With the temporary shutdown of the nuclear research-reactor at Chalk River, Ontario, Canada’s medical isotope industry has fallen into crisis, threatening health services across North America. The National Research Universal (NRU) reactor, as it is called, produced a third of the world’s molybdenum-99 (Mo 99), a medical isotope that decays into technetium-99 (Tc 99), which can be used to diagnose and treat cancer and other diseases. North America’s main suppliers of medical isotopes, Covidien and Lantheus, are desperately trying to meet demand for Mo 99 by increasing the supply coming from other reactors. However, there are only five medical isotope producers worldwide, including Chalk River, and the other four do not have sufficient capabilities to fill the gaping hole the NRU has left in Mo 99 production.

Canada’s hopes for becoming a nuclear force emerged in 1943, when then-prime minister Mackenzie King agreed to a nuclear research project at a meeting with Winston Churchill and Franklin Roosevelt. Today, its nuclear prospects are dwindling. The Chalk River reactor began leaking a small amount of heavy water (deuterium oxide) several weeks ago, forcing a shutdown to allow for serious maintenance to be done on the 52-year-old reactor. Authorities say the repairs will take at least three months, a significant amount of time for health care providers across North America to be without Mo 99. Since then, the reactor’s fuel, control and isotope rods have been removed, and the rate of the leak has somewhat abated. Atomic Energy of Canada Limited (AECL) is currently building a full-size model of the vessel to help construct a repair plan. They report that additional testing will require several more weeks.

Medical Risk
A survey conducted by the Society of Nuclear Medicine a number of weeks ago found that 91 percent of doctors and nuclear medicine technicians in the United States have been directly affected by the shortage of medical isotopes; 60 percent have postponed procedures, and 30 percent have canceled some procedures. Cotidien urged health care providers to triage their Tc 99 as a “short-term fix” while supplies lag. Mo 99’s short shelf-life of 66 hours has prevented medical teams from stockpiling isotopes in order to avert this shortage, since such supplies need to be used almost immediately.

Tc 99 is prescribed for approximately 80 percent of nuclear medical procedures, and can be used to diagnose and treat a number of diseases. It is commonly employed to image the heart, blood, brain, thyroid, lungs, liver, kidneys, skeleton, and tumors, as well as detect coronary artery disease and bone cancer. Tc 99 is capable of controlling and even eliminating cancerous cells, and is superior to other medical isotopes in two major ways: it has a half-life of six hours, which gives the doctor enough time to examine the patient while minimizing the amount of time the patient is exposed to radiation, and it emits gamma rays and low energy electrons, which are less harmful to the patient than high energy beta emission.

Worldwide Reactor Crisis
The shutdown of the Chalk River reactor has exposed some of the long-term issues facing the medical isotope industry. The five isotope producing reactors, located in Canada, the Netherlands, Belgium, France, and South Africa, barely produce enough Mo 99 to fulfill current medicinal needs when they all are functioning properly. However, temporary shutdowns for routine maintenance procedures are commonplace, and even these put a serious strain on nuclear medical supplies.

The High Flux Reactor (HFR) located in the Netherlands also will be down for four weeks beginning in mid July and again for several months in 2010. These are scheduled maintenance outages, meaning the other reactors can prepare for them and attempt to increase their production during this period. But none have the capacity to compensate for significant decreases in the production coming from other reactors. On the other hand, the unscheduled shutdown of Chalk River was impossible to prepare for and will prove much more debilitating for the isotope industry. Citizens for Medical Isotopes, a nonprofit organization, estimates that demand for medical isotopes will most likely grow somewhere between 8 and 20 percent a year for the next 2 decades, an increase that these nuclear reactors are not prepared to fulfill.

Canada giving up on isotopes?
On top of this, Prime Minister Stephen Harper recently told reporters, “Eventually we anticipate Canada will be out of the business of making isotopes.” AECL, which runs the NRU, has cost Canadian governments $26.5 billion since its creation, motivating Ottawa’s spokesman to refer to it as “dysfunctional” and a “sinkhole.” Harper has decided to mitigate the burden by dividing AECL into two parts: the Candu nuclear power business reactor, which will be sold commercially, and Chalk River, which will remain as a research facility. A nuclear reactor design competition held among AECL, Areva (France), and Westinghouse (USA) will determine whether AECL’s new Candu design will overcome the competition, or whether Canada’s energy company will become obsolete in its home country.

