According to the report, the current structure of the supply chain for medical radioisotopes leaves some participants unable to increase the prices of their services to levels that would cover costs.
The discontinuation of government funding would compel producers to increase prices. This could destabilise supply in the short-term and would need to be accompanied, at least temporarily, by measures to help ensure that price increases are passed on through the supply chain.
One way to achieve this, according to the Paris-based agency, would be to increase price transparency and encourage supply chain participants to comply with commitments to increase prices. A temporary price floor could help ensure that producers are able to make up for the reduction of government funding through additional revenue.
The report says the establishment of a commodities trading platform could make prices more responsive to supply and demand and help ensure production capacity is available. Alternatively, governments could maintain funding of production but have end-user countries bear the costs in proportion to the share of total supply they consume.
Governments could also aim to reduce the reliance on the current supply chain through substituting Tc-99m with alternative isotopes or diagnostic methods, or by investing in alternative means of producing Mo-99/Tc-99m. However, the latter two options could be costly, the report says.
Tc-99m is the most commonly used radioisotope in nuclear medicine diagnostic scans. It is used for diagnoses of cancer, heart disease and neurological disorders including dementia and movement disorders.
The properties of Tc-99m, however, make its supply chain complicated. Tc-99m is obtained from radioactive decay of its parent isotope, Molybdenum-99 (Mo-99). Neither of these products can be stored for very long and their supply is therefore a “just-in-time” activity requiring continuous production in a complicated and aging supply chain that combines a mix of governmental and commercial entities.
The supply of Mo-99 and Tc-99m to health care providers has often been unreliable over the past decade due to unexpected shutdowns and extended maintenance periods at some of the nuclear research reactor facilities that produce Mo-99, many of which are relatively old.
These shutdowns have created extended global shortages. In particular in 2009 and 2010, a series of unexpected outages of some reactors required for Mo-99 production led to a global supply crisis and a severe shortage of Tc-99m.