts alone are insufficient in addressing the global impact of this industry, which continues to grow. There is, to date, no Canadian legislation prohibiting the import of ejiao or related products. It is incumbent on Canadian veterinary bodies or organizations to refer the public to existing educational materials on the donkey hide trade and products, to publish formal statements on the issue and to lobby the federal government for a prohibition of the importation of these products in light of the poor animal welfare standards in harvesting the core ingredient.

It is important for veterinary professionals to actively address these types of issues due to our position as leaders of such discussions in the eyes of the general public. The AAEP statement notes a commitment to creating awareness of ejiao-related concerns within the North American veterinary community (8). As AAEP past president Dr. Margo MacPherson said of the AVMA’s endorsement of her organization’s statement, “[it] strengthens the position’s impact in the global arena” (4).

What steps can the Canadian veterinary community take?

The first step in addressing a complex issue is understanding the extent of the problem. The details of the ejiao market’s impact in Canada are limited at best, with little data available surrounding consumption, quantity and origin of imports, and degree of uptake among Canadian practitioners of traditional Chinese medicine. Whereas one may extrapolate proportionate Canadian demand from the estimated $12 million in annual ejiao imports in the United States, there are no reliable numbers available characterizing the industry here in Canada (1,7). Likewise, with the popularity of e-commerce transcending the typical boundaries of regional purchasing, it remains unknown to what extent consumers may be able to circumvent any federal restrictions implemented in the future.

Global Affairs Canada, the federal agency responsible for export and import controls, currently provides no information or insight related to the ejiao market. The agency’s own mandate acknowledges the need for responsible business practices that include an active interest in poverty reduction, female empowerment, and environmental sustainability, among other important endeavors (9). The far-reaching consequences of the ejiao industry in its current state should be urgently addressed by the appropriate government bodies and should disturb any professional subscribing to the One Health philosophy.

As veterinarians, we are often the first to not only raise awareness of pressing animal-related issues, but also the first to take deliberate steps to address such issues. As a relevant example of such a matter, the World Veterinary Association has established a position statement on the use of horses in the production of biological therapy products — a statement in which mention of ejiao is conspicuously absent (10). This statement addresses ethical and welfare concerns, urges prioritization of animal care, calls for “updated and transparent management” of related industries, and supports development of alternative products (10). It serves as an appropriate template for incorporation of similar standards for the ejiao market (10).

Given our profession’s enthusiastic promotion of One Health and its related concepts, it is clear that an explicit stance on this issue must be determined. Although the consequences are not likely to directly impact our Canadian clients or patients, we would be remiss in remaining silent on this critical matter.