By Alena Mastantuono

Every year, more than 10 million patients in Europe benefit from nuclear medicine through the diagnosis and treatment of illnesses such as cancer, but also of cardiovascular and neurovascular conditions.

Radiological and nuclear technologies that use radioisotopes are essential in the fight against cancer at all stages of care, in early detection, diagnosis, treatment and palliative care.

The number of patients benefiting from nuclear medicine is growing, mainly because of scientific breakthroughs. European researchers and businesses have developed some of the latest innovative radioligand cancer therapies, such as pharmaceuticals targeting endocrine and prostate cancer tumours and disseminated metastasis. For example, Lutetium-177 is a very promising radioisotope for the treatment of prostate cancer, which is responsible for 90 000 deaths in Europe every year. In comparison with traditional treatments, modern radionuclide therapy offers good targeting of cancer cells and is often less harmful to the body. Tens of thousands of cancer patients need targeted radionuclide therapy, which is often the only treatment available.

However, before reaching the patient, the supply chain of nuclear medicine is highly complex. It includes the supply of source materials and their storage, irradiation, processing, logistics and application. Once the radioisotopes are produced, they must be processed, shipped and used within a relatively short period of time, some on the same day, others within a few days, depending on their half-life. They are highly and quickly perishable.

Surprisingly enough, these characteristics are not reflected in cross-border transport and customs procedures. For instance, when it comes to cross-border transport, there are several barriers, leading to situations where priority may be given to shrimp over radioisotopes on their way to saving a patient’s life.

This is why, in its opinion on the supply of medical radioisotopes, the EESC calls for better cooperation among Member States for the regulatory barriers to be removed. The opinion looks at each and every stage of the supply chain of the radioisotopes in Europe and identifies the hurdles in cross-border deliveries as well as dependencies on third countries. It also brings forward solutions to missing infrastructure in Europe and the need for coordinated R&D.

In the recommendations put forward in our opinion, the EESC is aligned with the conclusions reached at the April summit of the EU heads of states, which stressed the need to reduce Europe’s strategic dependencies in sensitive sectors such as health and critical technologies. They also highlighted, in line with Enrico Letta’s report, the need to focus on the cross-border provision of services, as well as cross-border movement of goods, including such essential goods as medicines.

Europe has to provide production incentives in order to ensure better strategic autonomy in the supply of radioisotopes. Despite being a world leader in the supply of medical radioisotopes, Europe has critical dependencies on the US and Russia for the supply of metallic high-assay low enriched uranium (HALEU) and for the supply of some enriched isotopes for radioisotope production targets.

The EU remains highly dependent on Russia for the supply of stable isotope targets, which allow the production of certain radioisotopes used in modern or developing molecular radiotherapies, such as Yterbium-176 used to produce Lutetium-177

This presents a veritable challenge to the supply chain for this specific radioisotope, for which the global demand is expected to triple in the coming years.

The supply chain also depends on the systems of production using reactors or accelerators, as well as on processing and delivery to hospitals. To ensure equal access to care, the Member States, and in particular research centres and hospitals, should work together more closely. Access to radiation therapy is not uniform across the Member States, especially in the development and pilot phases. The aim is to have faster access to medicines in the research phase or in compassionate use, as well as to improve access for small hospitals that may lack expertise and infrastructure. For some patients, this access can be vital.

The European funding of research, development and innovation in nuclear medicine, particularly in the Horizon and Euratom programmes, is crucial to respond to the needs of patients. Europe should have strategic projects of common interest in this area under the EU’s future Multiannual Financial Framework (MFF). The European Commission’s SAMIRA strategy and the European Radioisotopes Valley Initiative (ERVI) in connection with Europe’s Beating Cancer Plan are valuable projects. The European Commission should go further and include nuclear medicine more prominently in Europe’s Beating Cancer Plan and in the Horizon Europe Mission on Cancer.

Member States should also finance public health policies with a focus on medical radiological and nuclear technologies. This will give a good signal to the industry and will allow research and innovation as well as industrial infrastructure to be developed and grow in Europe. It will also attract more people to the sector.

To conclude, we will only be able to better secure the supply of radioisotopes in Europe and meet the increasing demand from patients if we take bold political decisions.