Nuclear medicine practitioners just haven’t been able to catch a break. First, Canada’s National Research University Reactor at Chalk River in Ontario shuts down for repairs, followed by the High Flux Reactor in Petten, the Netherlands. Then just as the Maria Research Reactor in Poland began to produce medical isotopes in March, that supply was interrupted in April by an act of nature—the eruption of the Eyjafjallajökull volcano in Iceland that grounded air transatlantic and intra-European travel for a week.

Following the eruption of the volcano on March 21, prevailing winds spread ash and grid over much of Europe, forcing the closure of many of the continent’s airports in the middle of April and interrupting the supply of molybdenum-99 (Mo-99), the parent isotope of technetium-99m (Tc-99m).

According to Eurocontrol, which coordinates flights across 38 European countries, more than 95,000 flights were canceled between Saturday, April 17 and Tuesday, April 20.

In addition to the reactor in Poland, airport closures also affected isotopes supplied by the BR2 reactor in Mol, Belgium, and the Osiris reactor in Saclay, France.  “We heard from our supplier that the closing of airports in Europe affected the production of technetium,” says Dan Caldwell, executive director of Little Rock Cardiology Clinic in Little Rock, Ark. “We [had] no other options. That’s the crazy thing. Globally, our supply depended on so few suppliers.”

On April 19, several days after European airports began shutting down operations, Covidien sent out a letter to its customers explaining it was exploring options to do “everything possible to provide maximum patient access to this critical isotope as quickly as possible.” These options apparently included looking at rerouting supplies through other airports, arranging special charter flights or using commercial carriers not normally used for shipments. One problem, Covidien says, was that these alternatives “often involve complex regulatory hurdles.”

In the meantime, according to Tom Brennan, vice president, life sciences division, of AirNet Express (which provides transport for this material once it reaches the U.S.), the supply of Mo-99 to the U.S. was “completely shut down,” meaning that its customers, such as Cardinal Health, were “having to do more with less or substitute with alternative isotopes.”

One problem, as Cardinal Health explained to its customers in an April 21 letter, was that the shortages caused by the volcano occurred at the same time that the supply of Tl-201 (thallium) was limited because of unexpected increases in demand. According to a survey conducted last August, 82 percent of nuclear pharmacists were already using Tl-201 to replace Tc-99m agents.

By April 20, flights had resumed over much of Europe as some of the continent’s busiest hubs, including London, Paris and Frankfurt, all reopened. By Thursday, April 22, Covidien was reporting that it was again receiving Mo-99 at its U.S. generator manufacturing facility and that generator production had resumed “with a special Thursday run to address patient needs as quickly as possible.”
 
While neither Petten and Chalk River are expected to restart operations before the summer, Covidien believes the Mo-99 supply outlook for the months of June, July and August, appears “more positive.”  But with Petten and Chalk River still out of commission, should suppliers have learned any
lessons from the situation caused by the eruption of the volcano in Iceland?

Brennan hopes so. “We need to look for other points of exit out of Europe,” he says. “And better contingency plans need to be in place.”