Outage Raises Potential Medical Isotope Shortage

Client Alert

A structural flaw in a Netherlands-based nuclear research reactor may cause a global medical isotope shortage.

Overview

Per a European industrial association, a pipe deformation in the high-flux nuclear research reactor in Petten, Netherlands (“HFR Reactor”) will delay production of molybdenum-99 (“Mo-99”) and its decay byproduct technetium-99m (“Tc-99m”) — the most commonly used medical isotope in the world.

Tc-99m, critical to the modern practice of medicine, is extracted from generators that use Mo-99. It is used in more than 50,000 medical procedures each day in the U.S. alone to scan organs and other body parts in diagnosing medical conditions. Demand for Tc-99m has been growing in recent years and is expected to continue, which is fueling the proliferation of advanced nuclear imaging infrastructure. Such growth is evident in, among other places, U.S. government contracting data. This graph from DDIQ Analytics shows a ~44% jump (from 2022 to 2023) in federal contracts awarded to U.S.-based TC-99m generator manufacturers and their known customers.

The operator of the HFR Reactor has not announced a restart date, and it could take several weeks to complete repairs. The outage overlaps with scheduled maintenance of other Mo-99 reactors. Specifically, Poland’s MARIA reactor and Belgium’s BR-2 reactor are offline until November 7 and December, respectively.

These intersecting shutdowns may cause a temporary shortage of Mo-99 (and its byproduct Tc-99m) of up to 50%.

Medical Isotope Processing

Mo-99 has a relatively short half-life of 66 hours, meaning that it cannot be meaningfully stockpiled. Stable Mo-99 and Tc-99m supply chains depend on active nuclear research reactors, which are primarily used for applications in medicine, agriculture, forensics, and other fields. Global production of Mo-99 occurs at six major research reactors: HFR (Netherlands), BR-2 (Belgium), LVR-15 (Czech Republic), MARIA (Poland), OPAL (Australia), and SAFARI-1 (South Africa). Four main global processors of Mo-99 each rely on one or more of these six reactors.

Half of the main global Mo-99 processors — France-headquartered Curium Netherlands B.V. and Belgium-based National Institute for Radioelements — source Mo-99 from the HFR Reactor. Fortunately, HFR is not a sole supplier to either major processor. BR-2 (in Belgium) also supplies both Curium and the National Institute for Radioelements, while LVR-15 (in the Czech Republic) also supplies the National Institute for Radioelements. But, as noted, BR-2 is temporarily offline until December, placing further near-term strain on the Mo-99 supply chain.

Market Impact: U.S. Government Case Study

Two major providers of Tc-99m to the U.S. government — Curium U.S. LLC (the U.S. affiliate of the French company) and Lantheus Holdings Inc. — are directly or indirectly sourcing Mo-99 from the HFR Reactor. Curium is the world’s largest supplier of Tc-99m generators and the biggest global user of Mo-99. Both Curium and Lantheus support government programs in their downstream customer bases that rely on Tc-99m.

For example, in the last five years, at least three of five Lantheus customers have supplied the U.S. government — including the Veterans Administration and Department of Defense — with Tc-99m and other radiopharmaceuticals. The disruption engendered by the reactor outage could thus affect downstream U.S. government customers.

Developing a Domestic Source of Mo-99

Steps toward American production are in the works, which would help alleviate overlapping supply chain stressors. Wisconsin-based SHINE Technologies Inc. is a cooperative agreement partner with the National Nuclear Security Administration (NNSA), a semi-autonomous agency within the U.S. Dept. of Energy, to develop a domestic supply of Mo-99. In 2024, the NNSA awarded $32 million to SHINE for ongoing construction of its medical isotope facility in Wisconsin. The facility is expected to satisfy more than one-third of global demand for Mo-99 once it begins commercial production in 2027.

Previous attempts to develop domestic Mo-99 have been unsuccessful. In 2021, for instance, a partnership between Northstar Medical Radioisotopes LLC and the University of Missouri Research Reactor began to produce Mo-99 through non-uranium-based tech. But Northstar ceased Mo-99 production at the end of 2023, citing an inability to compete with foreign-government subsidized competitors and increasing raw material and reactor irradiation costs.

How Exiger Can Help

Exiger’s software and expertise can empower industry and government clients to understand their supply chain risks — including, as here, how a flaw in a Netherlands nuclear research reactor could impact consumers of medical isotopes and the global practice of medicine.

Learning about these kinds of disruptions and their potential knock-on effects is a first and foundational step toward managing supply chain risk, such as by identifying alternative suppliers, adjusting inventory levels, or changing procurement methods.

Contact Exiger to learn more about how advanced technology solutions in the 1Exiger platform can improve supply chain risk management for your organization.