The realities of Mo-99 production

27 May 2015

Reviews of the various molybdenum-99 (Mo-99) production initiatives currently under way in the USA and Canada tend either to ignore or to reference vaguely the important role of existing capacity in Australia, Belgium, the Netherlands and South Africa in the supply of Mo-99 to the USA, writes Don Robertson.

The sweeping statement that the USA currently imports the majority of its Mo-99 supply from "subsidised, aging facilities abroad most of which is produced with HEU" is most certainly not a fair or reasonable description of the Mo-99 industry in the rest of the world. If it were not for these alleged subsidised, aging, HEU based facilities abroad then, for example the USA would be without Mo-99 during the annual extended NRU (National Research Universal, in Canada) shutdowns.

Proclamations of the virtues of various production processes that are under development lack realism when it comes to projected time scales and costs associated with the construction and licensing of these proposed Mo-99 production facilities. In the early attempts to establish domestic production in the USA, the National Nuclear Security Administration Global Threat Reduction Initiative put forward a program which was aimed at identifying and supporting Collaborative Agreement partners. In terms of the program, these partners were required to produce 3000 6 day Curies of LEU-based Mo-99 by the end of 2013. None of the partners were able to achieve this target and this is still the case some two years later.

“Technetium-99m has become a trivially priced low value commodity with there being no correlation between the market price and the true cost of production.”

Don Robertson

This optimism regarding timescales is however quite understandable as it is only those, who have already constructed and operated large scale commercial Mo-99 production facilities, who will fully appreciate the complexities of production and the associated regulatory hurdles. It is therefore somewhat surprising that even Nordion is making optimistic projections as to when their novel SGE process will have achieved commercial readiness.

Most of the domestic programs were motivated on the basis of a supply shortage after October 2016 when medical isotope production was destined to cease in the NRU reactor. This was a position which had been consistently maintained until early in 2015 at which stage the Canadian government announced that it would support the extension of NRU operations until the end of March 2018 to help support global medical isotope demand should shortages occur in this time. Since it would appear that none of the current US domestic programs will be in commercial production by 2016, one could imagine that NRU will seamlessly continue to operate beyond October 2016 enabling Nordion to continue the supply of Mo-99 except for the annual NRU shutdown when presumably the suppliers from abroad will once again be required to step up to the plate.

Clearly capacity constraints are a major concern but this is the symptom arising from the real crisis confronting the industry namely the inappropriate pricing of technetium-99m (Tc-99m) and hence Mo-99. Historically, Mo-99 production evolved out of government research institutes and as a result government subsidisation was implicit in the industry. Because of these historical subsidisations, Tc-99m has become a trivially priced low value commodity with there being no correlation between the market price of the isotope and the true actual cost of production.

Back in 2009 there was an isotope supply crisis resulting from the extended closure of NRU. The supply shortages resulted in disruptions in the availability of critical nuclear medicine based diagnostic procedures. This impact on global healthcare led the OECD's Nuclear Energy Agency, at the request of its member countries, to establish the High Level Group on the Security of Supply of Medical Radioisotopes. Soon after its inception, this group identified and publicised that the unreliable supply of Mo-99 and Tc-99m could be directly attributed to the inappropriate pricing structure of the supply chain. It was emphasised that, unless this was urgently addressed, supply disruptions would continue, jeopardising the future of nuclear medicine diagnostic imaging. Unfortunately five years later, despite this warning, little to no progress has been made with the rectification of the situation and there is continual downward pressure on the price of Tc-99m.

Since it has been generally accepted that any form of government subsidisation should be removed from the industry all Mo-99 producers are presumably obliged to manage their businesses on sound commercial principles and of necessity deliver an appropriate ROI to shareholders and investors. Unfortunately the increasing operational costs on the one hand and the constant downward pressure on the price of Tc-99m and hence Mo-99 has resulted in a business environment which does not readily present itself as an attractive investment opportunity.

Over the years SPECT (Single photon emission computed tomography) diagnostic imaging has grown to a level where some 100 000 Tc-99m based scans are performed per day with an installed infrastructure of some 22 000 SPECT cameras worldwide. The market value of this industry, which significantly contributes to the general well-being of the global population, is estimated to be in the region of $13 billion. This important industry remains extremely vulnerable due to a tendency of some downstream participants in the supply chain to chase short term profitability at the expense of long term sustainability. It has, for example, been shown that if the current price of Mo-99 were doubled (which would enable producers to move towards some form of business sustainability), the final cost of a diagnostic procedure would increase by around 2%. Despite this the downward pressure on the price of Tc-99m and Mo-99 remains.

Over the years there have been significant investments in failed Mo-99 production ventures. Even today significant sums are being expended on a variety of novel production methods which are very interesting from a scientific perspective but might well not be able to make the transition from laboratory scale to full blown commercial production. Those that are able to successfully make the transition will take a lot longer and cost much more than was initially projected. Furthermore, if the Tc-99m and Mo-99 pricing level is not radically revised the technologically successful ventures will be at best marginal businesses.

There is undoubtedly a need for additional Mo-99 capacity but the greater SPECT market will have to reconcile to the fact that the surety of supply required to support this $13 billion industry will come at a price. Hopefully some of the US domestic programs will successfully transition to viable commercial businesses but this will take time and until this happens the US market will remain dependent on the "subsidised, aging facilities from abroad producing HEU based Mo-99".

Don Robertson

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Don Robertson is the retired managing director of NTP Radioisotopes SOC Ltd, a subsidiary of the South African Nuclear Energy Corporation (Necsa). NTP Radioisotopes conducts its operations from the Pelindaba nuclear facility near Pretoria.