Canada’s MAPLE
AECL spent 12 years pouring money into the MAPLE project, whose goal was to build 2 functioning replacement reactors for the aging NRU. However, AECL decided last year that the project should be scrapped after it failed several tests, especially since it was already hundreds of millions of dollars over budget and eight years behind schedule. MDS Inc., a global health sciences company that invested in the MAPLE project, is pressuring the government to resurrect the discarded project. MDS estimates that it is losing about $4 million a month due to the cancellation of the project.

Steve West, President of MDS Nordion, recently argued, “The reason for the current supply shortage [of medical isotopes] is Atomic Energy of Canada Ltd.’s (AECL) decision to cancel the MAPLE project. Had the MAPLE project been completed in 2000, as originally planned, Canada would not be in its current predicament. The MAPLE reactors were designed to fully supply the world demand of the nuclear medicine community and the patients they serve.”

Solution in Saskatchewan?
Saskatchewan Premier Brad Wall is proposing another unpromising solution to the isotope crisis: a nuclear reactor to be constructed at the University of Saskatchewan. Costing up to $2 billion, this reactor would be smaller than the NRU and would produce medical isotopes as well as allow for atomic research. Wall has said he hopes the federal government, the province and the private sector will all pitch in to help construct this reactor within the next few years, with the hope of returning Canada to its role as a serious force in medical isotope production and research. It could take between six and twelve years for this reactor to become fully operational, so this will not provide a short-term solution to the isotope crisis.

Many also believe Wall is pushing too hard for a reactor that has become an anathema to the constituents of his province. The provincial government is currently holding hearings to gauge public sentiment on the construction of the reactor, and thousands have shown up to voice their opposition. Jim Harding, a retired university professor, estimates that, “At the meetings I’ve attended, people are generally 70 to 80 percent opposed to any kind of nuclear development. It’s quite astonishing.”

Political activist David Orchard is angry that the premier seems to be plowing ahead with the reactor project without general approval. “What’s the purpose of having public hearings when the Premier himself is declaring his plans before the hearings are complete,” he asked at a meeting last month. “The people of Saskatchewan are being steamrolled right now by a government that doesn’t seem prepared to listen to the hearings that it itself set up.” Wall has stated that the reactor will not be constructed if the hearings do not support nuclear activity in the province, yet the federal government’s deadline for the reactor’s proposal will come before the arranged end of the hearings. He claims that, if necessary, he will withdraw the proposal after submitting it, although he is confident that it will receive public support. Since Saskatchewan currently produces almost 25 percent of the world’s uranium, he believes the public’s familiarity with the nuclear industry will encourage this latest project to be approved. Whether or not his proposal is accepted, the reactor would take many years to become operational and in any event, would not be able to ameliorate the current isotope shortage. However, health providers will always be in need of extra sources of Mo 99, so the Harper government should support Wall’s plan if it is embraced by Saskatchewan.

Confusion and frustration
The Harper government also has been criticized for basically proposing long-term solutions to short-term problems. Indeed, Health Minister Leona Aglukkaq has dedicated $28 million to alternative methods for the production of Tc 99, a plan that will likely only come to fruition long after the current shortage is over. Jean-Luc Urbain, the president of the Canadian Association of Nuclear Medicine, has said the medical community “is very confused and frustrated” by the government’s ineffective handling of the isotope shortage.

Thus far, most would say that Ottawa has botched its attempt to remedy the crisis. Federal Natural Resources Minister Lisa Raitt was caught on tape saying her career could potentially be boosted if she could ameliorate the “sexy” isotope shortage. Despite her numerous apologies, her quote is still a good indication of the extent to which Ottawa is underestimating the gravity of the situation. To mitigate the government’s blunders, Harper needs to take quick, decisive action, not only by fixing up the decrepit NRU, but also by either reinstituting the MAPLE Project or—if endorsed by Saskatchewan—supporting the construction of Brad Wall’s new reactor. The battered NRU probably supplies an insufficient long-term solution to the isotope crisis, and now is not the time for Canada to entirely abandon the medical isotope sector during a period of growing demand. Health care providers and patients dependent on medical isotopes for diagnosis and treatment are desperately awaiting Harper’s plan of action, which will become clearer in the coming months.