Safeguarding Canadian leadership: The importance of diversity and redundancy in mitigating medical isotope shortages in Canada’s Isotope Ecosystem

Abstract

As an essential piece of the global supply chain for isotopes, Canada has played an important leadership role in the research, development, and production of nuclear medicine technologies for decades. Canada’s powerful and sophisticated isotope ecosystem supports nearly the entire supply chain for several key isotopes yet remains reliant on foreign sources for supplies of raw materials, irradiation services, and equipment, among others, making Canada susceptible to international fluctuations. To illustrate this susceptibility, this paper offers several case studies of previous isotope shortages, including the 2009-2010 and 2022 Molybdenum-99 shortages, the 2019 Iodine-125 shortage, vulnerabilities in the Actinium-225 supply chain, and risks associated with international shipments. While Canada is well-positioned to help the global healthcare community prevent and overcome future shortages, we must utilize a collaborative, multi- stakeholder approach to achieve sufficient redundancy and diversity of isotopes. Only through adequate diversity, competition, and collaboration to secure wholly domestic supply chains for essential isotopes will Canada successfully insulate itself against in impacts of future shortages on Canadian patients.