The production of medical radioisotopes has continued during the COVID-19 pandemic but bottlenecks in transport and distribution could lead to shortages at hospitals, according to an International Atomic Energy Agency (IAEA) survey of the research reactors where the isotopes are produced.

Radiopharmaceutical preparation in progress at Indonesia's National Nuclear Agency (Image: M Gaspar/IAEA)

The IAEA survey has shown that most "major actors" continue to produce radioisotopes during the lockdown triggered by the pandemic, as production facilities have been defined as "essential" by governments, the acting head of the IAEA's Research Reactor Operation and Maintenance Section, Ram Sharma, said. Most radioisotope-producing research reactors 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 agency's Research Reactor Safety Section.

Radiopharmaceuticals are medicines containing small amounts of radioactive isotopes used for the diagnosis and management of some cancers and other chronic diseases. Radioisotopes including molybdenum-99 - the short-lived isotope used in hospitals to produce the even-shorter-lived technetium-99m which is the world's most widely used medical radioisotope - are produced in a limited number of research reactors then transported to other countries, mainly by air. However, many airlines are no longer operating due to the pandemic, and border closures are also affecting the distribution of radioisotopes.

"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," Joao Osso Junior, head of the IAEA's Radioisotope Products & Radiation Technology Section, said. The agency is to hold a webinar 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, he said.

Research reactors in Argentina, Australia, Belgium, France, Poland, the Netherlands, Russia, South Africa and the USA - the world's major producers of molybdenum-99 - all continue to operate, the IAEA survey found. However, hospitals in come countries have been forced to reschedule interventions as they are no longer receiving supplies of the isotope, the IAEA said.

It gave the example of South Africa, where the government announced a national lockdown from 27 March to prevent the spread of the virus. The Safari-1 research reactor and Nuclear Energy Corporation of South Africa subsidiary NTP Radioisotopes have continued operations to produce the medical radioisotopes the country supplies worldwide, after implementing 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, the IAEA said. Some production batches have had to be cancelled due to the cancellations of flights. If further cancellations occur, the operation of the reactor may be scaled down and its operators may even consider a temporary shutdown.

"We would need help to assist the isotope distribution chain around the world to get the product to users worldwide. 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 and cannot get the product now," said Koos du Bruyn, senior manager of the Safari-1 reactor.

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

Researched and written by World Nuclear News