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Medical Radioisotopes still Produced but Facing Distribution Challenges Globally, Data Collected by IAEA Shows

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A researcher at Indonesia’s National Nuclear Agency (BATAN) is using a hot cell to prepare a radiopharmaceutical. (Photo: M. Gaspar/IAEA)

The production of radioisotopes used in medicine has continued during the COVID-19 pandemic, but hospitals could face shortages due to bottlenecks in transport and distribution. This is the picture emerging from a survey conducted by the IAEA among research reactors that produce radioisotopes for radiopharmaceuticals – medicines containing small amounts of radioactive isotopes used for the diagnosis and management of some cancers and chronic diseases.

As the lockdown triggered by the COVID-19 pandemic around the world affects the delivery of goods and services, the IAEA recently conducted a survey among major reactor-based medical radioisotope producers to assess the continuity of the supply chain.

“The survey conducted by the IAEA shows that most major actors continue to produce radioisotopes, as the production facilities have been defined as essential by the relevant governments,” said Ram Sharma, Acting Head of the Research Reactor Operation and Maintenance Section at the IAEA.

“Most research reactors whose production of radioisotopes is vital for health care continue to operate, in line with the relevant IAEA Safety Standards, after having introduced measures to prevent the effects and spread of coronavirus, including the number of staff on site and social distancing measures,” said Amgad Shokr, Head of the Research Reactor Safety Section at the IAEA.

At the same time, due to the COVID-19 pandemic, many airlines are no longer operating, and borders are closed, which affects the distribution of medical radioisotopes around the world.

“The IAEA is working to assess the present need of medical radioisotopes, as most research and education activities using isotopes have been put on hold and many hospitals have delayed diagnosis applications. A webinar is planned with stakeholders from around the globe to help define needs, share best practices of operations and identify means to ease the bottlenecks, in order to ensure the continuity of the supply chain for patients,” said Joao Osso Junior, Head of the Radioisotope Products & Radiation Technology Section at the IAEA.

The example of South Africa

South Africa is among the major producers of medical radioisotopes, supplying clients all around the world.

The South African government announced a national lockdown as of 27 March 2020 to prevent the spread of the COVID-19 virus. Medical radioisotopes are classified as essential products and, as such, research reactor SAFARI-1 and South African manufacturer NTP Radioisotopes continue operations to produce them. Both SAFARI-1 and NTP Radioisotopes have implemented operational restrictions to curb the spread of COVID-19 on-site.  

Despite these measures, production is now below capacity, due to challenges in the cross-border distribution of the radioisotopes produced and to a decrease in international orders, as global medical efforts focus on responses to the pandemic. To accommodate this, NTP Radioisotopes has adjusted its production runs since lockdown but has continued sending out weekly shipments. The operation of SAFARI-1 has continued in tandem. It is envisaged that radioisotope production in these facilities will increase as lockdown measures across the globe are adjusted.

“Highest medical priority is given to COVID-19 patients in most or all countries, but let us not forget the millions of patients who depend on medical radioisotopes,” said Koos du Bruyn, Senior Manager of the SAFARI-1 Research Reactor at the South African Nuclear Energy Corporation (NECSA).  Global distribution of medical radioisotopes has been ensured through a partnership with South Africa's state-owned national carrier, South African Airways.

While some countries and companies are organizing charter flights for the delivery of radiopharmaceuticals, not all governments can afford that, Osso Junior said. 

Distribution chain

The most common medical radioisotope, technetium-99m (Tc-99m), is used in some 40 million procedures per year, according to the World Nuclear Association. It accounts for about 80% of all nuclear medicine procedures and 85% of diagnostic scans in nuclear medicine worldwide.

Technetium-99 comes from molybdenum-99 (Mo-99), and all major producers of this radioisotope continue to operate, according to the results of a survey conducted by the IAEA. Research reactors in Argentina, Australia, Belgium, France, Poland, the Netherlands, Russia, South Africa and the United States are prepared to continue to meet demand. Once molybdenum-99 is ready, it is sent to other countries – mainly by air – as a source of technetium-99m at hospitals and nuclear medicine centres, which is normally given to a patient within hours.

Hospitals in some countries around the world have been forced to reschedule interventions, as they no longer receive molybdenum-99.

 

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